Volume 3, Issue 2, Summer 2010

Abstracts from the 15th Annual

CyberPsychology & CyberTherapy Conference

June 13-15, 2010 – Seoul, Korea

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Journal of CyberTherapy
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rehabiliTaTion

Volume 3, Issue 2, Summer 2010

Brussels, Belgium
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J CR
Journal of
CyberTherapy
& Rehabilitation
ediTor-in-Chief
Brenda K. Wiederhold, Ph.D., MBA,
BCIA
Virtual Reality Medical Institute
Brussels, Belgium
Virtual Reality Medical Center
San Diego, California
managing ediTor
Emily Butcher
Interactive Media Institute
San Diego, California
ediTorial board
Mariano Luis Alcañiz Raya, Ph.D.
Universidad Politécnica de Valencia
Valencia, Spain
Rosa M. Baños, Ph.D.
University of Valencia
Valencia, Spain
A.L. Brooks
Aalborg University
Esbjerg, Denmark
Julian Dooley, Ph.D.
Edith Cowan University
Mount Lawley, Australia
Paul M.G. Emmelkamp, Ph.D.
University of Amsterdam
Amsterdam, Netherlands
Uri Feintuch, Ph.D.
Hadassah-Hebrew University
Medical Center
Jerusalem, Israel
Joshua Fogel, Ph.D.
University of New York
Brooklyn, New York
assoCiaTe ediTors
Cristina Botella, Ph.D.
Jaume I University
Castelló de la Plana, Spain
Stéphane Bouchard, Ph.D.
Université du Québec en Outaouais
Gatineau, Québec, Canada
Tom Furness, Ph.D.
University of Washington
Seattle, Washington
Charles Hughes, Ph.D.
University of Central Florida
Orlando, Florida
Wijnand IJsselsteijn, Ph.D.
Eindhoven University of Technology
Eindhoven, Netherlands
Linda A. Jackson, Ph.D.
Michigan State University
East Lansing, Michigan
Sun. I. Kim, Ph.D.
Hanyang University
Seoul, South Korea
Dragica Kozaric-Kovacic, M.D., Ph.D.
University Hospital Dubrava
Zagreb, Croatia
José Luis Mosso, M.D.
Regional Hospital No. 25 of the
IMSS
Mexico City, Mexico
103
Luciano Gamberini, Ph.D.
University of Padova
Padova, Italy
Giuseppe Riva, Ph.D., M.S., M.A.
Istituto Auxologico Italiano
Verbania, Italy
Paul Pauli, Ph.D.
University of Würzburg
Würzburg, Germany
Heidi Sveistrup, Ph.D.
University of Ottawa
Ottawa, Ontario, Canada
Richard M. Satava, M.D., F.A.C.S.
University of Washington
Seattle, Washington
Mark D. Wiederhold, M.D.,
Ph.D., FACP
Virtual Reality Medical Center
San Diego, California
XiaoXiang Zheng, Ph.D.
Zhejiang University
Hangzhou, P.R. China
 Journal of CyberTherapy & Rehabilitation

Summer 2010
Vo l u m e 3 , I s s u e 2

107 editorial
B. Wiederhold

111 oral presentation abstracts from the 15th annual Cyberpsychology & 
CyberTherapy Conference

187 poster presentation abstracts from the 15th annual Cyberpsychology & 
CyberTherapy Conference

235 Cyberprojects
G. Riva

237 Cyberfocus
D. Stevens

JCR
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Journal of CyberTherapy & Rehabilitation
S u m m e r 2 0 1 0 , Vo l u m e 3 , I s s u e 2
© Vi r t u a l R e a l i t y M e d i c a l I n s t i t u t e
ediTorial
Welcome to the Summer 2010 issue of the Journal of Cy-
berTherapy & Rehabilitation (JCR). As you know, JCR
is one of the two official journals of the International As-
sociation of CyberPsychology, Training & Rehabilitation
(iACToR). Now in its 15th year, the annual international
CyberPsychology & CyberTherapy Conference (CT15)
agreed, in 2009, to become the official conference of
iACToR. So, along with CyberPsychology, Behavior, &
Social Networking Journal (CPB&SN), CyberTherapy
& Rehabilitation (C&R) Magazine, and JCR, we cele-
brate our Combined Communications Platform. The
journals, conference, magazine, and association combine
into one powerful platform to address previous informa-
tion deficits in the utilization of advanced technologies
in healthcare. We will strive to speak with a united voice
to inform and educate about the uses of technologies in
healthcare, as well as how technologies are impacting
behavior and society.
This year we are proud to be holding CT in Asia for the
first time. Organized by the Interactive Media Institute
(IMI), a 501c3 nonprofit organization, in cooperation
with Hanyang University, CT15 is being held June 13-
15, 2010 in Seoul, Korea. This venue speaks to the con-
tinued growth and collaboration, not just amongst
Europe and America, but also amongst researchers and
scholars worldwide. This year’s conference theme is two
fold: First, CT15 will explore technologies as enabling
tools. This will include the uses of advanced technolo-
gies such as virtual reality simulations, videogames, tele-
health, video-conferencing, the internet, robotics, brain
computer interfaces, wearable computing, non-invasive
physiological monitoring devices, in diagnosis, assess-
ment, and prevention of mental and physical disorders.
In addition, we will look at interactive media in training,
education, rehabilitation, and therapeutic interventions.
Second, CT15 will explore the impact of new technolo-
gies. CT15 will investigate how new technologies are in-
fluencing behavior and society through cyberadvertising,
cyberfashion, and cyberstalking, to name a few.
I would like to take this opportunity to thank all those
who are helping to make this year’s conference possible
JCR
107
through their tireless energy and drive – the Co-Orga-
nizer and Conference Co-Chair Professor Sun Kim; this
year’s Scientific Chairs, Professors Stéphane Bouchard,
José Gutiérrez Maldonado and Giuseppe Riva; Tutorial
Chairs, Professor Luciano Gamberini and Alessandra
Gorini; Exhibit Chair and Conference Organizer, Profes-
sor Jang-Han Lee; Cyberarium Chair Professor Hunter
Hoffman; and Technical Chairs Professors Mariano Al-
cañiz and Evangelos Bekiaris. Many thanks also to the
Scientific Committee, made up of prominent researchers
from around the world, and the Local Advisory Commit-
tee in Seoul, as well as all of the presenters and attendees.
Finally, my gratitude to James Cullen and Jang-Han Lee
for overseeing the Conference Coordination, and to the
teams at Hanyang University, Interactive Media Institute,
Virtual Reality Medical Center, and Virtual Realty Med-
ical Institute for their time and contributions to all facets
of the conference.
To our sponsors, who continue to support our vision and
help make it a reality, a warm and heartfelt thank you –
Bionet, Defense Advanced Research Projects Agency/
Defense Science Office (DARPA/DSO), the European
Commission, DGINFSO, Hanyang University, Institute
of Aging Society Silver & u-Health Research Center, the
Interactive Media Institute, Istituto Auxologico Italiano,
Mary Ann Liebert, Inc. Publishers, National Institute on
Drug Abuse, National Institutes of Health, OsteoSys,
Université du Québec en Outaouais, the Virtual Reality
Medical Center, and the Virtual Reality Medical Insti-
tute.
As integral parts of our Combined Communications Plat-
form, the CT Conference series will continue to work to-
gether with iACToR, JCR, and C&R to educate industry,
academia, and government officials on the explosive
growth of advanced technologies for therapy, training,
education, prevention and rehabilitation.
As in previous conferences, this year’s conference will
be hosting an interactive exhibit area, the Cyberarium,
which allows conference attendees and members of the
press to try new technologies firsthand. To recognize
108

outstanding achievements by students, new researchers, CyberTherapy 16, to be held in Gatineau, Canada on
as well as lifetime achievement to a senior researcher, June 20-22, 2011. Thank you again for your commitment
we will also be hosting awards during the conference and to the evolution of healthcare!
announcing the 2010-2011 iACToR officers during the
General Assembly. Pre-conference workshops will high-
light psychotherapeutic applications, brain computer in-
terface devices, rehabilitation for seasoned researchers,
and an introduction to VR will be given for those newer
in the field. Brenda K. Wiederhold, Ph.D., MBA, BCIA
Editor-in-Chief,
As we approach CT15 with excitement, we begin too to Journal of CyberTherapy & Rehabilitation
look toward next year’s conference, CyberPsychology & Virtual Reality Medical Institute

JCR
Journal of CyberTherapy & Rehabilitation 109
S u m m e r 2 0 1 0 , Vo l u m e 3 , I s s u e 2
© Vi r t u a l R e a l i t y M e d i c a l I n s t i t u t e

abstracts from
the 15th annual Cyberpsychology
& CyberTherapy Conference

June 13-15, 2010

Seoul, Korea
110

JCR

oral presenTaTion absTraCTs
––––––––––––––––––––––––––––––––––––––––––––––
executive functions in a Virtual World:
a study in parkinson’s disease
Giovanni Albani a,1, Simona Raspellib, Laura Carellib,c,
Francesca Morgantic, Patrice L. Weisse , Rachel Kilzonye,f,
Noomi Katzf, Alessandro Mauroa and Giuseppe Rivab,d
a
Department of Neurosciences and Neurorehabilitation,
Istituto Auxologico Italiano, IRCCS,
Piancavallo-Verbania, Italy
b
Applied Technology for Neuro-Psychology Lab,
Istituto Auxologico Italiano, Milan, Italy
c
Department of Human Sciences,
University of Bergamo, Bergamo, Italy
d
Department of Psychology, Catholic
University of Milan , Milan, Italy
e
Department of Occupational Therapy,
University of Haifa, Haifa, Israel
f
Research Institute for the Health & Medical Profes-
sions, Ono Academic College, Kiryat Ono, Israel
1
Corresponding author:
Giovanni Albani
Department of Neurosciences
Istituto Auxologico Italiano, IRCCs
V.le Cadorna, 96
Piancavallo (Verbania), Italy
E-mail: g.albani@auxologico.it
abstract
In Parkinson’s disease executive functions are altered. We
used a Virtual Reality version of the Multiple Errand Test
in order to evaluate decision making ability in 12 patients
and 14 controls. Patients with Parkinson’s disease, even if
non-demented, showed strategies full of errors, suggesting
that impulse control disorder, very frequent in the course
of this disease, could precede cognitive dysfunction.
Keywords: Executive functions, Virtual Reality
introduction
Even if Parkinson’s disease (PD) is primarily known as a
111
movement disorder due to a dysfunction of the nigrostri-
atal dopaminergic system, in recent years, many scientific
studies, supported by clinical evidence, have also revealed
an alteration in executive functions. This includes diffi-
culty in planning, concept formation, working and visual
memory, lexical and attention deficits, and difficulty in
dual and sequencing tasks.
Virtual Reality (VR) immersion works as an experimental
model where “real” motor symptoms are eliminated or at-
tenuated, and thus helps to focus on findings by evaluating
the cognitive component of strategy.
The scope of our study was to evaluate planning, memory,
and attention abilities in PD non-demented patients by
using a virtual version of a neuropsychological test, the
Multiple Errand Test (VMET) (Fortin, Godbout, & Braun,
2003).
methods
We evaluated 12 PD not-demented patients and 14 con-
trols by clinical scores (Unified Parkinson’s disease Rating
Scale, Hoehn & Yahr stage), neuropsychological battery
(Minimental state, Token Test, Corsi’s memory span, Digit
span, Short Story recall, Word recall Test, Tower of Lon-
don Test, Frontal Assessment Battery, Trail Making Test,
Street Completion Test) and a virtual version of MET
(VMET), which was presented within a virtual supermar-
ket. This is an assessment of executive functions in daily
life which consists of performing tasks according prede-
fined rules, meaning there are items to be bought and in-
formation to be obtained. Specifically, subjects were
requested to select and buy various products presented on
shelves with the aid of a joy pad. The analyzed variables
were the execution times for the entire task, errors in ex-
ecuting the tasks, with a scoring range from 11 (the subject
has correctly done the tasks) to 33 (the subject has totally
omitted the tasks), inefficiencies, with a scoring range
from 8 (more inefficiencies) to 32 (no inefficiencies), rule
breaks, with a scoring range from 8 (more rule breaks) to
32 (no rule breaks), strategies, with a scoring range from
13 (more strategies) to 52 (no strategies), interpretation
failures, with a scoring range from 3 (more interpretation
JCR
112 Abstracts from CT15

Table 1
Group Statistics
group n mean std. deviation

Errors Healthy subjects 14 17,64 3,895

Patients 12 25,08 4,757

Searched item in the correct area Healthy subjects 14 8,86 1,512

Patients 12 11,92 2,314

Maintained task objective to completion Healthy subjects 14 8,86 1,351

Patients 12 11,83 2,368

Maintained sequence of the task Healthy subjects 14 8,93 1,328

Patients 12 12,08 2,234

Divided attention Healthy subjects 14 9,29 1,437

Patients 12 12,25 2,379

Organized materials appropriately throughout task Healthy subjects 14 9,50 1,990

Patients 12 12,25 2,454

Self corrected upon errors made during the task Healthy subjects 14 9,86 1,834

Patients 12 12,50 1,931

No evidence of perseveration Healthy subjects 14 8,50 1,160

Patients 12 11,92 2,429

Sustained attention throughout the sequence of the task Healthy subjects 14 9,43 1,342

Patients 12 12,17 2,082

Buying a chocolate bar Healthy subjects 14 9,29 2,555

Patients 12 13,25 3,888

Buying toilet paper Healthy subjects 14 9,07 2,165

Patients 12 13,33 3,939

Buying a sponge Healthy subjects 14 9,07 2,556

Patients 12 13,33 3,939

Buying two products from the refrigerated products aisle Healthy subjects 14 9,64 2,590

Patients 12 12,83 3,326

Going to the beverage aisle and asking about what to buy Healthy subjects 14 10,50 2,312

Patients 12 15,17 1,992

Rule breaks Healthy subjects 14 28,50 2,378

Patients 12 24,92 3,423

Strategies Healthy subjects 14 37,36 8,608

Patients 12 47,33 3,339

JCR
Abstracts from CT15
failures) to six (no interpretation failures) and partial task
failures, with a scoring range from 8 (no errors) to 16
(more errors).
results
Neuropsychological tests results correlated with VMET
findings: Short Story recall with inefficiencies ( r = .72,
p = .02); Word recall test with Rule Breaks(r = .68, p =
.02); Corsi’s memory span and time (r = -.58, p = .05).
Descriptive statistics were used to summarize the mean
values and standard deviations for the VMET outcomes
of PD patients and healthy subjects, as shown in Table 1.
The Mann-Whitney Test was used to evaluate the
VMET procedure with the clinical and control group.
The mean rank for patients was significantly higher for
errors in executing the task than for control subjects
(Asym. Sig. = 0.001) and the same result was also
found for the partial errors of the seven tasks.
Moreover, the mean rank for rule breaks was higher
for control subjects than for patients (Asym. Sig. =
0.01) while strategies used were inferior in patients
(Asym. Sig. = 0.000). This means, on the basis of the
scoring key employed, that control subjects broke a
lesser number of rules and used more strategies than
patients.
Finally, patients have a significantly higher mean of
partial errors of specific tasks than the control group
and, in particular, of the tasks of buying a chocolate
bar (Asym. Sig. = .01), buying toilet paper (Asym. Sig.
= .006), buying a sponge (Asym. Sig. = .007), buying
two products from the refrigerated products aisle
(Asym. Sig. = .01) and of going to the beverage aisle
and asking about what to buy (Asym. Sig. = .000),
which require a change in the primary task and the
ability to respond simultaneously to multiple task de-
mands.
Conclusions
If we exclude clinical forms of atypical parkinsonism,
such as Lewy Body disease, the course of mental dys-
function in PD usually starts from symptoms included
in dysexecutive syndrome (Sollinger, Goldstein, Lah,
Levey, & Factor, 2009) until the so-called subcortical
dementia.
During this time, patients can frequently exhibit be-
havioral symptoms included in an impulse control dis-
JCR
113
order, such as pathological gambling, hypersexuality,
compulsive shopping, and compulsive eating.
Acknowledgments
The work in preparing this paper was supported by the
funded project "Immersive Virtual Telepresence (IVT)
for Experiential Assessment and Rehabilitation”,
IVT2010, RBIN04BC5C.
references
Fortin S, Godbout L, and Braun CMJ. “Cognitive
structure of executive deficits in frontal lesioned head
trauma patients performing activities of daily living”,
Cortex, vol. 39, pp. 273-291, 2003.
Kulosevsky J, Pagonabarraga J. Cognitive impairment
in Parkinson’s disease: tools for diagnosis and assess-
ment. Mov Disor 2009 Jun 15;24 (8):1103-10.
Sollinger AB, Goldstein FC, Lah JJ, Levey AI, Factor
SA. Mild cognitive impairment in Parkinson’s disease:
subtypes and motor characteristics. Parkinsonism Relat
Disord 2009 Nov 23 (Epub ahead of print).
––––––––––––––––––––––––––––––––––––––––––––––
influence of the Tracking feedback in the
motor response of the users
Sergio Albiola,1, José-Antonio
Gil-Gómez and Mariano Alcañiz b
a
Departamento de Informática e Ingeniería de Sistemas
Universidad de Zaragoza, C/ Ciudad Escolar s/n,
44003 Teruel, Spain
b
Instituto Interuniversitario de Investigación en Bioinge-
niería y Tecnología Orientada al Ser Humano, Universi-
dad Politécnica de Valencia,Camino de Vera s/n,
46022 Valencia, Spain
1
Corresponding author:
Sergio Albiol
Universidad de Zaragoza
CPI - EDIFICIO 8B
Camino de Vera s/n,
46022 Valencia, Spain
Email: salbiol@unizar.es
abstract
In this experimental study, we present the results of users'
motor responses with and without the use of Tracking
Feedback to complete correct movements in Virtual Re-
114
habilitation Therapy. To carry out this study, used a system
for standing balance rehabilitation. We applied two differ-
ent conditions (with and without tracking feedback) to
twenty patients and analyzed their motor responses.
Through this analysis we can evaluate the importance of
this feedback and the possibility of eliminating the track-
ing components from the system, in order to obtain a
lower-cost system. Therefore, this low-cost system will
make the integration of Virtual Rehabilitation systems
available to more patients. Currently, we are completing
this study and will have definitive results with conclusions
before the deadline of this final paper.
Keywords: Virtual Rehabilitation Therapy, Motor Re-
sponse, Tracking Feedback
introduction
At the present time, Virtual Motor Rehabilitation (VMR)
is providing new roads in the motor rehabilitation field.
This technology is being used in patients with major in-
juries and illnesses, such as strokes, cerebral palsy, paral-
ysis and Parkinson’s disease.
Most of the VMR systems provide patients feedback of
their movements and actions. This requires the systems to
integrate a tracking component. This tracking component
is generally expensive, and limits environments where the
system can be used; therefore, it is the main restriction for
using them in rehabilitation.
This paper analyzes the influence of the Tracking systems
feedback with the patient’s movements for meeting the
goal. In order to achieve the correct movements, a VMR
system is applied in two different ways. Firstly, the system
shows the movements that the patient is doing in real time.
Secondly, the same system is used, but without showing
the movements.
methods
In our experimental design, we analyzed three parameters:
Response Time (the time necessary for the first response);
Completion Time (the time needed to accomplish the
goal); and the precision of the movement. Finally, the val-
idated Presence Test by Witmer and Singer (WS) was
used.
In the study we use a VMR system for standing balance.
In the system, the subject had to step on the same object
as the reference item one by one and return to the central
area.The system hardware consisted of a standard PC, a
Abstracts from CT15
Figure 1. Left: screenshot
of the system; above: pa-
tient using the system.
visualization setup, and the
tracking components. Addi-
tionally, this system used an
optical tracking consisting of
two webcams and two small
spheres. The spheres were
four centimeters in diameter and covered with catadioptric
Velcro strips. Each sphere was placed on the ankle of the
patient (see fig. 1, right), in order to track the movements.
Twenty subjects participated in this study. Each subject
had a session approximately for thirty minutes. At the be-
ginning of each session, the system was explained to the
user, to familiarize them with the system. Afterwards, the
subject completed two sub-sessions of ten minutes each.
Finally, the subject completes the presence test for the sys-
tem with and without movement feedback.
We divided the subjects into two groups: Group A: Ten
users utilized the system without movement feedback and
afterwards with movement feedback. Group B: Ten users
utilized the system with movement feedback and after-
wards without movement feedback.
results and Conclusions
Currently, we are completing a final quantitative analysis
of the system and will have definitive results in time for
the deadline. Through this analysis we can evaluate the
importance of this feedback and the possibility of elimi-
nating the tracking components from the system.
Without the tracking components, the VMR system would
have a minor cost and would be valid for a larger number
of environments. Therefore the system, and other similar
VMR systems, would be available to help rehabilitate
more patients and become accessible to clinics, and even
homes, Worldwide.
JCR
Abstracts from CT15
––––––––––––––––––––––––––––––––––––––––––––––
lean on Wii: physical rehabilitation With Virtual
reality and Wii peripherals
Fraser Andersona,1, Michelle Annetta, Walter F. Bischofa
a
Department of Computing Science,
University of Alberta
1
Corresponding author:
Fraser Anderson
University of Alberta
10720 83Ave, #306
Edmonton, Alberta, Canada
T6E2E4
E-mail: frasera@cs.ualberta.ca
introduction
Systems such as the Nintendo Wii encourage players to
use natural actions to play games (e.g., swinging the arm
to roll a bowling ball, or jogging in place to make a vir-
tual character run). In recent years, the Wii has been in-
tegrated into rehabilitation programs (Deutsch et al.,
2009; Dixon, 2008; Halton, 2008; Sugerman et al.,
2009) and has gained the support of occupational ther-
apists because it is easy to use and has a wide variety of
available activities. While the Wii has had much success
in the area of rehabilitation, it also has several problems
that prevent it from becoming widely adopted for reha-
bilitative purposes. Many of these problems are due to
its off-the-shelf nature and non-rehabilitation focus.
Most therapists indicate that the existing games are too
difficult for many patients, the game scores do not ade-
quately reflect patient progress, therapists are unable to
monitor patient performance outside the hospital, the
Wii provides poor feedback to patients, and most games
have loading screens and menus that are difficult and
time consuming to navigate.
To overcome many of these issues, we have developed
a rehabilitation system, Virtual Wiihab, which combines
the low cost, highly available Wii peripherals with a set
of virtual reality(VR)-based games. The Virtual Wiihab
system can be used by patients in the hospital or at home
and incorporates many of the exciting and enjoyable as-
pects of current Wiihabilitation practices.
Virtual Wiihab
Our Virtual Wiihab system integrates existing Wii pe-
ripherals (Wii Balance Board, Wii Remote, Wii Motion
JCR
115
Plus, or Wii Nunchuk) into PC-based, VR activities. We
have chosen to integrate Wii peripherals into our system
because most occupational therapists and patients are
already familiar and comfortable with them and such
peripherals are cheap and readily available. We have
created four rehabilitation-targeted activities for our sys-
tem that aim to increase trunk control, lower extremity
stability, and patient balance. Each activity is suitable
for the young and old, as well as a range of patient abil-
ities.
Our Virtual Wiihab system provides features and func-
tionalities that are currently unavailable to therapists
using the Nintendo Wii for rehabilitation:
Customization. Each activity can be customized to meet
patients’ skill sets or limits of mobility. These cus-
tomizations allow therapists to change task requirements
as patients advance through their rehabilitation program.
For instance, game speed and difficulty can be increased
to make activities more challenging.
Measurement. The Virtual Wiihab system can record a
number of behavioral and performance measurements.
The system can record data from the Wii Balance Board
and Wii Remotes (e.g., accelerations, button presses,
weight distributions, gyroscope angles) as well as a
number of task-specific measurements.
Feedback. Auditory, visual, and haptic feedback can be
presented and customized (e.g., sound effects, visual
overlays, Wii-remote vibrations). This allows therapists
to tailor feedback to specific learning styles or patient
characteristics and to gradually reduce the amount of
feedback presented in order to encourage patients to per-
form target actions without assistance or cueing.
Monitoring. The use of a simple web service allows the
Virtual Wiihab system to be used for tele-rehabilitation
purposes. Performance and behavioral measurements
can be uploaded to the web service and viewed using
authorized web clients. Therapists are able to view dia-
grams and graphs that can help identify areas of concern
or improvement.
Multi-Player. Each activity can support both single and
multiple player interactions. The introduction of addi-
tional players has the potential to motivate patients to
continue an activity longer than if they were doing it on
their own.
116
A. B.
C. D.
Figure 1: A) A patient and family member using the
Snowball Fight activity (similar to the Wii Fit Soccer
game). B) A patient using the balance board to navigate
to and ‘beam up’ cows in the Alien Invasion! activity. C)
The interface for the multi-player Steady Fish activity,
which is similar to the Wii Fit Locus Focus game. D)
The interface for the Mouse House activity. The balance
board is used as a navigation device to move the mouse
though the house to find pieces of cheese.
Conclusion
New methods of rehabilitation play a key role in restoring
physical functions to an aging population. Nintendo Wi-
ihabilitation offers a promising alternative to traditional
rehabilitation techniques, but suffers from problems that
prevent its widespread adoption. We have presented a
new system, Virtual Wiihab, which combines the flexi-
bility of VR with the availability and enjoyment of Wi-
ihabilitation. Our system includes four rehabilitation-
centric activities that demonstrate potential solutions to
the problems that exist with the Wii system. A user study
evaluating the effectiveness and usefulness of the system
is being conducted in a local rehabilitation hospital.
references
Deutsch, J., et al. Wii-based compared to standard of care
balance and mobility rehabilitation for two individuals
post-stroke. Virtual Rehabilitation, Pages 117-120, 2009.
Dixon, T. A Wii Spot of Fun. Australian Ageing Agenda,
Pages 28-32, March-April 2008.
Abstracts from CT15
Halton, J. Virtual rehabilitation with video games: A new
frontier for occupational therapy. Occupational Therapy
Now, Volume 10, Number 1, Pages 12-14, 2008.
––––––––––––––––––––––––––––––––––––––––––––––
hands, Tables, and groups
make rehabilitation awesome!
Michelle Annetta,1, Fraser Andersona,1,
and Walter F. Bischofa
Department of Computing Science,
a
University of Alberta
1
Corresponding author:
Michelle Annett
University of Alberta
6307 - 144 A Ave
Edmonton, Alberta, Canada
T5A1S3
E-mail: mkannett@cs.ualberta.ca
introduction
Over the last decade, interest and excitement surround-
ing interactive surfaces and multi-touch tabletops has
dramatically increased. One of the most recent applica-
tions of tabletop technologies has been for motor and
cognitive rehabilitation ( Mumford, et al., 2008; Facal,
et al., 2009, Annett, et al., 2009). Although tabletops
have been used in rehabilitation, they have largely neg-
lected an important aspect of the rehabilitation process,
namely group therapy. Group interaction in rehabilita-
tion settings can maximize client effort, induce positive
emotional changes, increase self-understanding, and
provide long-term improvements in patients’ quality of
life (Cole, 2008; Gauthier, 1987). It has also been
demonstrated that patients are more willing to spend ad-
ditional time performing rehabilitation exercises in
group settings than by themselves, ultimately speeding
their recovery (De Weerdt, 2001).
By their very nature, traditional tabletops (e.g., coffee ta-
bles, supper tables, and meeting tables) improve social
dynamics and encourage conversation and interaction.
The fusion of interactive tabletops and group rehabilita-
tion has the potential to greatly improve patient confi-
dence and give patients the motivation to work harder
and persevere through difficult activities. We have ex-
tended our suite of tabletop-based rehabilitation activities
(AIR Touch; Annett, 2009) to support cooperation and
JCR
Abstracts from CT15 117

competition between patients and their therapists, family

members, and peers. We also discuss a number of rec-
ommendations that should help to guide the development
of future activities for multi-user tabletop rehabilitation.

design and implementation

In our iterative design and implementation cycle, we
consulted with practicing occupational therapists. Dis-
A. B.
cussions with these experts produced a number of sug-
gestions, themes, and observations:

–Positive, salient elements (e.g., personal photographs)

in multi-user activities can help patients to become
"emotionally immersed" and will likely encourage pa-
tients to put in more effort and spend more time per-
forming an activity.
–Communication during multi-user activities can pro-
mote patient/therapist trust and encourage patients to
share with their caregivers.
–Cooperation within rehabilitation activities promotes
turn-taking, teamwork, and patience. It can also provide
patients with motivation from their peers.
–If patients can become "competitively immersed" in an
activity, they are more likely to try harder and work at
an activity longer in order to "beat" their competitor.
On the basis of these recommendations, we have created
six activities that help to induce immersion and increase
perseverance. These activities enable patients to receive
rehabilitative benefits by distracting them from their dis-
abling conditions or impairments (Figure 1). These ac-
tivities can be adjusted to easily meet the needs of
individual patients and enable therapists to quantita-
tively measure patient behavior and performance. To en-
courage social dialogue and emotional immersion, most
activities use patient photographs.
Conclusion and future Work
Previous tabletop rehabilitation technologies have fo-
cused on single-user interaction, neglecting the benefits
of collaboration and group rehabilitation. We have ad-
dressed this issue by working with practicing therapists
to create a number of multi-user activities. These activ-
ities allow patients to gain rehabilitative benefits while
working cooperatively or competitively with family
members, peers, or therapists. We have also identified a
number of design considerations that can be used to
guide the development of rehabilitation-based multi-
user tabletop activities.
C. D.
E. F.
Figure 1: A) Three patients assembling a Touch Tessel-
lation puzzle, B) A patient and his friend cooperatively
using Match Me! to find hidden tile pairs, C) A patient
and a family member competing to clear their Foggy
Windows and reveal the photograph underneath, D) Two
patients modifying a family photograph using Photo
Scrapbooking, E) Three patients playing Nomis Says, F)
Two patients exploring their hometown using Google
Earth.
The AIR Touch system is currently being used in a local
rehabilitation hospital. A pilot study using therapists, pa-
tients, and family members is currently underway to de-
termine the usefulness of the system. Patient interviews
are being conducted to evaluate patient enjoyment and
enthusiasm towards the collaborative nature of the AIR
Touch system and its software.
references
Annett, M., et al. Using a Multi-touch Tabletop for
Upper-Extremity Motor Rehabilitation. Proceedings of
OzCHI 2009, (2009), 261-264.
Cole, B. Client-centered groups. Occupational therapy
and mental health, (Elsevier, 2008), 315-329.

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118
De Weerdt, W., et. al. C. Group physiotherapy improves
time use by patients with stroke in rehabilitation. Aus-
tralian Journal of Physiotherapy, (2001), 47(1), 53-64.
––––––––––––––––––––––––––––––––––––––––––––––
Therapeutic games to improve
attachment Capabilities
Klaus M. Beiera,1, Klaus Rebensburgb, and Malte
Behrmannc
a
Charite - Universitätsmedizin Berlin
Universität Potsdam/Technische Universität Berlin
b
c
European Game Developer Federation
Corresponding author:
1
Klaus M. Beier
Charite - Universitätsmedizin Berlin
Luisenstr. 57
Berlin, Germany, 10117
Email: klaus.beier@charite.de.
introduction
Clinical experience in sexual medicine reveals the in-
creasing difficulties people have in obtaining sexual
and/or attachment satisfaction which is often cause for
seeking therapeutic help. From a diagnostic point of view,
disorders of sexual function, of sexual development and
also of sexual preference and sexual behavior are at the
center of attention. At the same time–always as a decisive
factor of influence concerning reduced life quality–there
is a frustration of fundamental basic needs for acceptance,
security, trust, warmth and closeness within a partnership.
This is also true for chronic diseases or, as in the case of
mental retardation, restrictions in social communication
capabilities. It is becoming obvious that computerized
“applied games” or “serious games” are playing an in-
creasingly important role in curing psycho-emotional
destabilization. On the other hand, there are games like a
game aimed at female adolescents, where a devaluated
stereotypical female is generated with the main aims of
looking attractive, staying slim and financing breast en-
largements. With this negative example in mind it seems
to make sense to develop “applied games” focusing on
other relevant issues, such as trying to enhance cognitive
and social competences as well as emotional and attach-
ment capabilities of the players.
approach and methods
The general idea is to set up a basic concept which can
Abstracts from CT15
be adapted to different fields and adjusted to reach dif-
ferent target groups (adolescents, the chronically ill, men-
tally retarded persons and individuals with sexual
preference disorders) by employing special modules. The
center of interest is a preventive approach with the aim
of conveying the latest scientific findings about what en-
hances sexual and/or attachment satisfaction and which
individual skills need to be improved in order to obtain
the desired results–always specifically adjusted for the
intended target group. The project has set up a catalogue
of application areas as follows:
–prostate cancer and breast cancer patients and family re-
lationships
–patients with mental and emotional retardation and sex-
ual behavior problems
–balanced relationships between adolescent individuals
with disorders of sexual preference (paraphilias)
–chronic diseases
This catalogue also defines desirable social competences
for target groups mapping success and failure on applied
games based on degree of empathy for partners and/or
social networks as related to cognitive distortion, self cen-
tered reactions and other factors. A book of duties pro-
vides necessary information to game and character
designers and IT specialists.
results
In a clinical sexological setting, individuals with the
above mentioned paraphilia-related sexual arousal pat-
terns, patients with chronic illnesses (like Prostate-Ca or
Mamma-Ca), patients with mental retardation and even
adolescents going through sexual maturation can be
reached by learning about the existence of fundamental
psychosocial needs. These therapeutic experiences could
be enhanced by employing special therapeutic games
modules, mainly aiming at prevention by helping to steer
against a possible false attitude. In a first pilot study a
prototype (therapeutic game) has been put into practice.
Methods and results will be presented at the congress.
references
Attwood, T., Exploring feelings. Cognitive behaviour
therapy to manage anxiety, Arlington, Future Horizons,
2004.
Beier, K.M., Loewit, K., Bosinski, H.A.G.. Sexualmedi-
zin. 2. Aufl. München, Elsevier (2005).
Bowlby, J. (1969, 1973, 1980): Attachment and loss. Vol.
1, 2, 3. New York: Basic Books.
JCR
Abstracts from CT15
Brezinka, V. , L. Hovestadt, L. , Serious games can sup-
port psychotherapy of children and adolescents, Lecture
Notes in Computer Science 4799, A. Holzinger. Berlin,
Springer:, USAB (2007), 359-366.
––––––––––––––––––––––––––––––––––––––––––––––
searching for an adequate stressor to practice stress
management skill prior to deployment: The
potential of immersion in stressful 3-d games
François Berniera, Stephane Bouchardb, Stéphanie
Dumoulinb, Tanya Guitardb, Mylène Laforestc, Éric
Boivina & Geneviève Robillardb,1
a
Defence R&D Canada – Valcartier
b
Université du Québec en Outaouais
c
Université d’Ottawa
1
Corresponding author:
Geneviève Robillard
Université du Québec en Outaouais
283 boul. Alexandre-Taché, C.P. 1250
succursale Hull, Gatineau, Québec
Canada, J8X 3X7
Email: genevieve.robillard@uqo.ca
The opinions expressed in the publication reflect the opin-
ion of the author and do not necessarily represent the opin-
ion of the Canadian Forces or the Department of National
Defence.
abstract
This study tested the efficacy of two commercial 3-D
video games to elicit a significant level of stress and com-
pared three immersive stereoscopic technologies–a 22-
inch monitor, a 73-inch monitor and a CAVE™. Fifty-six
soldiers returning from Afghanistan were recruited and
randomly assigned to one of five conditions in which they
played either the 3-D games “Killing Floor” or “Left 4
Dead” while immersed using the different technologies.
As a control and reference comparison of induced stress,
participants were exposed to a standardized stressful pro-
cedure. Subjective data were collected using the State
Anxiety scale for all participants but extremely slow
scores cast doubt on the validity of the results on this vari-
able. Repeated measures ANOVAs revealed statistically
significant increase in heart rate and respiration rate while
playing the 3-D games and during the TSST. No signifi-
cant group or interactions effects were found. Increases in
JCR
119
physiological arousal were significant when comparing
the baseline to the immersion and to the TSST, but not
when comparing both stressors. Immersion in 3-D games
is proposed as a practical and cost-effective option to prac-
tice SMT.
Keywords: Stress Management Training, PTSD,
3-D Game, Heart Rate.
introduction
Among the military population, data shows that exposure
to combat or peacekeeping missions are associated with
the risk of developing posttraumatic stress disorder
(PTSD). To help soldiers to cope with stress, and hopefully
reduce the risks of developing PTSD, soldiers could ben-
efit from stress management training. Although prelimi-
nary data from the few available programs are somewhat
encouraging, they are confronted with significant adher-
ence problems. Practicing stress management skills is a
challenge for people involved in a culture where virility
and an “Army Strong” mentality prevail. In addition, it re-
quires the trainers to stress the soldiers so they can practice
their coping skills. Using Virtual Reality (VR) and 3-D
games to induce a manageable level of stress could be an
interesting option to practice stress management skill with
this population. However, instead of trying to create a vir-
tual environment without knowing if it will be signifi-
cantly stressful, researcher can use off-the-shelf 3-D
games. Several 3-D games companies are investing mil-
lions of dollars each year to analyze, design, and build
games that are highly stressful, such as “Left 4 Dead” and
“Killing Floor.”
method
This study set out to verify the capacity of two commer-
cial 3D video games (“Left 4 Dead” and “Killing Floor,”
see Figures 1 and 2) to elicit a significant level of stress
in soldiers, and also to compare three immersive tech-
nologies–a 22-inch stereoscopic monitor, a 73-inch
stereoscopic monitor and a CAVE™ (a room with four 9
feet by 9 feet walls with retro-projected stereoscopic im-
ages). The games were selected after considering 38 cri-
teria, such as elements of surprise, forewarning, human
corpses and casualties, blood, cries and spooky sounds,
etc. “Left 4 Dead” was more attractive as a stressful stim-
ulus because of superior graphics quality compared to
“Killing Floor,” but only “Killing Floor” could be modi-
fied to be used in the CAVE. It was therefore decided to
use both games, as it would allow comparing two levels
of graphics quality.
120 Abstracts from CT15

presence is Just an illusion: using fmri to locate

the brain area responsible for the
meaning given to places

Stéphane Boucharda,1 and Geneviève Robillarda

a
Université du Québec en Outaouais
Figure 1. Screenshot from Figure 2. Screenshot from
“Left 4 Dead.” “Killing Floor.” 1
Corresponding author:
Stéphane Bouchard
Université du Québec en Outaouais
An initial sample of 56 solder participated in the study.
Dept. de Psychoéducation et de psychologie
Subjective data were collected on all participants using the
CP 1250, Succ Hull, Gatineau,
State anxiety scale of the State Trait Anxiety Inventory but
Qc. J8X 3X7 Canada
extremely slow scores (e.g., baseline mean score of 29.7,
E-mail: Stephane.bouchard@uqo.ca
sd = 7.1) cast very serious doubt on the validity of the re-
sults on this variable. Therefore, only psychophysiological
This presentation is based on a reanalysis of data pre-
parameters will be reported. Due to technical problems,
sented at the 2009 Presence Conference in Los Angeles.
only 36 participants could be used for the analysis of heart
rate data and 42 for the breathing data.
introduction
Being immersed in virtual reality (VR) can create the sub-
Participants were randomly assigned to one of five con-
jective impression of being “there” in the virtual environ-
ditions in which they played either the 3-D game “Killing
ment (VE) (Sadowski & Stanney, 2002; van der Straaten
Floor” or “Left 4 Dead” using the small monitor (22-inch),
& Schuemie, 2000). The illusion of presence requires
the large monitor (73-inch) or the room-size CAVE (only
processing multimodal input (visual, auditory, tactile, ki-
used with Killing Floor). To have a control and reference
naesthetic or olfactory) from the VE be combined to form
comparison of induced stress, participants were exposed
coherent perceptions so the VE be recognized as “real”,
to the well-validated Trier Social Stress Test (TSST;
and integration of these multimodal stimuli into some
Kirschbaum, Pirke & Hellhammer, 1993) after the collec-
egocentric reference frame so the user feels that he or she
tion of baseline physiological data and before the experi-
is within the environment. A previous study (Bouchard,
mental manipulation with 3D games. Participants’ heart
Dumoulin, Labonté-Chartrand, Robillard, & Renaud,
rate and respiration rate were measured continuously using
2006) showed that it is possible to increase presence sim-
the Bioharness from Biopack.
ply by manipulating the narrative context of an immer-
sion in VR (i.e., without changing any objective
results
properties of the VE). It opened the possibility of studying
Repeated measures ANOVAs (3 Times X 5 Conditions)
neural correlates of presence without creating artifacts in-
revealed significant increases in heart rate (HR) and res-
duced by the modifications of the stimuli (i.e., comparing
piration rate (RESP) while playing the 3D games (HR: F
immersions with / without sound, or in mono / stere-
= 5.21, p < .05; RESP: F = 33.51, p < .05) as well as during
oscopy would predictably stimulate different brain areas).
the TSST (HR: F = 15.94, p < .05; RESP: F = 15.76, p <
.05). However, no significant interactions between condi-
After a brief overview of studies suggesting that presence
tions were found (see Figure below). Repeated-measures
is simply a (rather good) perceptual illusion, we will re-
contrasts confirmed that increases in heart rate and respi-
port on a study investigating neural correlates associated
ration rate were significant when comparing the baseline
with the illusion of presence in VR.
to the 3-D games and to the TSST, but not when compar-
ing the TSST to the 3-D games. The discussion will ad-
method
dress implications of these findings for the development
Five adults (all right-handed, three females, two males,
of reliable stressors allowing practicing stress manage-
mean age of 33) provided their informed consent and
ment skills with solders.
were submitted to a standardized psychiatric assessment
––––––––––––––––––––––––––––––––––––––––––––––

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Abstracts from CT15
to ensure qualification for study participation based on
several selection and exclusion criteria (e.g., not suffer-
ing from a mental disorder, based on the Structured Clin-
ical Interview for DSM-IV-Non-Patient Edition (First,
Spitzer, Gibson, & Williams, 2002)). During the experi-
mental task, participants first visited a staff room adja-
cent to the fMRI scanner room and were informed that
during their brain scan they would at times see a live
video-feed from this room (high presence condition) or
a good 3D copy of the room (low presence condition).
Participants were scanned in the fMRI using a 1.5 Tesla
scanner. A preliminary rapid sagittal T1-weighted scan
was used as a localizer to verify participant head position
and image quality. For the experimental scan, a three-di-
mensional gradient echo acquisition was used to collect
160 contiguous, 1 mm T1 weighted structural images in
the sagittal plane for corregistration with the Echoplanar
images. Structural images were acquired using the mod-
ified International Consortium for Brain Mapping T1
Protocol. The virtual environment was displayed using
a stereoscopic fMRI-friendly HMD (Silent Vision SV-
7021) a set of noise cancellation headphone were used
to reduce the loud ambient noise caused by the scan. The
localization of brain areas was based on the Wake Forest
University PickAtlas (v. 2.3).
For the high and low presence conditions, the exact same
virtual stimuli were presented to participants during each
condition. However, the context (narrative) provided to
the participants differed significantly (see details in the
following paragraph). In the high presence condition, par-
ticipants were informed via instruction provided in the
HMD that the image were coming directly from the ad-
jacent staff room, “relayed in real time from the real staff
room”. In the low presence condition, they were informed
via instruction provided in the HMD that the images were
copies of the adjacent staff room. The paradigm we used
was a repeated measures condition where each participant
saw the “real staff room”, then the “copy of the staff
room”, followed again by the “real” and the “copy” of
the staff room. During each immersion, participants ob-
served as the camera flew over the virtual environment
and were asked to look at the details of the VE.
At the fMRI clinic, participants met the research assistant
who provided a visit of the experimental set-up in the
staff room and explained that “We want to know which
areas of the brain are involved in the experience of vir-
tual reality by using a high tech device that will take im-
ages of your brain in action. For the very first time, we
JCR
121
were able to create a system that allows projecting, in
real time, images taken from this adjacent staff room and
project it directly, live, in the fMRI scanner. You will
therefore be able to see this room, as you are just doing
now, but seeing through the eyes of virtual reality. Our
cameras will record images in real time as they move in
the room, send them to our computers and our virtual re-
ality software; they will recreate the virtual reality and
send it directly into the scanner. The cameras will move
along a predetermined path so you won’t have anything
to do but let yourself be immersed in the virtual environ-
ment and looking around. We also built a copy of this
staff room. After having the unique chance of being im-
mersed in the real staff room, we will also show you a
copy of the staff room. The experience will be repeated
twice, so you will again see the real room and the copy
of the room. ” Once placed in the fMRI scanner, the
HMD was adjusted for clear vision and a first scan was
performed to ensure participants had no brain abnormal-
ities. For the experimental scan, the instructions were
projected in the HMD once more “In this unique experi-
ence, you will visit the real staff room, then a copy. This
will be repeated twice. Let go, observe these virtual en-
vironments and we will talk about it after the scan”. Then
a message appeared in the HMD indicating “Live staff
room. Let go of yourself and take the time to observe the
virtual environment” and the 60-second immersion in the
VR environment began. In the next condition, a message
appeared in the HMD indicating “Copy of staff room.
Let go of yourself and take the time to observe the virtual
environment” before the 60-second immersion. The two
immersions were repeated before participants stepped
out of the scanner and were debriefed.
results
Significant differences were found in only one structure,
located in the medial temporal lobes. Both the right and
left parahippocampus (uncorrected, p < 0.001) were sig-
nificantly activated by the experimental manipulation.
Significant cluster of voxels in the right parahippocampal
gyrus (MNI 28 -4 -36) cluster size KE= 5 cluster was ac-
tivated, as well as a significant cluster in the left parahip-
pocampal gyrus (MNI -28 - 16 -24) cluster size KE = 5
cluster.
Conclusion
The design of this preliminary study was based in previ-
ous findings (Bouchard, Dumoulin, Labonté-Chartrand,
Robillard, & Renaud, 2006) where manipulating the con-
text or narrative associated with the immersion statisti-
122
cally influenced presence. Any other manipulation in-
volving the properties of the stimuli would have blurred
the results by recruiting other areas of the brain.
Despite the small sample size, clear and significant re-
sults were obtained in one specific region, the parahip-
pocampal cortex. This area of the brain mediates the
representation and processing of contextual associations
(Aminoff & Schacter, 2008). The parahippocampus pro-
vides contextual meaning of scenes and places. Our re-
sults follow this recent finding and suggest that
contextual processing may be involved in feeling where
events are happening in a virtual environment, or where
the person is during the immersion in virtual reality. We
propose that an immersion in VR create a strong percep-
tual illusion that triggers three events: (a) basic reflex re-
actions, (b) integration of sensory information, and (c)
self-reflexive conscious-cognitive dissonance. We pro-
pose that conscious-cognitive dissonance involves the
parahippocampal gyrus and constitutes what is usually
referred to as Presence.
references
Bar, A., Aminoff, E., Schacter, D.L. Scenes unseen: The
parahippocampal cortex intrinsically subserves contex-
tual associations, not scenes or places per se. Journal of
Neuroscience, 28, 8539-8544, 2008.
Bouchard, S. Dumoulin, S., Labonté-Chartrand, G., Ro-
billard, G., Renaud, P. Perceived Realism has a Signifi-
cant Impact on the Feeling of Presence. 11th Annual
CyberTherapy Conference, Gatineau (Québec), June 12-
15. 2006.
First, C.D., Spitzer, R.L., Gibson, M., Williams, J.B.W.
Structured Clinical Interview for DSM-IV-TR Axis I Dis-
orders, Research Version, Non-patient Edition (SCID-
I/NP). Biometrics Research, New York State Psychiatric
Institute, New York. 2002.
Sadowski, W., Stanney, K.M. Presence in virtual environ-
ments. In K.M. Stanney (Eds.). Handbook of virtual en-
vironments: Design, implementation and applications
(pp. 791-806), Mahwah : IEA. 2002.
Van der Straaten, P., Schuemie, M.J. Interaction af-
fecting the sense of presence in virtual reality [On-
line]: http://graphics.tudelft.nl/vrphobia/intpres.pdf.
2000.
Abstracts from CT15
––––––––––––––––––––––––––––––––––––––––––––––
multi-modal memory restructuring for patients
suffering from Combat-related pTsd: a pilot study
Matthew van den Steena, Willem-Paul Brinkmana,
Eric Vermettenb,c and Mark Neerincxa, d
a
Delft University of Technology, The Netherlands
Military Mental Health Research Center, Central Mili-
b
tary Hospital, Utrecht, The Netherlands
c
Rudolf Magnus Institute of Neuroscience, University
Medical Center, Utrecht, The Netherlands
d
TNO, Soesterberg, The Netherlands
1
Corresponding author:
Willem-Paul Brinkman
Mekelweg 4
Delft, Netherlands
2628 CD
E-mail: w.p.brinkman@tudelft.nl
abstract
This paper discusses the design and evaluation of a multi-
media software application which can be used in the treat-
ment of combat-related Posttraumatic Stress Disorder
(PTSD). The application allows patients and therapists to
visualize the patients' past experiences using maps, per-
sonal photos, stories and self-created 3D virtual worlds.
The tool aims to allow patients to restructure and relearn
about their past experiences involving problematic stres-
sors.
Keywords: PTSD, Trauma-Focused Psychotherapy,
Memory, Multimedia
introduction
Combat-related Posttraumatic Stress Disorder (PTSD) is
one of the health problems soldiers may face upon their re-
turn from deployment. As an increasing number of soldiers
return from war situations such as those ocurring in Iraq
and Afghanistan, the demand for PTSD treatment is also
likely to increase. Supporting the treatment with computer
assisted technology is not new. Recently, Virtual Reality
Exposure Therapy (VRET) has been extended to the treat-
ment of PTSD. VRET focuses on exposure with pre-de-
fined scenarios. Instead of using prolonged exposure
therapy, this paper explores the possibility of using com-
puter assisted technology to support trauma-focused psy-
chotherapy, to be used both in a group therapy setting as
JCR
Abstracts from CT15
well as a single patient-therapist setting. The proposed
Multi-Modal Memory Restructuring (MMMR) system
aims at giving the patient more flexibility to restructure
narrative about their deployment and to manage various
deployment-related memory elements themselves with the
purpose of facilitating time sequencing of memory con-
tent, as well as adding narrative elements to visual content
such as pictures.
mmmr system
Traditional treatment of veterans with deployment-related
PTSD is set within a group context as soldiers are often fa-
miliar with operating in a group. In these sessions, patients
talk about their experiences in an exposure-based format,
facilitated by the drawing of maps and other visual aids.
Usually a flap–over as well as maps and photographs are
used to facilitate memory content. Often memory is com-
promised and due to memory distortions or amnesia con-
cerning details, these elements can be quite helpful. The
MMMR methodology takes this idea a few steps further.
The MMMR focus does not rely on direct exposure, but
on the way patients facilitate and manage their memories
to restructure and relearn about their past experiences in-
volving problematic stressors. Patients are invited along a
set timeline to sequentially add media and self-created vir-
tual 3D worlds. In this way, patients are able to express and
think again about their experiences during their time of de-
ployment. The MMMR system provides contextual infor-
mation in various modalities to these experiences. It is
designed to run on a laptop with a projector displaying the
computer screen on a wall for group members to see. This
in itself creates a safe zone, in which direct eye contact
among members can be legitimately avoided since some
patients do not like to be stared at during their exposure,
and others do not want to look at someone in a potentially
distressing state. Additionally, a camera is attached to the
laptop allowing snapshots to be taken from photos or ob-
jects patients brought with them. The system support con-
sists of several elements. (1) Patient information is created
as a digital space or folder. (2) The session starts with a
projection of a timeline set on the present day. From here
the patient can move to a specific day of their deployment.
To emphasize that this event has taken place in the past,
the years and days from the present day to the selected day
are counted back while showing photos of historical events
of that time period. (3) Once the patient arrives at the spe-
cific day, they are asked to organize the events of that day
by using their own photographic material, videos, or music,
and by annotating this material using satellite-based geo-
graphical maps. In addition, the patient can also use an
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123
easy-to-use 3D editor to recreate a specific scene. Using
these facilities, the patient can restructure the events and
place them, together with narrative elements, on a chrono-
logical timeline. (4) This can be worked through and com-
mented on back and forth. (5) The session ends again by
visually moving back from the event in the past to the pres-
ent day. A psycho-educational element of the system is the
ability to display the past and planned treatment sessions
on the timeline.
design and evaluation
The design of the system followed a situated cognitive en-
gineering approach. This started with establishing an in-
ventory of envisioned technology, relevant human factors,
and operational (therapeutic) demands. This was done in
close cooperation with a military psychiatrist experienced
in treating PTSD patients. Using this information, scenarios
and claims were specified, which resulted in three short
films focusing on (1) personalization of the system (time-
line, own text annotations, and 3D virtual world), (2) the
use of the 3D editor (pausing and resuming editing work,
and interaction with the therapist and other group mem-
bers), and (3) the return to a previous session (amending
and extending previous work). These films were used in a
review with eight therapists. At the start of the in-depth in-
terviews, the films were shown to the therapist, followed
by an assessment of the underlying claims on the usability
and support of the therapeutic process. Overall, therapists
were very interested. A prototype was therefore imple-
mented and used in a usability evaluation with 18 partici-
pants, and in a small case study with a single patient. Initial
results suggest that the system can facilitate patients' shar-
ing and reappraising past experiences and in managing var-
ious autobiographic memory elements.
––––––––––––––––––––––––––––––––––––––––––––––
optimizing non-immersive devices
Susan Brucka,1 and Paul A.Watters b
a
Macquarie University, Sydney, Australia
b
University of Ballarat, Victoria, Australia
1
Corresponding author:
Susan Bruck
Macquarie University
Department of Computing
North Ryde, Australia
2109
E-mail: sbruck@science.mq.edu.au
124 Abstracts from CT15

abstract the SSQ before and after watching a six-minute roller

Simulated immersive environments displayed on large coaster video (Bruck & Watters, 2009) on the handheld
screens are a valuable therapeutic asset in the treatment non-immersive device.
of a range of psychological disorders. Permanent envi-
ronments are expensive to build and maintain, require results
specialized clinician training and technical support and The hypothesis was tested using a Wilcoxon Matched
often have limited accessibility for clients. Ideally, Vir- Pairs Signed Rank Test. The prediction that there would
tual Reality Exposure Therapy (VRET) could be acces- be no significant difference between the Pre-Test SSQ
sible to the broader community if we could use and the Post-Test SSQ scores was not supported on five
inexpensive hardware with specifically designed soft- SSQ symptoms (Table 1). In contrast, there was no sig-
ware. This study tested whether watching a handheld nificant difference between the Pre-Test and the Post-
non-immersive gaming device causes nausea and other Test for 11 symptoms. The results indicate that exposure
cybersickness responses. Using a repeated measure de- to a handheld non-immersive device can cause signifi-
sign we found that nausea, general discomfort, eyestrain, cant discomfort for individuals exposed to simulated
blurred vision and an increase in salivation significantly movement.
increased in response to handheld non-immersive gam-
ing device exposure. Table 1
Wilcoxon Matched Pairs Signed Rank Test Significant
Keywords: Non-immersive gaming, cybersickness, vir- Difference Pre and Post- Test
tual reality exposure therapy
Wilcoxon matched pairs
ssQ symptoms
signed rank Test
introduction
Virtual Reality Exposure Therapy (VRET) (Powers & General Discomfort z = -2.000, p = 0.046
Emmelkamp, 2008) has immense potential, however, it
inherently has the drawback that it can be expensive to
establish and requires specially trained counselors and Eyestrain z = -3.000, p = 0.003
technicians to efficiently run a clinic and is not always
accessible for all clients due to distance or work/study Salivation z = -2.449, p = 0.046
or family commitments. Cybersickness is a collection of
symptoms that are reported in response to simulated im-
Nausea z = -2.121, p = 0.034
mersive environments (Kim, Kim, Kim, Ko, & Kim,
2005). The Simulator Sickness Questionnaire (SSQ)
(Kennedy, Lane, Berbaum & Lilienthal, 1993) is a stan- Blurred Vision z = -2.121, p = 0.034
dardized sixteen symptom questionnaire that is used to
identify the severity of responses specific to exposure to discussion
computer-generated environments. This study proposes The results indicate that a handheld non-immersive gam-
that the use of a small, inexpensive apparatus such as a ing device can cause cybersickness symptoms when the
handheld non-immersive gaming device may be an al- client is exposed to significant simulated motion. Fur-
ternative to using exclusive well equipped clinics for ther work is required to determine whether exposure to
VRET. It is hypothesized that there will be no reports of less capricious simulated movement would provide a
cybersickness in response to simulated movement on a more comfortable experience, and to test whether these
handheld non-immersive gaming device. results are applicable to a clinical population.

method
Twenty-nine (13 male, 16 female) healthy Macquarie
University students (aged between 18 and 35 years) vol-
untarily participated in the Macquarie University Human
Ethics Committee approved experiment. A within-sub-
ject design was used to compare self-reported measures
of cybersickness using the SSQ. Participants completed
Acknowledgment
The authors are extremely grateful to the Apple Univer-
sity Consortium for providing the Apple iPod Touch®
for this experiment.
references
Bruck, S. and Watters, P.A. Estimating cybersickness of

JCR
Abstracts from CT15
simulated motion using Simulator Sickness Question-
naire (SSQ): A controlled study, Proceedings of the 2009
Sixth International Conference. Computer Graphics, Im-
aging & Visualization, IEEE Computer Society, Califor-
nia, 2009.
Kennedy, R.S., Lane, N.E., Berbaum, K.S., and Lilien-
thal, M. G, Simulator Sickness Questionnaire: An en-
hanced method for quantifying simulator sickness,
International Journal of Aviation Psychology 3 (1993),
203-220.
Kim, Y. Y., Kim, H. J., Kim, E. N., Ko, H. D., and Kim,
H. T. , Characteristic changes in the physiological com-
ponents of cybersickness, Psychophysiology 42 (2005),
616-625.
Powers, M. and P. Emmelkamp, P., Virtual reality expo-
sure therapy for anxiety disorders: A meta-analysis, Jour-
nal of Anxiety Disorders 22 (2008), 561-569.
––––––––––––––––––––––––––––––––––––––––––––––
pda self-register system for eating disorders:
a study on acceptability and satisfaction
A. Cebollaa,b, E. Oliverb, R. Bañosa,c, C Botellaa,b, I.
Zaragozáa,d, M. Alcañiza,d, R. Molinere, J.H. Marcoe, M.
Jonquerae, V. Guillene
CIBER de Fisiopatología de la Obesidad y Nutrición
a
(CIBEROBN)
b
Universidad Jaume I
c
Universidad de Valencia
d
I3BH Innovation & Research Institute on Bioengineer-
ing for Humans- Universidad Politécnica de Valencia
e
PREVI Clinical Center
1
Corresponding author:
Rosa Maria Baños
University of Valencia
Av. Blasco Ibañez, 21
46010 Valencia, Spain
E-mail: banos@uv.es
abstract
Self-monitoring techniques, such as the use of dietary reg-
isters, are considered to be central to cognitive-behavioral
treatment of Eating Disorders (ED). This information al-
lows the clinician to identify the triggers of the behaviors
associated to ED as purges and/or binges, and the associ-
JCR
125
ated thoughts and emotions, helping to carry out a more
accurate assessment. Traditionally, these registers are kept
using a paper and pencil mode, where the patient has to
register every eating activities and the emotions/thoughts
associated, but this system has some problems, such as low
portability, low adherence and methodological difficulties.
The use of PDA for self-registers can help to solve these
problems. The aim of this study is to study the levels of ac-
ceptability and satisfaction with a PDAs self-register sys-
tem specifically designed for assessment and treatment of
ED. A sample of 30 patients diagnosed with ED are receiv-
ing a PDA with software specifically designed for record-
ing food intake amount and type, emotions experienced
before and after eating, and other behavior. The participants
are completing a self-register daily during one week, and
afterwards answer an acceptance and satisfaction question-
naire. This work is in progress at this moment. It is ex-
pected that the PDA system will show high levels of
acceptance and satisfaction.
Keywords: Eating Disorders,
Personal Digital Assistant, Self-registers
introduction
The self-register technique is an important tool for the di-
agnosis, functional analysis and evaluation of treatment in
Eating Disorders (ED). The self-register is a semi-struc-
tured assessment technique that measures behavior in nat-
ural settings such as home, work, school,and others. It is
also useful to know the monitoring of therapeutic guide-
lines and assess the effects of treatment and patient out-
comes. Traditionally, the patient receives a paper to record
food intake, and also the thoughts and emotions felt before
and after the eating. This information allows the clinician
to identify the triggers of purges and/or binges, and the as-
sociated thoughts and emotions, helping to carry out a more
accurate assessment. But the traditional self-register system
has several problems, such as situational constraints, miss-
ing reports because of lapses in motivation and memory
(Piasecki, Hufford, Solhan, & Trull, 2007), difficulties in
identifying if the information has been recorded in real time
(Baker & Kirschenbaum, 1993) and poor rates of adher-
ence to the treatment (Helsel, Jakcic, & Otto, 2007). It is
necessary to design more efficient methods to simplify the
process of self-monitoring and to improve the consistency
and completeness of self-reports (Stone, Shiffman,
Schwartz, Broderick, & Hufford, 2002). Information and
Communication Technologies (ICT) can help achieve this
goal. In recent years, new mobile technologies such as per-
sonal digital assistants (PDAs) and mobile phones have be
126
Figure 1 Figure 2
come more readily available, thus generating new interest
in developing systems adapted for these tools. The aim of
this study is to study the levels of acceptability and satis-
faction with a PDAs self-register system specifically de-
signed for assessment and treatment of ED.
method
The sample group is composed of 30 patients diagnosed
with Anorexia Nervosa (purging type), Bulimia Nervosa,
or Binge Eating disorder (according to DSM-IV-TR). Ex-
clusion criteria are major depression, schizophrenia or
other psychotic disorder and severe physical illness. The
participants have entered into the study voluntarily and
have signed an informed consent form (if the participant is
underage, consent has been signed by parents or
guardians). The sample is receiving a PDA with software
specifically designed for recording type and amount of
food taken in, emotions before and after eating [Fig.1],
thoughts before and after intake, the intensity of hungry,
the general environmental circumstances that are surround-
ing their eating behavior [Fig. 2], frequency of binge eat-
ing, vomiting and laxative use. The participants are
completing a self-register daily for a week. The degree of
acceptance and satisfaction is being evaluated with scales
specifically designed at the end of the recording time.
results
Work in progress. It is expected that the PDA system will
show high levels of acceptance and satisfaction.
Conclusion
The use of electronic PDA diaries offers important advan-
tages and may enhance weight loss treatments and assess-
ment of ED. It is expected that in this study the PDA
system will show high levels of acceptance and satisfaction
Abstracts from CT15
in the participants. The specifically-designed software and
technology used will help the participants to find it easy to
use and user-friendly. It is expected that due to the porta-
bility and novelty of the system, the adherence will im-
prove rather than allowing users' motivation to deteriorate
over time. These improvements will act together to facili-
tate acceptance of the system in ED patients. These advan-
tages of the PDA recording system are also anticipated to
increase therapeutic efficiency in ED treatment. Electronic
diaries using PDAs are likely to become routine tools in
clinical psychology, and as mobile technologies become
ubiquitous, more robust, and less expensive, new software
programs to meet the needs of the clinicians will be devel-
oped (Piasecki, Hufford, Solhan, & Trull, 2007).
references
Baker R., & Kirschenbaum D. (1993) Self-monitoring may
be necessary for successful weight control. Behavioral
Therapy, 24, 377–394.
Helsel, D.L., Jakcic J.M. & Otto A.D. (2007.) Comparison
of Techniques for Self-Monitoring Eating and Exercise Be-
haviours on Weight Loss in a Correspondence- Based In-
tervention. Journal of American Diet Association 107,
1807-1810.
Piasecki T.M., Hufford M.R., Solhan M., & Trull T.J.
(2007) Assessing Clients in their natural environments with
electronic diaries: Rationale, Benefits, Limitations, and
Barriers. Psychological Assessment, 19, 25-43.
Stone A.A., Shiffman S., Schwartz J.E., Broderick, J.E. &
Hufford, M.R. (2002) Patient non-compliance with paper
diaries. British Medical Journal, 324, 1193-1194.
–––––––––––––––––––––––––––––––––––––––––––––
The moderating role of need for Cognition on
excessive searching bias: a Case of finding
romantic partners online
Mu-Li Yanga and Wen-Bin Chioub,1
a
Chang Jung Christian University
b
National Sun Yat-Sen University
1
Corresponding author:
Wen-Bin Chiou
National Sun Yat-Sen University
70 Lien-Hai Rd.
JCR
Abstracts from CT15
Kaohsiung
Taiwan
Province of China 80424
E-mail: wbchiou@mail.nsysu.edu.tw
abstract
Using online-dating Web sites to expand social networks
and form close relationships is popular for people in the
information technology era. Wu and Chiou (2009)
demonstrated that more options triggered excessive
searching, leading to poorer decision-making and reduced
selectivity. They proposed that the more-means-worse ef-
fect refers to the fact that more searching leads to worse
choices by reducing users’ cognitive resources, distracting
them with irrelevant information, and reducing their abil-
ity to screen out inferior options. A two by two experi-
mental study was conducted to investigate the moderating
effect of individual differences in need for cognition
(NFC) and number of available options on excessive
searching and decision quality. A total of 120 undergrad-
uates with experiences of online romantic relationships
participated in the experiment. After participants were ad-
ministrated their need for cognition, they were assigned
to review either a small or a large number of options to
search for their most desirable romantic partners via a
popular online-dating Web site in Taiwan. Results indi-
cated that high-NFC participants exhibited higher rates
of excessive searching than did low-NFC participants.
Moreover, the more-means-worse effect was more salient
for high-NFC participants than low-NFC participants.
The findings suggest that users with high NFC may be
more vulnerable to the negative effect of excessive
searching.
Keywords: Need for Cognition, Search Bias
introduction
To date, one of the predominant reasons for Internet use
is online social interactions (Cummins, Butler & Kraut,
2002). Recently, Wu and Chiou (2009) demonstrated that
more options triggered excessive searching and decreased
choice quality for finding online romantic partners based
on a cognitive information-processing perspective. Wu
and Chiou argued that more options would trigger exces-
sive searching, and then reduce decision quality, i.e., the
more-means-worse effect.
Need for cognition (NFC) is a promising cognitive per-
sonality characteristic (Cacioppo, Petty, Feinatein,
&Jarvis, 1996). An individual’s need for cognition has
JCR
127
been identified as one of the precedent variables contribut-
ing to cognitive involvement and, hence, the motivation
to process information (Andrews, Craig, & Akhter, 1990).
Regarding the context of searching for a romantic partner
on online dating Web sites, individuals with high NFC,
compared to those with low NFC, would be more likely
to engage in an exhaustive search of all available options.
Such differences in desires of engaging information pro-
cessing are attributed to the fact that high-NFC individuals
may suffer from creating a more onerous choice-making
process for themselves. An experimental study was con-
ducted to examine whether individual differences in NFC
would moderate the effects of available options on exces-
sive searching and decision quality in the context of find-
ing partners for online romantic relationships.
method
One hundred and twenty undergraduates (58 males; aged
15 to 23 years, M = 17.49, SD = 2.69) participated in this
experiment. A random ordering of experimental packets
assigned participant to a two (number of available op-
tions–small or large number of options) by two (need for
cognition–low or high) between-subjects design. Assign-
ment of participants to levels of the second factor, i.e.,
need for cognition (high or low), was based on their re-
sponses to the Need for Cognition Inventory short form
(Cacioppo, Petty, Feinatein, &Jarvis, 1996) assessed two
weeks previously.
In the formal experiment, participants were given a packet
with instructions. Actual purpose was disguised by intro-
ducing this experiment as a study on “Finding Your Best
Partner for a Romantic Relationship.” Participants read
the explanation of the search engine’s ranked list of rec-
ommended partners. They were randomly assigned to
view either small or large numbers of available profiles
(i.e., the top 40 rankings from the recommended list or the
top 80). Each participant was asked to review the available
profiles until he/she found the most desirable partner for
a romantic relationship.
results
Regarding the searching ratio, participants in the large
number condition (M = 0.81, SD = 0.10) examined more
subject profiles than did those in the small number condi-
tion (M = 0.73, SD = 0.11), F(1, 116) = 34.86, p < .001,
η2 = .23. This finding was congruent with previous studies
[2,5]. As to the preference difference of the chosen subject,
the effect of number of available options was contingent
upon need for cognition of participants, F(1, 116) = 21.07,
128
p < .001, η2 = .15. Further analyses indicated that the
more-means-worse effect was robust for high-NFC par-
ticipants (Mlarge = 8.57; Msmall = 4.57), F(1, 58) = 89.38,
p < .001, η2 = .61. However, this effect was small for low-
NFC participants (Mlarge = 4.60; Msmall = 3.23), F(1,
58) = 12.45, p < .001, η2 = .18. The selectivity data indi-
cated that the more-means-worse effect was prominent for
high-NFC participants (Mlarge = 0.62; Msmall = 0.97),
F(1, 58) = 67.92, p < .001, η2 = .54, whereas this effect
was small for low-NFC participants (Mlarge = 0.92; Ms-
mall = 1.06), F(1, 58) = 9.96, p < .01, η2 = .15.
Conclusion
Search tools of online-dating Web sites may provide large
sets for users to find a desirable partner. However, the
present findings support earlier research by Wu and Chiou
(2009) and indicate that a greater number of options would
trigger excessive searching, thus weakening the effort-sav-
ing benefit of search tools. Moreover, need for cognition
was demonstrated as a moderator of the more-means-
worse effect indicating the detrimental effect of excessive
searching on decision quality would be more prominent
for high-NFC individuals. Those people should be aware
of their tendencies towards excessive searching when
using search tools to consider their options.
references
Andrews, J.C., Craig, S.D., Akhter, S. H., A framework
for conceptualizing and measuring the involvement con-
struct in advertising research, Journal of Advertising 19
(1990), 27–40.
Cacioppo, J.T., Petty, R.E., Feinatein, J.A., Jarvis, W.B.G.,
Dispositional differences in cognitive motivation: The life
and times of individuals varying in need for cognition,
Psychological Bulletin 119 (1996), 197–253.
Cummings, J. N., Butler, B., Kraut, R., The quality of on-
line social relationships, Communications of the ACM 45
(2002),103–108.
Wu, P., Chiou, W., More options lead to more searching
and worse choices in finding partners for romantic rela-
tionships online: An experimental study, CyberPsychology
& Behavior 12 (2009), 315–318.
Yang, M., Chiou, W., Looking online for the “best” ro-
mantic partner reduces decision quality: The moderating
role of choice-making strategie, CyberPsychology & Be-
havior 13 (2009, in press).
Abstracts from CT15
––––––––––––––––––––––––––––––––––––––––––––––
Contributions of functional magnetic
resonance in the field of psychological
Treatments with Virtual reality
Miriam Clementea,b,1, Beatriz Reya,b, Mariano Alcañiza,b,
Juani Bretónl-Lópezb,c, Inés Moragregab,c, Rosa M.
Bañosb,d, Cristina Botellab,c and César Ávilae
a
Instituto en Bioingeniería y Tecnología Orientada al Ser
Humano, Universidad Politécnica de Valencia, Spain
b
Ciber Fisiopatología Obesidad y Nutrición (CB06/03)
Instituto Salud Carlos III
c
Departamento de Psicología Básica, Clínica y Psicobi-
ología, Universidad Jaume I, Valencia, Spain
d
Departamento de Personalidad, Evaluación y
Tratamientos Psicológicos, Universidad de Valencia, Va-
lencia, Spain
e
Dept. Psicología Bàsica, Clínica i Psicobiología, Uni-
versitat Jaume I, Castelló, Spain
1
Corresponding author:
Miriam Clemente
Universidad Politecnica de Valencia
Camino de Vera s/n - Edif. 8B - Acceso N
46022 Valencia, Spain
E-mail: mclemente@labhuman.i3bh.es
abstract
Our research has been focused in studying the possibility
of provoking the activation of brain areas related to pho-
bias, specifically a phobia to insects (spiders and cock-
roaches), using virtual reality (VR) as stimulus. To study
brain activation, subjects will be introduced to a functional
magnetic resonance imaging (fMRI) machine. Two differ-
ent sessions using fMRI will be performed, before and
after an intensive treatment specific for the phobia. Par-
ticipants will wear specific glasses to visualize the VR en-
vironments they have to navigate using a joystick adapted
to fMRI and they will have to perform tasks while being
exposed to the phobic stimuli. The VR environment used
in the fMRI sessions has three different conditions– firstly,
a clean room without spiders or cockroaches, secondly,
the same room, but dirty and disordered (giving the sen-
sation of containing insects, although there actually are
none), and thirdly, the same dirty room with spiders and
cockroaches. With these three environments, we expect to
generate anxiety in the patients when the insects are pres-
ent. The first experiments will take place during January
and February of 2010.
JCR
Abstracts from CT15
Keywords: Virtual Reality, Phobia, fMRI
Introduction
Many studies have taken advantage of the benefits of
fMRI for analyzing brain activation. In these works, ana-
lyzation has been done of the activation of brain areas re-
lated to phobias (Canli et al., 2001), and, more precisely,
to a phobia of spiders (Paquette et al., 2003). Other re-
search has been done combining VR with fMRI, for ex-
ample, for motor rehabilitation (You et al., 2005) or for
pain distraction (Hoffman, 2004). However, the research
field of phobias combined with VR and fMRI is unex-
plored yet. Previous studies used images of real animals
to stimulate activation of brain areas related to specific
phobias. The principal aim of our study is to demonstrate
that we can obtain activation levels similar to those studies
using virtual spiders and cockroaches in environments that
allow the user to navigate and carry out tasks.
method
The study will be done in the Hospital General of Castel-
lon. The glasses used to visualize the environment and the
joystick used to navigate are adapted to the magnetic fields
inside the magnetic resonance unit (1.5 Tesla). The virtual
environments have been developed with GameStudio. The
study consists of 30 participants–20 phobic subjects and
10 control subjects. Patients have been diagnosed by ex-
perienced psychologists.
Our study uses virtual environments as stimuli where sub-
jects can navigate freely during shorts periods of time
(avoiding the possible habituation effect). Different exper-
imental conditions will be applied in a repetitive and coun-
terbalanced way–a clean room without spiders or
cockroaches, the same room, but dirty and disordered
(giving the sensation that insects could appear) and the
same dirty room containing spiders and cockroaches.
Previously to the first fMRI, subjects will undergo a training
process to learn to navigate in the environment. Afterward,
the first fMRI session takes place while patients navigate
within the described virtual environments. In a session after
the fMRI, phobic subjects will undergo an intensive treat-
ment for the phobia. Two different groups of patients will
be created, and each group will receive a different treatment
option to compare between the two groups. A month later,
all the subjects go to a second fMRI session.
results
The first sessions with fMRI will take place during the
JCR
129
months of January and February 2010. Results will be
available at this time. We expect brain activation to be sim-
ilar to the studies that used images of real spiders as stim-
uli. Furthermore, we also hypothesize that the activation
in the control subjects will remain the same in the second
fMRI, and it will be reduced in the phobic participants.
Conclusions
VR allows us to reliably emulate reality. In this case, we
expect that it will generate the same brain activation pat-
terns of fear/anxiety in phobic subjects that are observed
in the presence of the real, feared stimulus.
references
Canli, T., Zhao, Z., Desmond, J. E, Kang, E., Gross, J.,
and Gabrieli, J. D.E. An fMRI study of personality influ-
ences on brain reactivity to emotional stimuli. Behavioral
Neuroscience, 115(1):33–42, 2001.
Hoffman, H. G., Richards, T. L., Coda, B., Bills, A. R.,
Blough, D.,Richards, A. L. and Sharar, S. R. Modulation
of thermal pain-related brain activity with virtual reality:
evidence from fMRI. Neuroreport, 15(8):1245, 2004.
Paquette, V., Lévesque, J., Mensour, B., Leroux, J. M.,
Beaudoin, G., Bourgouin, P., and Beauregard, M. change
the mind and you change the brain": effects of cognitive-
behavioral therapy on the neural correlates of spider pho-
bia. Neuroimage, 18(2):401–409, 2003.
You, S. H., Jang, S. H., Kim, Y. H., Hallett, M., Ahn, S.
H., Kwon, Y. H., Kim, J. H., and Lee, M. Y. Virtual real-
ity-induced cortical reorganization and associated loco-
motor recovery in chronic stroke: an experimenter-blind
randomized study. Stroke, 36(6):1166, 2005.
––––––––––––––––––––––––––––––––––––––––––––––
Virtual reality adaptive stimulation of limbic
structures in mental readiness Training
Krešimir Ćosića, Siniša Popovića, Davor Kukoljaia,1,
Ivica Kostovićb and Miloš Judašb
a
Faculty of Electrical Engineering and Computing, Uni-
versity of Zagreb, Croatia
b
Croatian Institute for Brain Research, School of Medi-
cine, University of Zagreb, Croatia
Corresponding author:
1
Davor Kukolja
130
Faculty of Electrical Engineering and Computing
University of Zagreb
Unska 3, 10000
Zagreb, Croatia
E-mail: davor.kukolja@esa.fer.hr
abstract
A significant proportion of severe psychological problems
related to combat stress in recent large peacekeeping op-
erations underscores the importance of effective methods
for strengthening the stress resilience of military person-
nel. Virtual reality (VR) adaptive stimulation techniques
presented in the paper, based on an estimation of the par-
ticipant’s emotional state from physiological signals, may
enhance mental readiness training (MRT). Understanding
neurobiological mechanisms by which MRT and VR
adaptive stimulation can affect stress resilience may be
useful for practical applications in stress resilience build-
ing. Following the delivery of a traumatic audio-visual
stimulus in VR adaptive stimulation, a cascade of events
occurs in the brain, which results in different physiological
manifestations. In addition to emotional and visceral brain
circuitry, other large-scale brain networks (sensory, cog-
nitive, and memory) participate with lesser known param-
eters in this physiological response. VR adaptive
stimulation may reinforce brain-body interaction during
MRT. Elucidating the foundations of stress resilience and
possible improvement mechanisms may benefit from this
interdisciplinary approach, coupling brain imaging and
VR adaptive stimulation with stress resilience research
from a military psychology perspective.
Keywords: Virtual Reality Adaptive Stimulation, Re-
sponse of Limbic Structures, Mental Readiness Training,
Stress Resilience, Physiological Measurements, Emo-
tional State Estimation
introduction
A significant proportion of severe psychological problems
related to combat stress in recent large peacekeeping op-
erations (Tanielian & Jaycox, 2008) highlights the signif-
icance of effective stress resilience training of military
personnel. Mental readiness training (MRT), an adaptation
of stress inoculation training (SIT) for military personnel,
has been proposed by other researchers as a stress re-
silience building approach. MRT places less emphasis
than SIT on lectures regarding stress, and greater emphasis
on acquisition and application of stress-coping skills in the
context of relevant military training. Existing brain corre-
lates of treatment outcomes in psychotherapy, such as
Abstracts from CT15
demonstrated byNardo, Högberg et al.'s work (2009), sug-
gest that neurobiological considerations of stress resilience
may strengthen practical applications of MRT.
physiology-driven adaptive Virtual reality
stimulation for mrT
Following promising applications of virtual reality (VR)
in psychotherapy of stress-related disorders and SIT
(Wiederhold & Wiederhold, 2008), the concept of physi-
ology-driven adaptive VR stimulation (Ćosić, Popović et
al., 2010) is proposed as a potentially useful adjunct to
MRT. The concept involves delivery of audio-visual stim-
uli (e.g. static pictures, sounds, video clips, or synthetic
stimuli in a virtual environment) in a closed loop, based
on information about the participant’s emotional state,
which is extracted from physiological measurements by
the neural network-based emotional state estimator
(Kukolja, Popović et al., 2009). This approach facilitates
personalized elicitation and monitoring of potential psy-
chophysiological correlates of stress resilience, using the
stimuli of desired semantics and emotional properties.
neurobiological Considerations of stress resilience
Physiological fluctuations during physiology-driven adap-
tive VR stimulation for MRT reflect changes in brain-body
interaction influenced by the presented stimuli, and also
baseline brain activity and other potential stimuli-unre-
lated processes. Thalamo-amygdala and thalamo-cortico-
amygdala routes, via amygdala and prefrontal cortex
projections to hypothalamus and brainstem (Arnsten,
2009), may be pathways by which external stimuli exert
physiological changes. Baseline brain activity is related to
resting-state networks (Damoiseaux, Rombouts et al.,
2006), while both stimuli-elicited and unrelated complex
functions may involve large-scale brain networks (Marr-
elec, Bellec et al., 2006). The so-called “paralimbic” and
“limbic” structures are known to be affected in stress-re-
lated disorders (Nardo, Högberg et al., 2009). An interdis-
ciplinary approach may help elucidate the foundations of
stress resilience and possible improvement mechanisms
by coupling brain imaging and physiology-driven adaptive
VR stimulation with stress resilience research from a mil-
itary psychology perspective.
references
Arnsten, A.F.T., Stress signalling pathways that impair
prefrontal cortex structure and function, Nature Reviews
Neuroscience 10 (2009), 410–422.
Ćosić, K. Popović, S. et al., Physiology-driven adaptive
JCR
Abstracts from CT15
virtual reality stimulation for prevention and treatment of
stress related disorders, Cyberpsychology, Behavior and
Social Networking 13(1) (2010), 73–78.
Damoiseaux, J.S., Rombouts S.A., et al., Consistent rest-
ing-state networks across healthy subjects, PNAS 103
(2006), 13848–13853.
Kukolja, D., Popović, S. et al., Real-time emotional state
estimator for adaptive virtual reality stimulation,
LNCS/LNAI 5638 (2009), 175–184.
Marrelec, G., Bellec, P., et al., Exploring large-scale brain
networks in functional MRI, Journal of Physiology-Paris
100(4) (2006), 171–181.
Nardo, D., G. Högberg, G. et al., Gray matter density in
limbic and paralimbic cortices is associated with trauma
load and EMDR outcome in PTSD patients, J. Psychiatr.
Res. (2009 Nov 24).
Tanielian, T., L.H. Jaycox, L.H., editors, Invisible wounds
of war: psychological and cognitive injuries, their conse-
quences, and services to assist recovery. RAND Corpora-
tion, 2008.
Wiederhold, B.K., Wiederhold, M.D., Virtual reality for
posttraumatic stress disorder and stress inoculation train-
ing, Journal of Cybertherapy & Rehabilitation 1 (2008),
23–35.
––––––––––––––––––––––––––––––––––––––––––––––
effect of mood induced by Virtual reality
exposure on body image disturbances
Marta Ferrer-Garciaa, 1 and Jose Gutierrez-Maldonadoa
University of Barcelona, Spain
a
1
Corresponding author:
Marta Ferrer-García
Department of Personality,
Assessment and Psychological Treatments
University of Barcelona
Paseo del Valle de Hebrón, 171
08035, Barcelona, Spain
E-mail: martaferrerg@ub.edu
abstract
Previous research suggests that negative mood increases
body image disturbances. The aim of this study was ex-
JCR
131
amining if mood produced by virtual reality (VR) expo-
sure influenced body image disturbances. As expected,
dysphoric mood increases body image disturbances in pa-
tients with eating disorders.
Keywords: Body Image, Eating Disorders,
Virtual Reality, Mood
introduction
Previous research has provided evidence about the capa-
bility of virtual reality (VR) exposure to produce emo-
tional responses (anxiety and depression) (Ferrer-García,
Gutierrez-Maldonado, Caqueo-Urízar,Moreno, 2009) and
fluctuations on body image disturbances in patients with
eating disorders (ED) (Gutierrez-Maldonado, Ferrer-Gar-
cía, Caqueo-Urízar, Moreno). Furthermore, several studies
show that there is a strong relation between dysphoric
mood and the increase of body image disturbances
(Kasper, 2001; Kulbartz-Klatt, Florin, & Pook, 1999).
The aim of this study was to examine if anxiety and de-
pressed mood produced by VR exposure influences body
image distortions and body image dissatisfaction in both
eating ED patients and controls.
method
Eighty-five patients diagnosed with eating disorders (ED)
and 109 non-ED students were exposed to four virtual en-
vironments randomly displayed – the kitchen with low-
calorie food (VE1), the kitchen with high-calorie food
(VE2), the restaurant with low-calorie food (VE3), and
the restaurant with high-calorie food (VE4).
Anxiety, depressed mood, body image distortion and body
image dissatisfaction were assessed in the interval be-
tween the presentations of each virtual situation.
results
Table 1 shows that correlations between mood variables
(anxiety and depression) and body image disturbances
(body image distortion and body image dissatisfaction)
were higher in ED patients than in controls, both when
considering virtual environments separately and when
considering the mean scores of all of them. The strongest
relation was found between mood and body image dissat-
isfaction.
As Table 2 shows, depressed mood was the best predictor
of body image dissatisfaction in ED patients. Neither anx-
iety nor depression significantly influenced control par-
ticipants' body image disturbances.
132 Abstracts from CT15

Table 1
Correlations between mood and body image disturbances

body image distortion body image dissatisfaction

VE1 VE2 VE3 VE4 Mean VE1 VE2 VE3 VE4 Mean

Anxiety .083 .189* .265** .226** .224** -.099 -.344** -.294** -.205* -.278**
Control ED .430** .468** .464** .517** .511** -.593** -.583** -.549** -.638** -.672**
Depressed mood .113 .176* .267** .139† .175* -.179* -.297** -.338** -.200* -.235**
Control ED .405** .467** .496** .516** .511** -.575** -.606** -.582** -.653** -.678**
† p <.10 (marginally significant); * p < .05; ** p < .01
Table 2
Regressions between anxiety-depressed mood , and body image distortion- body image dissatisfaction

body image distortion body image dissatisfaction

VE1 VE2 VE3 VE4 Mean VE1 VE2 VE3 VE4 Mean

Anxiety .024 .131 .161 .213† .185 -.080 -.259* -.138 -.137 -.214†
Control ED .289† .262† .170 .286† .279† -.369** -.275† -.210 -.310* -.351*
Depressed mooda .098 .101 .167 .025 .064 -.031 -.149 -.252* -.127 -.106
Control ED .183 .259† .355* .280† .280† -.292* -.388** -.408** -.398** -.386**
Anxiety + Dep. .144 .206† .295** .228† .229† .102 .365** .355** .231† .291**
Moodb Control ED .445** .493** .505** .541** .535** .621** .629** .594** .667** .706**
a
Beta; b R; † p <.10 (marginally significant); * p < .05; ** p < .01
Conclusions tion, British Journal of Clinical Psychology 38 (1999),
Mood experienced by ED patients in virtual environments, 279–287.
especially depressed mood, influences their body image
disturbances, mainly body image dissatisfaction. Results ––––––––––––––––––––––––––––––––––––––––––––––
agree with previous research done in this field. a myoelectric-Controlled Virtual hand for the
assessment and Treatment of phantom limb pain in
references Trans-radial upper extremity amputees:
Ferrer-García, M., Gutierrez-Maldonado, J., Caqueo- a research protocol
Urízar, A., Moreno, E., The validity of virtual environ-
ments for eliciting emotional responses in patients with Andrea Gaggiolia,b,1, Amedeo Amoresanoc,
eating disorders and in controls, Behavior Modification 3 Emanuele Gruppionic, Gennaro Vernic and
(2009), 830-854. Giuseppe RIVAa,b

Gutierrez-Maldonado, J., Ferrer-García, M., Caqueo- ATN-P Lab, Istituto Auxologico Italiano, Milan, Italy
a

Urízar, A., Moreno, E., Body image in eating disorders: b

Department of Psychology, Catholic
The influence of exposure to virtual environments, Cy- University of Milan, Italy
berPsychology & Behavior (in press). c
Centro Protesi INAIL, Vigorso di Budrio
(Bologna), Italy
Kasper, S.A., The impact of self-Esteem and depressed
mood on body image dissatisfaction, Dissertation Ab- 1
Corresponding author:
stracts International: Univ Microfilms International, 2001. Andrea Gaggioli
Istituto Auxologico Italiano
Kulbartz-Klatt, Y.J., Florin, I., Pook, M., Bulimia nervosa: Via Pelizza da Volpedo 41, Milan, Italy
mood changes do have an impact on body width estima- E-mail: andrea.gaggioli@auxologico.it

JCR
Abstracts from CT15
abstract
At least 90% of individuals with limb amputations expe-
rience phantom limb pain (PLP). Recent clinical research
suggests that providing patients with the mirror image rep-
resentation of the amputated limb may alleviate PLP.
However, mirror therapy cannot be used with bilateral am-
putees, as visual feedback is dependent on the movement
of the intact limb. To overcome this limitation, we de-
signed a novel myoelectric-controlled virtual reality (VR)
system for the treatment of phantom limb pain in trans-ra-
dial upper extremity amputees. The proposed system al-
lows the patient to directly control the virtual limb by
recognizing stump muscle patterns recorded with EMG
sensors. The hypothesis behind this strategy is that the VR
image of the amputated limb induces better limb imagery
than the reflected image of their intact limb and, therefore,
is more effective in reducing PLP. A research protocol to
test this hypothesis is described.
Keywords: Phantom Limb Pain, Virtual Reality, EMG,
Myoelectric, Recognition, Real-Time Control
introduction
phantom limb pain
It has been estimated that at least 90% of individuals with
limb amputations experience phantom limb pain (PLP)
(Melzack, 1990). Clinical research suggests that providing
patients with the mirror image representation of the am-
putated limb may alleviate PLP (Ramachandran &
Rogers-Ramachandran, 1996). In a randomized controlled
trial in patients who had undergone amputations of lower
limbs (n=22), Chan and collaborators (2007) found that
mirror therapy was effective in reducing PLP. However,
the use of mirror therapy is associated with methodologi-
cal limitations, highlighted by previous research (Murray,
2007). Mirror therapy cannot be used with bilateral am-
putees, as visual feedback is dependent on the movement
of the intact limb. Further, conventional mirror therapy re-
quires the patient to maintain attention on the reflected
image as opposed to the moving anatomical limb. Finally,
the mirror box requires the patient to operate from a fixed
position.
Virtual reality in the treatment of plp
A possible solution to overcome the drawbacks of con-
ventional mirror therapy is to use augmented reality (AR)
or virtual reality (VR) technology to generate a graphic
representation of the limb moving in 3D space. Desmond
and collaborators (2006) developed and evaluated an
"augmented reality mirror box" to allow artificial visual
JCR
133
feedback to be generated independently of contralateral
limb movement, thus facilitating presentation of phantom
limb movement. The AR system consists of a 3D graphic
representation of an arm displayed on a flat screen con-
trolled by a wireless data glove worn on the intact arm,
which measures finger flexure and the orientation of the
user's hand. The information received from the glove is
fed back to the computer so that the image on the screen
appears to the participant to move in real time. However,
the small number of patients involved in the trial (three)
did not allow these researchers to draw conclusions on the
clinical efficacy of the treatment.
Murray et al. (2007) designed an immersive VR system
to treat phantom limb pain. The VR system provides par-
ticipants with a 3D virtual representation of the phantom
limb by transposing the participant’s opposite anatomical
limb into the phenomenal space of their phantom limb. A
data glove and sensors were used for upper-limb am-
putees, while sensors only were used for lower-limb am-
putees. The virtual representation of the phantom limb is
presented through a head-mounted display equipped with
a head-tracking sensor. The authors evaluated the efficacy
of the VR system in a case-series study (n=5). Although
this study was small, findings were promising, with the
majority of participants reporting a reduction of their
phantom limb pain throughout testing.
myoelectric-controlled virtual hand for
the treatment of plp
Building on previous research (Chan et al., 2007; Mur-
ray et al., 2007; Desmond, O'Neill, de Paor, MacDarby,
& MacLachlan, 2006), the goal of this project is to de-
sign, develop and test a novel immersive VR system for
the treatment of phantom limb pain in trans-radial upper
extremity amputees. Differently from the above-de-
scribed technological solutions, the proposed system al-
lows the patient to control, in real-time, the virtual limb
by means of a pattern-recognition algorithm applied to
EMG signals recorded by a g.USBamp (g.tec Guger
Technologies, Austria, Europe). In such a way, is is pos-
sible to recognize, also from residual muscles of tran-
sradial amputees, different type of grasping and the
strength related (Castellini, Gruppioni, Davalli, & San-
dini, 2009). From the technical point of view, the devel-
opment will concern the software interfaces, shown in
Figure 1 as “To Do”, that will allow the system’s oper-
ation overall. The myoelectric-controlled virtual limb is
presented in a head-mounted display equipped with
head-tracking sensor.
134
Figure 1. Architecture of the
myoelectric-controlled virtual limb
research protocol
The hypothesis behind this strategy is that the VR image
of the amputated limb induces better limb imagery than
the reflected image of their intact limb and, therefore,
is more effective in reducing PLP.
To test this hypothesis, 40 consecutive patients with PLP
resulting from traumatic upper limb amputation are ran-
domly assigned to one of two groups–one that view the
myoelectric-controlled virtual limb (VR group), and one
that view a mirror image of their intact limb (mirror
group). Patients are included on a voluntary basis. The
Groningen Questionnaire Problems after Amputation
(GQPA) is used for defining patients suitable for inclu-
sion in the clinical trial. The exclusion criteria are–
upper extremity paralysis after neurological lesions,
sensory alterations (caused i.e. by diabetic neuropathy
or by lesions to sensory nerves) and cognitive deficits
(Mini-Mental State Examination < 21).
The treatment protocol for both groups consists of 15-
20 minutes of therapy daily for a minimum of two
weeks. Pre- and post-assessment measures include the
Brief Pain Inventory, which is used to assess the inten-
sity of pain (the sensory dimension) as well as the de-
gree to which pain interferes with function (the reactive
dimension) and the stump muscle EMG activity.
references
Castellini, C., Gruppioni, E., Davalli, A., Sandini, G.:
Fine detection of grasp force and posture by amputees
via surface electromyography. Journal of Phisiology
(Paris), 103(3-5) (2009), 255-262.
Chan, B.L., Witt, R., Charrow, A.P., Magee, A.,
Howard, R., Pasquina, P.F., Heilman, K.M., Tsao, J.W.,
Mirror Therapy for Phantom Limb Pain, N Engl J Med
357(21) (2007), 2206-2207.
Abstracts from CT15
Desmond, D.M., O'Neill, K., de Paor, A., MacDarby, G.,
MacLachlan, M., Augmenting the Reality of Phantom
Limbs: three case studies using an augmented mirror
box procedure. Journal of Prosthetics & Orthotics, 18(3)
(2006), 74-79.
Melzack, R. Phantom limbs and the concept of a neuro-
matrix, Trends Neurosci 13 (1990), 88-92.
Murray, C. D., Patchick, E., Pettifer, S., Howard,
T.L.J., Kalkarni, J., and Bamford, C., Investigating the
efficacy of a virtual mirror box in treating phantom limb
pain in a sample of chronic sufferers. International Jour-
nal of Disability and Human Development, 5(3) (2007),
227-234.
Ramachandran, V.S., Rogers-Ramachandran, D.,
Synaesthesia in phantom limbs induced with mirrors,
Proc Biol Sci 263 (1996), 377-386.
––––––––––––––––––––––––––––––––––––––––––––––
intersubjectivity as a possible Way
to inhabit future Cyberplaces
Carlo Galimbertia,1, Eleonora Brivioa, Matteo
Cantamessea and Francesca Cilento Ibarraa
a
Centro Studi e Ricerche di Psicologia della
Comunicazione (CSRPC), Università Cattolica
del Sacro Cuore, Milano, Italy
Corresponding author:
1
Carlo Galimberti
Centro Studi e Ricerche di Psicologia della
Comunicazione, Dipartimento di Psicologia
Università Cattolica del Sacro Cuore
L.go Gemelli 1, 20123
Milano, Italy
E-mail: carlo.galimberti@unicatt.it.
abstract
A change of perspective in online interaction research
shifts attention from technologies to what people actually
do online. It’s time to study how subjects interact with oth-
ers and how they "take possession" of virtual environ-
ments on a perceptive, emotional and relational plan. This
means to study: a) how actors "construct" themselves as
subjects facing others during online interactions; b) the re-
lationships actors establish with virtual environments and
JCR
Baus and Bouchard
how actors transform "simple" cyberspaces in cyber-
places; c) how actors – on the basis of a) and b) –"bridge
the gap" between themselves and their interlocutors using
communication as a tool to give form to intersubjectivity,
intended as an effective relational structure. A research
program built around these three issues –both on the the-
oretical and empirical plan – should become the core of
the social psychology of cyberplaces as this paper will
demonstrate.
Keywords: Intersubjectivity, Cyberplaces, Avatar
introduction
Subjectivity is a fluid and circumscribed image proposed
by the subjects to the outside world, in a sense, a portion
of what the person is (Galimberti & Cilento Ibarra,
2009). It is an intention based on the part of the self rel-
evant in that context, strategically presented and consid-
ering the interlocutor and the environment. To be
understood by others during mediated interactions, sub-
jects shape their subjectivities according to feedback and
artifacts offered by the context. Subjectivity is dialogi-
cally-generated and continuously adjusted by social ac-
tors during their interactions. Every social interaction is
characterized by a unique combination of subjectivities
created in a specific context at one moment, a combina-
tion that generates intersubjectivity. Intersubjectivity
refers to a specific frame of interaction constituting a
shared world for the subjects to enact in (Galimberti &
Cilento Ibarra, 2007). The peculiarities of such worlds
should be the conjoint definition of subjectivities and the
rules to create and support relationships as well as the
definition of objects and conversational rules to deal with
them (Galimberti). From a psychosocial point of view,
mediated interactions are a part of cyberplaces more than
of cyberspaces (virtual places built thanks to new tech-
nologies), but made of relationships and of social mean-
ings co-produced by their users.
method
To illustrate this process, we shall make reference to three
of the most recent CSRPC’s team researches. The first
study (Cantamesse, 2008) focuses on the creation of sub-
jectivity and relational rules. Forty-eight conversations in
a Shared Virtual Environment were analyzed in order to
understand the specific structure, dynamics, and phenom-
enology of intersubjectivity (“interactive micro-chains”).
The second study (Brivio, Cilento Ibarra, & Galimberti,
2008) has been conducted on 20 fandom blogs that were
analyzed in their structural and design elements to show
JCR
35
how, by means of referring to specific objects, subjects
talk about themselves. The third study (Cilento Ibarra,
Brivio, Galimberti, Monti, & Bonisolli, 2009) explores the
strategies that 10 couples of players drew together to shape
a self-representative avatar in video games (tennis and
bowling) played with the Nintendo WII console.
results
Results of the first study show that, in order to collabo-
rate successfully, actors need to build a shared represen-
tation of the world, of the objects and of their position.
They need to be sure, and make the other user be sure
about, where they are, what they are doing, how to do it
and the results of their action. The second study shows
that each element of the blog refers to a community-spe-
cific jargon and subtle shared meanings and hints, and
foster feelings of connection to the community. Through
such specific manipulation of the blog structure, subjects
talk about themselves as member of a specific fandom –
being an intersubjective asynchronous environment, the
fandom blog is a real cyberplace. The third study stresses
the importance of a significant other in the avatar cre-
ation, performed as a collaborative process. Therefore
we can state that avatars may partially contribute to the
definition of a kind of subjectivity brought about "inter-
subjectively." As a partial representation of the self,
avatars act as body representations in a virtual environ-
ment. By "bringing the body" into the virtual environ-
ment, avatars allow subjects toemotionally and
relationally invest in the environment itself, turning
"simple" cyberspaces into cyberplaces, environments
made of meanings co-produced intersubjectively.
Conclusion
These three examples respectively show: 1) how subjects
create rules to define and manipulate objects by speaking
about themselves, 2) how subjects speak about themselves
through object manipulation, 3a) how subjects’ construc-
tion of their own face in virtual environments (avatar) is
affected by the other and 3b) how this cooperation among
subjects can bring about intersubjectivity and transform
mere cyberspaces into "future" cyberplaces rich in co-con-
structed affective investments and shared meanings.
references
Brivio, E., Cilento Ibarra, F., Galimberti, C., Social life in
Blogs: Fandom culture Revealed Through Users’ self
presentation. Poster presented at Eurpean Communication
Research and Education Association 2nd European Com-
munication Conference, Barcelona, 2008.
136
Cantamesse, M., Reciprocal presence: A qualitative analy-
sis of psycho-social interaction in Virtual Reality, Doctoral
Thesis, Università Cattolica del Sacro Cuore, Milano,
2008.
Cilento Ibarra, F., Brivio, E, Galimberti, C., Monti, A., &
Bonisolli, B., Avatar based self-presentation and self-po-
sitioning in a blended reality context, CSRPC-Diparti-
mento di Psicologia Università Cattolica Internal Research
Report, Milano, Italy, 2009.
Galimberti, C., Cilento Ibarra, F., Tra riproduzione dell'i-
dentità e negoziazione della soggettività in rete,
in "La Pluralità Inevitabile", Talamo, A. & Roma, F. (Eds),
Apogeo, Milano, 2007.
Galimberti, C., Cilento Ibarra, F., ‘I’ and ‘other’ in online in-
teractions: Intersubjectivity as a Social Bridge, Annual Re-
view of Cybertherapy and Telemedicine 7 (2009), 13-15.
Galimberti, C., Segui il coniglio bianco: Strategie identi-
tarie e costruzione della soggettività nelle interazioni me-
diate. In E. Marta, & C. Regalia (Eds.), “Identità in
Movimento”, Carocci, Roma, in press.
––––––––––––––––––––––––––––––––––––––––––––––
using nintendo Wii® as behavioral Technology
Stefano Cardulloa, Bruno Seragliaa and
Luciano Gamberinia,1
a
University of Padova, Department of Psychology
1
Corresponding author:
Luciano Gamberini
University of Padova
Department of Psychology
Padova, Italy
Tel.: +39 0498276605
Fax: +39 0498276600
E-mail: luciano.gamberini@unipd.it
abstract
The advantages of videogames in keeping motivation
high are leading to their widespread use in new psycho-
logical treatments. Here we present an application for
cognitive training, in which cognitive tasks are adminis-
tered to elderly people through a popular videogame con-
sole, the Nintendo Wii®. The application was
successfully tested in a nursing home, by comparing its
Abstracts from CT15
performance with traditional paper-and-pencil tasks for
attention, memory and motor control. The results are de-
scribed and discussed.
Keywords: Cognitive training, Elderly, Videogames
introduction
The worldwide elderly population growth is expected to
increase rapidly until 2050 and beyond (UN. World Pop-
ulation Prospects: The 2008 Revision). This expansion
highlights the need to elaborate simple, quick and low-
cost solutions in order to intervene and delay the natural
cognitive decline connected with aging, and then keep the
elderly population as much independent and self-suffi-
cient as possible. Side by side with classic cognitive train-
ing, new experimental methodologies implying digital
technologies have emerged, to help reach this goal on a
large scale; in particular, we will focus here on cognitive
tasks realized through videogames (Gamberini, Barresi,
Majer, & Scarpetta, 2008; Gamberini et al., 2006) and pres-
ent an application that uses the Nintendo Wii® platform.
The research
The goal of the application was to create a tool that makes
full use of the ergonomic potential of the Nintendo Wii®
interface in order to test and exercise the cognitive skills
of the elderly person. Differently from other published re-
search on Nintendo Wii® in elderly care centers, which
usually employs the videogames licensed by Nintendo®
(Neufeldt, 2009), the games included in the application
presented here were newly developed by us to address
three different areas: attention, memory and motor control.
They underwent a first validation test to assess their cor-
relation with traditional, standardized paper and pencil
tasks.
Twenty elderly participants whose mean age was 77 (SD
= 9.92; range = 61-97) took part in the research. They were
requested to perform Wii®-based cognitive tasks (Fig. 1)
and, after one week, to take traditional paper and pencil
tests: Deux Barrages for attention, Digit Span (DS) and
Memory with Interference (MI) for memory, and Trial
Making Test (TMT) for motor control. The purpose was
to check the validity of the Wii® tests by correlating their
performance with the results of traditional standardized
tests. The former were built using Adobe® Macromedia®
Flash® Professional 8.0 with ActionScript 2.0 code.
The results show a significant correlation between all tests,
except for the Digit Span (Table 1).
JCR
Abstracts from CT15 137

Figure 1. Wii Tests: (from left to right) Attention, Memory (DS), Memory (MI), Motor Control.
Table 1
Pearson coefficient values between Wii® tests and Paper and Pencil tests (PP Tests)
Wii Tests
attention memory (mi) memory (ds) motor Control
deux barrages ,777*
Testspp

mi ,689**
digit span 0,263
TmT ,464**

*Correlation is significant at the 0.01 level (2-tailed); **Correlation is significant at the 0.05 level (2-tailed).

Conclusion
Thanks to the ergonomic features and the play metaphor
of the application proposed in this study, elderly people
were able to use it and engage with it even though they
had never dealt with videogames before and are com-
monly considered to be close to rejecting any new tech-
nology. Moreover, being small, financially affordable and
portable, this solution can be used not only in elderly care
centers but also at home, allowing the participation to the
rest of the family. This initial study reveals promising; the
results of a task at the Wii-based interface correlates with
the results of a classic task administered via paper and pen-
cil, suggesting the possibility to pursue in this direction
and further testing the training ability of the package.
references
Gamberini, L., Alcaniz, M., Barresi, G., Fabregat, M.,
Ibanez, F., Prontu, L., Cognition, technology and games
for the elderly: An introduction to ELDERGAMES Proj-
ect, PsychNology Journal, 4(3) (2006), 285-308.
––––––––––––––––––––––––––––––––––––––––––––––
Training presence: the importance of Virtual reality
experience on the “sense of being There”
Pedro Gamitoa,b,1, Jorge Oliveiraa, Diogo Moraisa, André
Baptistaa, Nuno Santosa, Fábio Soaresa, Tomaz Saraivaa,
Pedro Rosaa,c
a
Universidade Lusófona de Humanidades e Tecnologias
b
Clínica São João de Deus
c
Instituto Universitário de Lisboa
1
Corresponding author:
Pedro Gamito
Universidade Lusófona de Humanidades e Tecnologias
Campo Grande, 376
Lisbon, Portugal
1749 - 024
E-mail: pedro.gamito@gmail.com
abstract
Nature and origin of presence are still unclear. Although
it can be characterized, under a neurophysiological per-
spective, as a process resulting from a synchrony between
cognitive and perceptive systems, the multitude of asso-
ciated processes reduces the chances of brain mapping
presence. In this way, our study was designed in order to
understand the possible role of VR experience on presence
in a virtual environment. For this purpose 16 participants
(M=28.39 years; SD=13.44) of both genders without com-
puter experience were selected. The study design consisted
of two assessments (initial and final), where the partici-
pants were evaluated with the BFI, PQ, ITQ, QC,
MCSDS-SF, STAI, visual attention and behavioral meas-
ures after playing an FPS. In order to manipulate the level
of VR experience the participants were trained on a dif-

JCR
138
ferent FPS during 12 weekly sessions of 30 minutes each.
Results revealed significant differences between the first
and final assessment for presence (F(1,15)=14.213;
MSE=1044.321; p<.01) and immersion scores (F(1,15)
=6.519; MSE=200.893; p<.05), indicating higher levels
of presence and immersion in the final assessment. No sta-
tistical significant results were obtained for cybersickness
or for the behavioral measures. In sum, our results
showed that training and the subsequent higher computer
experience levels can significantly increase presence and
immersion.
Keywords: Presence, Immersion, Cybersickness, Anxiety,
Personality, Behavioral measures, First-Person Shooters
introduction
Presence has long been recognized as the key factor of any
virtual reality (VR) experience. It is known as the “sense
of being there” and is responsible for draining or tele-
transporting the participant into the VR setup, tricking
his/her perception so that the virtual world is perceived as
being real (Heeter, 1992).
Many factors may affect presence. Some studies identified
variables that are suggested to predict the profile of pa-
tients that could be more suited for VR-based therapy
(Gutiérrez-Maldonado, Alsina-Jurnet, & Rus-Calafell,
2009) while others pursued the identification of variables
that could contribute to individual differences in presence
(Sas, O'Hare, & Reilly, 2004).
However, most studies were largely inconclusive and fur-
ther research is needed in order to devise the effect of in-
dividual variables in the level of presence (Sacau, Laarni,
& Hartmann, 2008). This paper aims at identifying the
contribution of VR experience on presence.
method
The study design consisted of two assessments (initial and
final), where the participants were evaluated with person-
ality measures (BFI), presence (PQ), immersion (ITQ),
cybersickness (QC), social desirability (MCSDS-SF), trait
anxiety (STAI), visual attention levels (Stroop task) and
behavioral measures (number of rounds, shots fired, shots
taken, given damage and taken damage) after playing a
first person shooter (FPS) game, "Counter-strike." In order
to manipulate the level of VR experience the participants
were trained on a different FPS, "Call of Duty – Modern
Warfare," during 12 weekly sessions of 30 minutes each.
The study sample consisted of 16 participants (M=28.39
Abstracts from CT15
years; SD=13.44) of both genders without computer ex-
perience.
results
Results revealed significant differences between the first
and final assessment for presence (F(1,15)=14.213;
MSE=1044.321; p<.01) and immersion scores
(F(1,15)=6.519; MSE=200.893; p<.05) indicating higher
levels of presence and immersion in the final assessment.
No statistical significant results were obtained for cyber-
sickness.
Behavioral measures showed no statistical significant dif-
ferences between assessments, although descriptive sta-
tistics have shown an overall increase in performance.
Furthermore, no statistical significant interaction effects
of personality type and trait anxiety on presence assess-
ments were registered. Social desirability and visual at-
tention levels were considered as normal.
Conclusion
In general, our results showed that training and the subse-
quent higher computer experience levels can increase im-
mersion and presence. These findings can suggest that
beyond exogenous and endogenous factors, presence can
also be related with level of experience with the virtual
environment even with the absence of a clearer improve-
ment in task performance.
Also, but far being conclusive, this study points towards
the prevalence of VR experience over individuals differ-
ences such as gender, personality and anxiety traits.
References
Gutiérrez-Maldonado, J., Alsina-Jurnet, I. & Rus-Calafell,
M., Influence of personality and individual abilities on the
Sense of Presence experienced in virtual environments,
Proceedings of the 2nd conference on Human System In-
teractions (2009), pp. 149-152.
Heeter, C., Being there: The subjective experience of pres-
ence, Presence (1992), 1(2), pp. 262-271.
Sacau, A., Laarni, J. & Hartmann, T., Influence of indi-
vidual factors on Presence, Computers in Human Behav-
ior (2008), 24 (5), 2255-2273
Sas, C., O'Hare, G.M.P. & Reilly, R., Presence and Task
Performance: An Approach in the Light of Cognitive
Style, International Journal of Cognition Technology and
Work (2004) . pp. 53-56.
JCR
Abstracts from CT15
––––––––––––––––––––––––––––––––––––––––––––––
efficacy of Virtual reality for Triggering smoking
Craving: relation with level of presence and
nicotine dependence
Marta Ferrer-Garcíaa, Olaya García-Rodrígueza,1, José
Gutíerrez-Maldonadoa, Irene Pericot-Valverdea,
Roberto Secades-Villab
a
University of Barcelona, Spain
b
University of Oviedo, Spain
1
Corresponding author:
Olaya García-Rodríguez
Department of Personality,
Assessment and Psychological Treatments
University of Barcelona
Paseo Valle de Hebrón, 171
08035, Barcelona, Spain
E-mail: olayagarcia@ub.edu
abstract
Virtual Reality environments that reproduce typical con-
text associated with tobacco use could be useful for smok-
ing cessation. The main objective of this study was to
confirm the validity of eight environments to produce
smoking cravings and to determine the relation of craving
with nicotine dependence and level of presence. Results
showed that all the environments were able to generate a
desire to smoke and a direct relation was found between
sense of presence and craving.
Keywords: Virtual Reality, Nicotine Dependence,
Craving, Presence
introduction
Cue-induced craving is considered the main reason respon-
sible for relapse after smoking cessation (Shiffman, Paty,
Gnys, Kassel, & Hickcox, 1996). Cue Exposure Treatment
(CET) consists of controlled and repeated exposure to stim-
uli associated with substance use in order to produce and
reduce cravings (Carter & Tiffany, 1999). Previous studies,
using mainly paraphernalia and virtual bars, have shown
that virtual reality could be a good alternative to traditional
exposure methods to generate craving (Lee et al., 2004;
Traylor, Bordnick, & Carter, 2008). In order to adapt this
technology to smoking cessation interventions, more di-
verse environments that enhance the probability of gener-
alization of extinction in real life are needed.
JCR
139
The aim of this study was to assess the validity of eight
immersive virtual reality environments to produce smok-
ing cravings as well as to determine the relationship be-
tween level of presence and nicotine dependence with
self-reported craving.
method
Twenty-five former smokers participated in the study. In-
clusion criteria were being 18 years of age or older and
having smoked 10 or more cigarettes per day.
Participants were exposed, in random order, to seven com-
plex virtual scenes with smoking-related cues that repro-
duce typical situations where people smoke – being in a
pub, having lunch and having breakfast at home, drinking
coffee in a cafe, after having lunch at a restaurant, waiting
in the street and watching TV at night – and to a neutral
virtual environment – a museum.
A Head Mounted Display with tracking sensors was used
for the exposure. Subjective craving (measured with a vi-
sual analogical scale from 0 to 100) were assessed before
the experiment and during the exposure to each environ-
ment.
Nicotine dependence was determined by means of number
of cigarettes per day and presence was assessed using a
Spanish translation of the Presence Questionnaire (Slater,
Steed, McCarthy, & Maringelli, 1998).
results
Figure 1 shows that mean craving levels were significantly
higher in all the environments than on the pre-exposure
assessment (* = p < .05). All the environments, including
the museum, were able to generate a desire to smoke. Nev-
ertheless, having lunch at home, watching TV at night,
being in a pub and having lunch at a restaurant seemed to
produce more cravings than the other situations. A signif-
icant correlation was found only between presence and
craving levels (r= .480; p=.01).
Conclusions
These results suggest that complex virtual reality environ-
ments that simulate real situations are able to elicit crav-
ing. This technology could be useful in the improvement
of CET for substance use disorders and more specifically
for smoking cessation programs. Nevertheless, it is nec-
essary to incorporate a minimal number of situations that
enhance the probability of generalization of extinction in
real life, and to pay attention to some variables as the sense
140
Figure 1. Craving levels during exposure to
virtual environments.
of presence experienced in the virtual environments that
could be related to the effectiveness of the exposure.
references
Carter, B.L., Tiffany, S.T., Meta-analysis of cue-reactivity
in addiction research, Addiction 94 (1999), 327-340.
Lee, J., Lim, Y., Graham, S.J., Kim, G., Wiederhold, B.K.,
Wiederhold, M.D., et al. Nicotine craving and cue expo-
sure therapy by using virtual environments, CyberPsy-
chology & Behavior 7 (2004), 705-713.
Shiffman, S., Paty, J.A., Gnys, M., Kassel, J.A., Hickcox,
M., First lapses to smoking: within-subjects analysis of
real-time reports, Journal of Consulting and Clinical Psy-
chology 64 (1996), 366-379.
Slater, M., Steed, A., McCarthy, J., Maringelli, F., The In-
fluence of Body Movement on Subjective Presence in Vir-
tual Environments, Human Factors 40 (1998), 469- 477.
Traylor, A.C., Bordnick, P.S., Carter, B.L., Assessing crav-
ing in young adult smokers using virtual reality, The
American journal on addictions 17 (2008), 436-440.
––––––––––––––––––––––––––––––––––––––––––––––
ebaVir - easy balance Virtual rehabilitation
system: a study With patients
Miriam Gonzáleza, José-Antonio Gil-Gómeza,1, Mariano
Alcañiza, E. Noéb, C. Colomerb
a
Instituto Interuniversitario de Investigación en Bioinge-
niería y Tecnología Orientada al Ser Humano, Universi-
dad Politécnica de Valencia, Valencia (España)
b
Servicio de Daño Cerebral de NISA; Fund. Inst. Valen-
ciano de Neurorrehab. (FIVAN)
1
Corresponding author:
José-Antonio Gil-Gómez
Universidad Politécnica de Valencia
Abstracts from CT15
Camino deVera
46020 Valencia (España)
E-mail: jgil@upv.es
abstract
eBaViR is a virtual rehabilitation system, developed for
balance rehabilitation for people with stroke. The system
is composed by three games customized for the rehabili-
tation, and use a low-cost interface (Nintendo Wii Balance
Board). An experimental study was carried out using
eBaViR system. Patients after stroke were divided into
two different groups depending on their score regarding
the BERG scale (Group I: BERG 30-45; Group II: BERG
46-56). At the same time, these two groups were randomly
subdivided into control and treatment groups. The patients
received twenty sessions of one hour, consisting of be-
tween three and five days of rehabilitation per week. The
quantitative measures used in order to evaluate the balance
of the patients were the following – the BERG Balance
Scale, the Brunel Balance Assessment, timed scales, and
a short feedback questionnaire. We are currently finishing
the study and we will have definitive results with conclu-
sions before the deadline of this final paper.
Keywords: Virtual Rehabilitation Therapy,
Wii Balance Board, Stroke, Balance
introduction
Stroke patients are hindered by a high level of postural
control difficulties that have an impact on daily activities.
Thus, the improvement of the postural control would be
essential for their independence.
The traditional rehabilitation applied to patients with
stroke includes a balance rehabilitation therapy. However,
with the development of new, innovative technologies the
Virtual Motor Rehabilitation (VMR) presents an interest-
ing complement for this type of traditional therapy.
In this study we evaluate a Virtual Rehabilitation system
that uses the Nintendo Wii Balance Board (WBB). This
system is the first of its kind and uses a unique interface.
The rehabilitation with eBaViR takes place using three
games specifically designed with the help of experts in the
rehabilitation of balance disorders. The game-based
scheme is used in the system in order to increase the pa-
tients’ motivation. In fact, since the motivation is a crucial
characteristic of the rehabilitation effectiveness, by intro-
ducing the game scheme the patient would enjoy the vir-
tual rehabilitation sessions more than the traditional
rehabilitation sessions.
JCR
Abstracts from CT15
Figure 1. Screenshots of
the eVaBiR system.
methods
The eBaViR system includes three virtual and interactive
games (Figure 1). The user interacts with the system
through the WBB by moving his/her body. This set-up
leads the patient to execute exercises designed to improve
balance control.
More specifically, the patient is located on the platform,
standing or seating, and controls the game by displacing
his/her center of mass.
The parameters of the games, such as size or speed of the
elements, can be parameterized in order to adapt to the dif-
ficulty level needed for the patients. Moreover, the sensi-
tivity of the WBB is automatically adjusted to the patients’
limitations. The physiotherapist can program in the virtual
rehabilitation system the duration of both the activity dur-
ing the game and the time break and the hardware is com-
posed of a standard PC and the WBB.
Forty patients participated in this study. The participants
had no previous experience with any virtual reality sys-
tems. All the participants did not display any balance dis-
order symptoms before their first stroke, and their age
ranged from 18 to 70 years old. The evaluation was a two-
group comparison in which participants were divided ac-
cording to their BERG scale score (i.e. a group of
participants with fall risk and a group of participants with-
out fall risk). These two groups were then randomly sub-
divided in a control and a treatment groups. Twenty
one-hour sessions were held and the subjects participated
three to five rehabilitation sessions per week.
The patients’ balance was evaluated using the following
quantitative measures – ordinal scales, timed scales, and
a feedback questionnaire completed by both the patients
JCR
141
and the physiologists. The measures were collected in the
following periods of time – 15 days before starting the re-
habilitation (T-15), at the beginning of the rehabilitation
(T0), at the end of the rehabilitation (T20), and 15 days
after the end of the rehabilitation (T20+15).
results and Conclusions
We are currently finishing a final quantitative analysis of
the results obtained during the rehabilitation training. By
comparing the improvement of the balance control in both
groups (control and treatment) we will be able to confirm
our assumptions that the eBaViR system is an adapted and
efficient tool for balance disorders rehabilitation. In that
case, we will adapt the eBaViR system in order to allow
the patients to use it in a more comfortable environment
such as in their own home.
––––––––––––––––––––––––––––––––––––––––––––––
assessment of the emotional responses produced by
exposure to real food, Virtual food and photographs
of food in patients affected by eating disorders
Alessandra Gorinia,1, Anna Petrovab
and Giuseppe Rivac
a
Applied Technology for Neuro-Psychology Laboratory,
Istituto Auxologico Italiano IRCSS, Milano, Italy
b
Faculty of Psychology, Moscow State University,
Moscow, Russia
c
Faculty of Psychology, Università Cattolica del Sacro
Cuore, Milan, Italy
1
Corresponding author:
Alessandra Gorinia
Istituto Auxologico Italiano
Via Pelizza da Volpedo, 41
20143 Milano, Italy
Tel: +39 348 8031129
E-mail: alessandra.gorini@gmail.com
abstract
This paper investigates the efficacy of high-calorie virtual
food to induce emotional reactions in patients affected by
eating disorders (ED). Twenty ED patients and 10 controls
were randomly exposed to three experimental conditions–
real food, photographs of food, and virtual food while their
psychological and physiological anxiety was recorded.
Results show that, as expected, real food, as well as virtual
food and photographs of food, provoked anxiety only in
ED patients but not in the control subjects. More interest-
142
ingly, in the ED groups, real and virtual foods induced
greater anxiety than photographic materials.
Keywords: Virtual Reality, Virtual Food,
Anorexia Nervosa, Bulimia Nervosa
introduction
Many researchers and clinicians have proposed using vir-
tual reality (VR) in adjunct to in-vivo exposure therapy to
provide an innovative form of exposure for patients suf-
fering from different psychological disorders. The ration-
ale behind the “virtual approach” is that real and virtual
exposures elicit a comparable emotional reaction in sub-
jects, even if, up to date, there are no experimental data
that directly compare these two conditions. To test if vir-
tual stimuli are as effective as real stimuli and more effec-
tive than photographs in inducing anxiety, we tested the
emotional reactions to real food (RF), virtual foods (VR)
and photographs (PH) of food in two samples of patients
affected, respectively, by anorexia (AN) and bulimia ner-
vosa (BN), and in a group of healthy volunteers (CTR).
The two main hypotheses were the following: (a) If VR
produces emotional responses similar to those induced by
RF, psychological and physiological anxiety will increase
both in the RF and VR conditions in ED patients, but not
in the CTR group; (b) Being that the VR condition is more
immersive and more ecological than the photograph con-
dition, the first one will be more effective than the latter
in eliciting subjects’ emotional reactions.
methods
Ten AN, 10 BN and 10 CTR were randomly exposed to
three experimental conditions–RF, PH, and VR while their
psychological (STAI-S, VAS-A) and physiological (heart
rate, respiration rate, and skin conductance) responses
were recorded. In the RF condition six real high-calorie
foods (three savory and three sweet) (Fig. 1) were pre-
sented to the subject on a table for 30 seconds each with a
pause of 30 seconds between each item. During the pause,
all foods were covered with six red plastic lids. In the PH
condition a Powerpoint presentation including photo-
graphs of the same six foods presented in the RF condition
was presented on a computer screen. The presentation
time and the interval between the different pictures were
the same used in the RF condition. During the 30-second
pauses, a picture of the red lid covering a hidden food ap-
peared on the screen. Finally, in the VR condition subjects
were asked to wear a Head Mounted Display (HMD) in
order to have a three-dimensional view of the virtual en-
vironment. The motion-tracker included in the HMD and
Abstracts from CT15
a joystick allowed them to explore the environment and
to interact with the virtual food. The environment repre-
sented a small restaurant with a buffet table in it (the vir-
tual restaurant is included in NeuroVR, the free, open
source software available at: www.neurovr.org). The same
six foods presented in the RF and PH conditions appeared
on the restaurant table covered by six red lids (Fig. 2).
Subjects were asked to explore the environment and to
virtually open the lids one by one as it happened in the
two other conditions. Before each of the three conditions
there was a three-minute baseline during which subjects
sat in front of the table (or in front of the computer screen)
and were asked to stay relaxed while their physiological
parameters were recorded. Afterwards, the session started
and heart rate, skin conductance and respiration rate were
continuously recorded until the end of the task.
Figures 1 and 2.
results
When exposed to real food, photographs of food and vir-
tual food, only ED patients showed a significant increase
in the STAI-S questionnaire, VAS-A, HR and SCR com-
pared to the baseline. On the contrary, no differences were
found between the baseline and the three experimental
conditions in the CTR group.
Analyzing the within-subjects effects in the AN and BN
groups we found that:
- In the AN group, STAI-S, VAS-A, HR and SCR values
were higher in the RF (STAI-S: t = 3.10, p = 0.024; VAS-
A: t = 5.13, p = 0.012; HR: t = 2.56, p = 0.030; SCR: t =
6.92, p = 0.000) and in the VR conditions (STAI-S: t =
4.21, p = 0.015; VAS-A: t = 3.79, p = 0.019; HR: t = 2.22,
p = 0.048; SCR: t = 4.02, p = 0.010) than in the PH con-
dition;
- In the BN group, VAS-A, HR and SCR values were
higher in the RF (STAI-S: t = 2.86, p = 0.34; VAS-A: t =
5.13, p = 0.001; HR: t = 3.25, p = 0.034; SCR: t = 4.98, p
= 0.012) and in the VR conditions (STAI-S: t = 2.56, p =
0.032; VAS-A: t = 3.01, p = 0.028; HR: t = 2.80, p = 0.030;
SCR: t = 2.52, p = 0.032) than in the PH condition;
- No effects on the respiration rate were found in the two
groups.
JCR
Abstracts from CT15
Regarding the CTR group, no within-subjects differences
were found in the level of psychological and physiological
anxiety experienced in the three conditions (anxiety was
low in all of them).
Conclusions
All three conditions provoked anxiety in ED patients, but
not in the CTR subjects. More interestingly, RF and VR
induced a comparable level of anxiety in patients that was
higher than the one elicited by the PH condition. Even
though these data are still preliminary, due to the small
number of subjects, they suggest the potential of VR in a
variety of experimental, training and clinical contexts, il-
lustrating its range of possibilities is extremely wide and
customizable. In particular, in a psychological perspective
based on a cognitive-behavioral approach compared to
real exposure, the use of VR facilitates the provision of
specific contexts to help patients cope with their diseases
through a very controlled stimulation.
references
Ferrer-Garcia M, Gutierrez-Maldonado J, Caqueo-Urizar
A, Moreno E: The Validity of Virtual Environments for
Eliciting Emotional Responses in Patients With Eating
Disorders and in Controls. Behavior Modification 2009,
33:830-854.
Gutierrez-Maldonado J, Ferrer-Garcia M, Caqueo-Urizar
A, Letosa-Porta A: Assessment of emotional reactivity
produced by exposure to virtual environments in patients
with eating disorders. Cyberpsychol Behav 2006, 9:507-
513.
Lozano JA, Alcaniz M, Gil JA, Moserrat C, Juan MC,
Grau V, Varvaro H: Virtual food in virtual environments
for the treatment of eating disorders. Stud Health Technol
Inform 2002, 85:268-273.
Riva G, Gaggioli A, Villani D, Preziosa A, Morganti F,
Corsi R, Faletti G, Vezzadini L: NeuroVR: an open source
virtual reality platform for clinical psychology and behav-
ioral neurosciences. Stud Health Technol Inform 2007,
125:394-399.
––––––––––––––––––––––––––––––––––––––––––––––
presence, involvement and efficacy of a
Virtual reality intervention on pain
Jose Gutierrez-Maldonadoa,1, Olga Gutierrez-Martineza,
Desiree Loretoa, Claudia Penalozaa & Ruben Nietob
JCR
143
University of Barcelona, Spain
a
b
Universitat Oberta de Catalunya, Spain
1
Corresponding author:
Jose Gutierrez-Maldonado
Department of Personality, Assessment and
Psychological Treatments
University of Barcelona
Paseo Valle de Hebrón, 171
08035, Barcelona, Spain
E-mail: jgutierrezm@ub.edu
abstract
We explored the impact of an interactive VR environment
on pain cognitions (in vivo catastrophizing and pain self-
efficacy) and pain-related measures: pain threshold, pain
tolerance, Pain Sensitivity Range (PSR), pain intensity and
time estimation in a sample of healthy students. Sense of
presence is essential to conduct a psychological treatment;
if patients are not able to involve themselves in a virtual
world they cannot experience relevant emotions, and the
desired processes that are necessary for most psychologi-
cal treatments will not occur. However, some authors
argue that presence must be distinguished from the degree
of engagement, involvement in the portrayed environ-
ment. The results obtained in our study are consistent with
this view, since the Involvement scale of the IPQ did not
correlate with any of the measures related with the treat-
ment's efficacy.
Keywords: Virtual Reality, Presence, Involvement, Pain.
introduction
The use of virtual reality (VR) for pain management is a
relatively new approach that has been proved useful with
specific populations and acute medical procedures
(Mahrer & Gold, 2009). The efficacy of this technique
for pain reduction has been attributed to attentional dis-
traction. In fact, to be processed pain needs attention.
Therefore, if attention is distracted, it could be hypothe-
sized that pain would be perceived with less intensity.
Other alternative would be to explore the use of this tech-
nology to change cognitions associated with pain adjust-
ment in chronic pain patients. Although therapeutic
mechanisms underlying the process of the pain patients’
improvement in VR, besides its attention diversion ef-
fects, are posited to be changes in patient cognitions and
behaviours, little research has systematically tested this.
Both clinical studies conducted with patients receiving
painful medical procedures (Konstantatos, Angliss,
144
Costello, Cleland, & Stafrace, 2009; Hoffman et al.,
2008) and laboratory-induced pain studies with healthy
populations (Hoffman et al., 2006; Rutter, Dahlquist &
Weiss, 2009) have explored the changes that VR produces
on pain-related measures such as the perceived pain in-
tensity, pain threshold and pain tolerance, yet little is
known about VR effects on cognitive variables associated
with pain. Specifically, two important cognitions that
have accumulated evidence of this relation with pain ad-
justment are catastrophizing and sel-efficacy. There is
growing evidence suggesting that especially catastrophiz-
ing and self-efficacy for pain management mediate some
of the relationships between pain and adjustment (Brekke,
Hjortdahl, & Kvien, 2003; Jensen, Turner, Romano, &
Karoly, 1991; Keefe, Rumble, Scipio, Giordano & Perri,
2004; Turner, Holtzman, & Mancl, 2007; Sullivan et al.,
2001). Our research group is working to test if a VR
experience specifically designed to modify catastrophiz-
ing and pain self-efficacy in a controlled laboratory en-
vironment can be developed. Given the importance of
these two constructs, it is interesting to explore if VR can
have an effect changing these two kinds of cognitions. If
this is the case, this could be a strategy to use VR for
chronic pain patients. In fact, results obtained recently in
our laboratory show that this is possible. We explored the
impact of an interactive VR environment on pain cogni-
tions (in vivo catastrophizing and pain self-efficacy) and
pain-related measures: pain threshold, pain tolerance,
Pain Sensitivity Range (PSR), pain intensity and time es-
timation in a sample of healthy students. The virtual en-
vironment consisted of a stereoscopic figure that appeared
in the center of the screen with a black background, to
test the hypothesis that the experience of control over the
parameters that defined the virtual geometric figure that
represents the pain, would be transferred to the expecta-
tion of control that the subject has over a painful experi-
ence. The initial figure and the sound represented an
unpleasant pain sensation. The figure and the sound could
be manipulated in the virtual environment so it could
gradually be converted into a pleasant and quiet environ-
ment (analogue to a situation of no pain). This VR expe-
rience showed to decrease pain cognitions and to increase
pain threshold, pain tolerance and PSR in a cold-pressor
task. Moreover, VR reduced the subjective ratings of the
duration of the task (Gutierrez-Maldonado, Gutierrez-
Martinez, Loreto, & Nieto).
There are several factors that modulate the effect of any
VR intervention. In this presentation we will offer some
data regarding the contribution to the efficacy of our VR
Abstracts from CT15
intervention on pain of one of the most important of those
intermediary variables: presence.
One of the core features in VR treatment of psychological
disorders is the sense of presence. The term “sense of pres-
ence” is used to describe the illusion of “being there” in a
virtual environment. One of the most important conse-
quences of this illusion is that a virtual environment can
evoke the same reactions and emotions as the experience
of a similar real-world situation (Hodges et al., 1994). This
implies that sense of presence is essential to conduct a psy-
chological treatment; if patients are not able to involve
themselves in a virtual world they cannot experience rel-
evant emotions, and the desired processes of habituation
and extinction that are necessary for most psychological
treatments will not occur. Although there is no generally
accepted definition of presence, and in spite of the diffi-
culties involved in its measurement, most researchers
agree to define it as a multicomponent construct. Thus,
some factor analysis studies (Schubert, Friedmann, & Re-
genbrecht, 2006; Lessiter, Freeman, Keogh, & Davidoff,
2001). suggest a multidimensional structure for presence
based on three factors: Sense of Physical Space (the sense
of being located in a contiguous spatial environment), En-
gagement/Involvement (attention devoted to the virtual
environment) and Ecological Validity/Realism (the partic-
ipant’s sense of believability and realism of the content).
However, some authors argue that presence must be dis-
tinguished from the degree of engagement or involvement
in the portrayed environment (Slater, Lotto, Arnold, &
Sanchez-Vives, 2009). Presence and involvement may be-
long to different logical levels. One can be present but not
involved, as in many situations in everyday life. Listening
to some quadrophonically broadcast music you might feel
like being in the theatre listening to the orchestra but with-
out any interest for the music itself. This is high presence,
low involvement (or interest). On the other side, one can
be involved but not present (e.g., watching a soap opera
on TV) (Slater, Lotto, Arnold, & Sanchez-Vives, 2009).
method
In order to explore the contribution of presence to the ef-
fect of our VR intervention on pain, the ratings of presence
were measured by means of IPQ (Igroup Presence Ques-
tionnaire; Schubert, Friedmann & Regenbrecht, 2001) in
a sample of 45 healthy participants who underwent two
consecutive cold pressor trials, one using VR and one
without VR exposure, in counterbalanced order. The VR
intervention encouraged participants to actively search the
correspondence between the experienced pain and a VR
JCR
Abstracts from CT15
stereoscopic figure, which could be interactively manipu-
lated with the mouse. IPQ contains three subscales, as-
sessing involvement (awareness of the VE), spatial
presence (relation between the VE and the subject’s own
body) and realness (sense of reality attributed to the VE).
It also contains a general item that assesses the “sense of
being here.” Since the environment used in the current
study was not a simulation of a “real” world, items of the
realness factor were removed.
results
Presence, as measured by the IPQ, obtained medium rat-
ings (sense of being, mean = 2.40, SD = 1.66; spatial pres-
ence, mean = 2.78, SD = 1.25; involvement, mean = 2.42,
SD = 1.34; total, mean = 2.60, SD = 1.17). Concerning
the item that assessed the general "sense of being there",
46.67% of participants reported moderate or higher rat-
ings. The relationship between the IPQ subscales and the
different measures used was investigated using Pearson
product-moment correlation coefficients. The amount of
VR “spatial presence” reported correlated significantly
and positively with threshold and tolerance, and negatively
with ratings of most pain intensity, time estimation, and
catastrophizing. A similar pattern of correlations was
found for the single item of “sense of being there.” No sig-
nificant correlations were found with the “involvement”
subscale.
Conclusions
Since the Involvement scale of the IPQ did not correlate
with any of the measures related with the treatment's ef-
ficacy, these results indicate that the relationship between
involvement and treatment's efficacy may not be the
same as the one between presence and treatment's effi-
cacy. The questions of whether or how involvement is
JCR
145
related to the sense of presence have interested many re-
searchers, and some of them (Slater, Lotto, Arnold, &
Sanchez-Vives, 2009) claim that presence is a response
to media form while involvement is a response to media
content, throwing an interesting twist into the general as-
sumption about the relationship between presence and
involvement. In fact, some studies (Kurita, 2005) have
found that involvement may not necessarily be a dimen-
sion of presence.
references
Brekke, M., Hjortdahl, P., & Kvien, T. Changes in self-ef-
ficacy and health status over 5 years: A longitudinal ob-
servational study of 306 patients with rheumatoid arthritis.
Arthritis & Rheumatism 49 (2003), 342-348.
Gutierrez-Maldonado, J. Gutierrez-Martinez, J., Loreto,
D., & Nieto, R. The use of virtual reality for coping with
pain: an experimental test with healthy participants. Sub-
mitted
Hodges, L., Rothbaum, B.O., Kooper, R., Opdyke, D.,
Meyer, T., de Graaf, J.J., &Williford J.S. Presence as the
defining factor in a VR application. Georgia Institute of
Technology (1994).
Hoffman, H.G., Seibel, E.J., Richards, T.L., Furness, T.A.,
Patterson, D.R. & Sharar, S.R.. Virtual reality helmet dis-
play quality influences the magnitude of virtual reality
analgesia. The Journal of Pain 7 (2006), 843-850.
Hoffman, H.G., Patterson, D.R., Seibel, E.J., Soltani, M.,
Jewett-Leahy, L., & Sharar, S.R. Virtual reality pain con-
trol during burn wound debridement in the hydrotank.
Clinical Journal of Pain 24 (2008), 299-304.
Jensen, M.P., Turner, J.A., Romano, J.M., & Karoly, P.
Coping with chronic pain: a critical review of literature.
Pain 47 (1991), 249-283.
Keefe, F.J., Rumble, M.E., Scipio, C.D., Giordano, L.A.,
& Perri, L.M.. Psychological aspects of persistent pain:
current state of the science. The Journal of Pain 5 (2004),
195-211.
Konstantatos, A.H., Angliss, M., Costello, V., Cleland, H.,
& Stafrace, S., Predicting the effectiveness of virtual re-
ality relaxation on pain and anxiety when added to PCA
morphine in patients having burns dressings changes.
Burns 35 (2009), 491-499.
146
Kurita, S. Presence and time estimation. A comparison be-
tween the relative and the absolute value approaches.
Paper presented at the 55rd annual conference of the In-
ternational Communication Association, New York, USA
(2005)
Lessiter, J. Freeman, J., Keogh, E., & J. Davidoff, J. A
Cross-Media Presence Questionnaire: The ITC-Sense of
Presence Inventory. Presence 10(3) (2001), 282-297
Mahrer, N.E. & Gold, J.I.. The use of virtual reality for
pain control: a review. Current Pain and Headache Reports
13 (2009), 100-109.
Rutter, C.E., Dahlquist, L.M., & Weiss, K. Sustained effi-
cacy of virtual reality distraction. The Journal of Pain 10
(2009), 391-397.
Schubert, T., Friedmann, F., & Regenbrecht, H. The ex-
perience of presence: Factor analytic insights. Presence:
Teleoperators and virtual environments 10(3) (2006), 266-
281.
Slater, M., Lotto, B., Arnold, M.M., & Sanchez-Vives.,
M.V. How we experience immersive virtual environments:
the concept of presence and its measurement. Anuario de
Psicología 40(2) (2009), 193-210
Sullivan, M., Thorn, B., Haythornthwaite, J., Keefe, F.,
Martin, M., Bradley, L., & Lefebvre, J. Theoretical per-
spectives on the relation between catastrophizing and pain.
Clinical Journal of Pain 17 (2001), 52-64.
Turner, J.A., Holtzman, S., & Mancl, L. Mediators, mod-
erators and predictors of therapeutic change in cognitive-
behavioral therapy for chronic pain. Pain 127 (2007),
276-286.
––––––––––––––––––––––––––––––––––––––––––––––
The use of Virtual reality for a
human Classical Conditioning procedure
Olga Gutiérrez-Martineza, 1, Jose Gutierrez-Maldonadoa,
and Desirée Loretoa
University of Barcelona, Spain
a
Corresponding author:
1
Olga Gutiérrez-Martínez
University of Barcelona
Absracts from CT15
Paseo Vall d’Hebron, 171
Facultad de Psicología
08035 Barcelona, Spain
E-mail: olgagutierrez@ub.edu.
abstract
The present study investigated the use of a Virtual Reality
(VR) stereoscopic figure as a conditioned stimulus (CS).
A differential conditioning procedure was applied to 67
students (mean age 22.75), where a VR stereoscopic figure
(CS+) was paired with electric shock and another VR
stereoscopic figure (CS−) was presented without shock.
Evaluative measures (valence and arousal scales) were
taken. Results showed that, after acquisition, the reported
arousal and negative valence for CS+ was higher than for
CS−. The use of VR stereoscopic figures as CSs seems
feasible to design innovative experimental paradigms.
Keywords: Virtual reality, Classical conditioning
introduction
Classical conditioning studies are very useful for experi-
mental research on fears and phobias and exposure-based
techniques. The application of VR technology to exposure
treatments has proved to be effective (Cote & Bouchard,
2008) but major questions regarding fear conditioning in
virtual reality environments remain relatively unexplored.
Although VR has been successfully applied to demon-
strate a general context conditioning to a virtual room
where colored panels functioned as explicit conditioned
stimuli (CS) (Baas, Nugent, Lissek, Pine, & Grillon, 2004)
the use of VR stimuli as CSs has been scarcely studied.
Therefore, the present study is novel in that it aims to elicit
fear conditioning using VR stereoscopic figures as CSs.
method
stimuli and apparatus
The virtual reality environment was adapted from a study
on VR to cope with pain conducted with the authors’ re-
search team and consisted of a stereoscopic figure pre-
sented via two BARCO ID R600 projectors onto a 2.43 x
1.82 m. screen. The CS+ consisted of an eight-second
presentation of an irregular sharp-edge polygon, mainly
in warm colors – yellow and red – which was presented
together with an unpleasant sound (600 Hz; 80 dB). The
CS− consisted of an eight-second presentation of a spher-
ical shape, mainly composed of cool colors – blue and
white – with a certain resemblance to natural scenery, and
combined with a quieter sound. Electric shocks were used
as unconditional stimulation (UCS).
JCR
Abstracts from CT15
procedure
Prior to conditioning trials, participants (n=67) were asked
to make ratings of the CS+, the CS− and two control stim-
uli (C1, C2) on two 21-point scales – arousal (-100 = very
calm; +100 = very aroused) and valence (-100 = very
pleasant; +100 = very unpleasant). Then, an aversive dif-
ferential delay conditioning procedure was applied. There
were 10 presentations of the CS+ followed by the shock
and 10 presentations of the CS− alone. Next, participants
again rated CS+, CS−, C1 and C2 on the arousal and va-
lence scales.
results
Mean arousal scores for CS+, CS−, and the two control
stimuli at the beginning and at the end of the experiment
are presented in Figure 1. After acquisition, the CS+ was
rated as more arousing than at the beginning of the exper-
iment, t (66) = -10.54, p <.001 Since pain-relevant stimuli
were used as CSs, differences between Cs+ and Cs− were
found at the beginning of the experiment. However, these
differences were much larger after acquisition. Thus, dif-
ferences between CS+ and CS− at the end of the experi-
ment remain significant after adjusting the pre-acquisition
differences, F (1, 65) = 137.47, p <.001, η2 = .68. The pat-
tern of results was the same for the valence scores. For
control stimuli no pre-post shifts were found.
Figure 1. Mean arousal scores for CS+, CS−, C1, C2
before (Pre) and after (Post) conditioning.
discussion
This study is the first showing that a VR stereoscopic CS+
can elicit self-reported arousal and valence responses. Al-
though future studies should replicate these findings with
physiological measures, these preliminary findings justify
further efforts to advance the use of VR in conditioning
experiments.
references
Baas, J.M., Nugent, M., Lissek, S., Pine, D.S., Grillon, C.,
JCR
147
Fear conditioning in virtual reality contexts: a new tool for
the study of anxiety. Biological Psychiatry 55 (2004),
1056-1060.
Cote, S. Bouchard, S., Virtual reality exposure’s efficacy
in the treatment of specific phobias. Journal of Cyberther-
apy and Rehabilitation 1 (2008), 75-91.
––––––––––––––––––––––––––––––––––––––––––––––
The illusion of presence influences Vr distraction:
effects on Cold-pressor pain
Olga Gutiérrez-Martineza, José Gutierrez-Maldonadoa,1,
Kattia Cabas-Hoyosa, and Desirée Loretoa
a
University of Barcelona, Spain
1
Corresponding author:
José Gutiérrez-Maldonado
University of Barcelona
Paseo Vall d’Hebron, 171
Facultad de Psicología
08035 Barcelona, Spain
E-mail: josegutierrezm@ub.edu
abstract
This study investigated whether Virtual Reality (VR)
presence influences how effectively VR distraction re-
duces pain intensity during a cold-pressor experience.
Thirty-seven healthy students (mean age 23.8) under-
went a cold pressor task while interacting with a VR dis-
traction world. After the VR cold-pressor experience,
each subject provided VAS ratings of the most intense
pain experienced during the hand immersion and rated
their illusion of having been inside the virtual world. Re-
sults showed that the amount of VR presence reported
correlated significantly and negatively with ratings of
pain intensity. The importance of using an appropriately
designed VR system to achieve effective VR analgesia
is highlighted.
Keywords: Virtual Reality, Presence, Distraction
introduction
Researchers have recently proved that the magnitude of
Virtual Reality (VR) analgesia is related with VR presence
levels reported by participants exposed to controlled ther-
mal pain stimulation (Hoffman et al., 2006; Hoffman et
al., 2004). However, a possible weakness of both studies
using a 30-second heat pain stimulus is that VR exposure
148
time and pain stimulation duration were brief. Other lab-
oratory-induced pain paradigm that allows administering
longer painful stimulation is cold-pressor. Besides, this
procedure is suggested to mimic the effects of chronic
conditions effectively because of its unpleasantness and it
has excellent reliability and validity (Edens & Gil, 1995).
The aim of this study is to explore whether the illusion of
VR presence influences how effectively VR reduces cold-
pressor pain.
method
Vr intervention and equipment
The VR intervention consisted of a stereoscopic environ-
ment named “Surreal World” that involves attention-di-
version techniques. It was presented via two BARCO ID
R600 projectors onto a 2.43 by1.82 meter Maxwell polar-
ized screen. The "Surreal World" is a virtual environment
with auditory and visual inputs based on art images de-
signed to surprise the participant with unreal objects that
challenge the laws of physics. These features and the in-
teractive nature of the experience enable the environment
to attract and maintain participants’ attention, leaving less
attentional resources available to focus on pain. Figure 1
shows two snapshots of what subjects saw in the “Surreal
World.”
Figure 1. Two snapshots of what subjects saw in the
“Surreal World.”
design and procedures
The present study was part of a larger research project that
required a within-subjects experimental design. Subjects
participated in two consecutive cold-pressor trials, one
using VR and one without. During the VR condition, the
participants interacted with the VR environment using the
mouse with their dominant hand, while immersing their
nondominant hand in the cold-pressor.
Instructions and procedures for the cold-pressor task were
as usual. Subjects were asked to keep their hand immersed
for as long as possible, but were instructed that they could
Abstracts from CT15
withdraw at any time. The immersion was limited to five-
minute duration, but subjects were not informed of that
time limit. Once the participant decided to remove their
hand from the water, he/she was asked to complete a VAS
rating of the most intense pain experienced during the
hand immersion. Also, a VR presence measure adapted
from Slater, Usoh, and Steed (1994) was administered.
Other measures for other research purposes not reported
here were provided.
results
VR distraction decreased levels of pain intensity by an av-
erage of 51%, across male and female students. The rat-
ings of VR presence were medium (mean = 3.57, SD =
1.66, range 0-6). The relationship between VR presence
and the intensity of pain in VR was investigated using
Pearson product-moment correlation coefficients. The
amount of VR presence reported correlated significantly
and negatively with ratings of most pain intensity, r (37)
= -.37, p < .05.
discussion
Levels of VR presence were associated with lower inten-
sity pain during a VR cold-pressor trial. These results are
consistent with previous studies (Hoffman et al., 2006;
Hoffman et al., 2004) showing that VR presence influ-
ences VR analgesia when a brief thermal pain stimulus
was administered. Future studies concerning the condi-
tions that maximize VR presence seem crucial to design
VR systems that increase analgesic effectiveness for pa-
tients.
references
Edens, J.L., Gil, K.M., Experimental induction of pain:
Utility in the study of clinical pain. Behavior Therapy 26
(1995), 197-216
Hoffman, H.G., Sharar, S.R., Coda, B., Everett, J.J., Ciol,
M., Richards, T., Patterson, D.R., Manipulating presence
influences the magnitude of virtual reality analgesia. Pain
11 (2004), 162-168.
Hoffman, H.G., Seibel, E.J., Richards, T.L., Furness, T.A.,
Patterson, D.R., Sharar, S.R., Virtual reality helmet display
quality influences the magnitude of virtual reality analge-
sia. The Journal of Pain 7 (2006), 843-850.
Slater, M., Usoh, M., Steed, A., Depth of presence in im-
mersive virtual environments. Presence Teleoperator Vir-
tual Environment 6 (1994), 130-144.
JCR
Abstracts from CT15
––––––––––––––––––––––––––––––––––––––––––––––
The effects of augmented reality on learning
Kuei-Fang Hsiaoa,1
a
Deptartment of Information Management, Ming-Chuan
University, Taiwan
1
Corresponding author:
Kuei-Fang Hsiao
Deptartment of Information Management
Ming-Chuan University, No. 5
Teh-Ming Rd., Gwei-Shan
Taoyuan County 333, Taiwan
E-mail: kfhsiao@mail.mcu.edu.tw
abstract
In this study, a new approach to the implementation of AR
in the educational environment was taken by creating a
Chemistry Augmented Reality Learning System
(CARLS), using the existing teaching curriculum, together
with physical activity. This system combined learning with
three types of physical activity – aerobic fitness, muscle
strength and flexibility fitness. This study reveals that the
students using all three types of physical activity together
with CARLS result in significantly higher academic per-
formance compared to the traditional Keyboard-Mouse
CAI (KMCAI). The improvement is most evident for the
non-memorized knowledge component of science. More-
over, the students in the AR group with the "muscle
strength" physical activity had a significantly higher pos-
itive learning attitude change toward science than those in
the KMCAI group. A great additional benefit of our ap-
proach is that students also obtained more physical fitness
while learning. Finally, a comprehensive investigation of
this research reveals that students with an average of four
to five hours of weekly computer use time showed a better
academic performance among all students.
Keywords: Augmented Reality,
Physical Activity, Learning
introduction
Adolescent health concerns have been the subject of many
recent studies as the typical amount of time spent on phys-
ical exercise has decreased, whilst the time spent on com-
puters has increased. A recent national survey in Taiwan
revealed that adolescent students spent too much time on
computers and this resulted in negative impacts on their
JCR
149
daily life routines and health condition (Chou & Peng,
2007). However, it is not clear that increased computer-
related activity always has negative health consequences.
A recent study reported that some computer game players
are fitter than the general population in the U.S. like one
of the popular online games, MMO EQ2. for example
(Williams, Yee, & Caplan, 2008).
Given that computer use will become a lifestyle choice by
adolescents later in life, it would seem beneficial to ex-
plore new ways to utilize computers to assist in learning
and recreation, while avoiding the risk of negative health
effects. Moreover, given the need to increase physical ac-
tivity for health reasons, it is interesting to determine if
there is a link with learning ability. This study describes
new findings that indicate a strong link between increased
physical activity and learning ability.
methods
Augmented Reality (AR) technology is being applied in
an increasingly large range of applications for improved
educational efficiency. In this study, a new approach to the
implementation of AR in the educational environment was
taken by creating a Chemistry Augmented Reality Learn-
ing System (CARLS), using the existing teaching curricu-
lum, together with physical activity. This system
combined learning with three types of physical activity –
aerobic fitness, muscle strength and flexibility fitness. Stu-
dents (n=673) from five high schools were divided into
four groups. The first three groups used the CARLS learn-
ing system while a control group used a traditional way to
operate the computer – a keyboard and a mouse. We ex-
plored changes in academic achievement as well as atti-
tudes towards learning science resulting from the
implementation of CARLS.
results
This study reveals that the students using all three types
of physical activity together with CARLS resulted in sig-
nificantly higher academic performances compared to the
traditional Keyboard-Mouse CAI (KMCAI). The im-
provement is most evident for the non-memorized knowl-
edge component of science. Moreover, the students in the
AR group using the "muscle strength" physical activity
had significantly higher learning attitude change toward
science than those in the KMCAI group. Finally, compre-
hensive investigation of this research reveals that students
with an average of four to five hours weekly of computer
use had better academic performances among all students.
150
Conclusions
This study provides a new approach to increasing students’
extra physical activity without diminishing students’ aca-
demic performance. In addition, better academic achieve-
ment in non-memorized knowledge of science and a more
positive attitude toward science were also promoted by
using CARLS. In addition, a great benefit of our approach
is that students also obtained physical fitness while learn-
ing. If the school timetable has been constrained, an AR
learning system with a physical activity function, like
CARLS, might provide an alternative solution.
references
Chou, C., H. Peng, H., Net-friends: Adolescents’ attitudes
and experiences vs. teachers’ concerns, Computers in
Human Behavior 23 (2007), 2394–2413.
Williams, D., Yee, N., Caplan, S.E., Who plays, how
much, and why? Debunking the stereotypical gamer pro-
file, Journal of Computer-Mediated Communication 13
(2008), 993–1018.
––––––––––––––––––––––––––––––––––––––––––––––
Combined functional electrical stimulation (fes)
and robotic system for Wrist
rehabiliation after stroke
X. L. Hua, K. Y. Tonga,1, R. Lia, M. Chena, J. J. Xuea,
S. K. Hoa, P. N. Chena
Deptartment of Health Technology and Informatics
a
The Hong Kong Polytechnic University
Corresponding author:
1
K. Y. Tong
Department of Health Technology and Informatics
The Hong Kong Polytechnic University
Hung Hom, Kowloon, Hong Kong
E-mail: K.y.tong@polyu.edu.hk
abstract
Motor recovery after stroke depends on intensive practice
of the affected limb with voluntary efforts. Functional
electrical stimulation (FES) and using rehabilitation robots
are techniques used to assist in post-stroke rehabilitation.
However, FES and rehabilitation robots are still separate
systems currently and their combined training effects on
persons after stroke have not been well studied yet. In this
work, a new combined FES-robot system driven by the
Abstracts from CT15
user’s voluntary movement was developed for wrist joint
training after stroke. In a 20-session wrist training program
assisted with the FES-robot, five subjects with chronic
stroke attended the training and obtained significant motor
improvements (P<0.05) at their elbow, wrist, and hand,
assessed by clinical scores of the Fugl-Meyer Assessment
(FMA), Modified Ashworth Score (MAS), action research
arm test (ARAT), and by co-activation patterns of the re-
lated muscle pairs measured with electromyography
(EMG).
Keywords: Functional Electrical Stimulation,
Rehabilitation Robot, Stroke Rehabilitation
introduction
The extent of the restoration of limb functions after
stroke is highly associated with the intensive practice of
the affected limbs by their own neuromuscular efforts
(Farmer et al., 2004). Functional electrical stimulation
(FES) can stimulate the muscles through electrical cur-
rent, which generates limb movement by activating a
person’s own muscles to restore motor functions and also
evokes sensory feedback during muscle contraction to
the brain to promote motor relearning (Chan, Tong, &
Chung, 2008). Rehabilitation robotic systems can pro-
vide external assistive support to body parts (e.g. limbs),
which help persons to experience limb movements at the
paretic side to improve related sensory-motor functions
during limb movements (Volpe et al., 2004). Currently,
FES and rehabilitation robots are still separate systems.
In comparison with FES, robot systems use a motor to
provide external assistive force – it does not have the
same effect as FES which directly activates a person’s
own motor power from the paretic muscles to generate
the assistive force. However, difficulties also could be
met when using FES to activate groups of muscles with
dynamic limb movements, since electrode size and the
number of FES channels could pose challenges concern-
ing whether the paretic muscle groups could achieve
movements with the desired kinematic qualities, such as
speed and trajectory. It is possible that a combined reha-
bilitation system with both FES and robotic supports
may enhance the training effects by either pure robot or
FES training. In this work we developed a combined
FES-robot system, which may assist wrist rehabilitation
trainings for persons after stroke interactively to their
voluntary residual motor intentions.
methodology
The experimental setup diagram of the FES-robot system
JCR
Abstracts from CT15
is shown in Fig 1. The system could assist wrist training
for persons after stroke continuously and interactively ac-
cording to their voluntary electromyography (EMG) from
the paretic upper limb. A subject would be asked to con-
duct the wrist flexion and extension in a horizontal plane
from -45o (extended position) to 60o (flexed position) to
track a target cursor moving with a speed of 10o/s. During
the tracking, continuous assistance from the robot and the
FES parts would be provided, proportional to the real time
EMG amplitude of the flexor carpi radialis (FCR) in the
flexion phase and extensor carpi radialis (ECR) in the ex-
tension phase.
Figure 1. Experimental setup diagram of
the FES-robot system.
Five subjects with chronic stroke were recruited in a 20-
session wrist training program assisted with the FES-
robot, with a training intensity of 3-5 sessions a week. In
each session there were 14 tracking trials, containing five
cycles of wrist flexion/extension. Clinical scores of the
Fugl-Meyer Assessment (FMA), Modified Ashworth
Score (MAS), and the action research arm test (ARAT)
were assessed before and after the training. EMG signals
from the muscles of FCR, ECR, biceps brachii (BIC), and
triceps brachii (TRI) were recorded during the training.
results
After the FES-robot assisted wrist training, the FMA
(wrist/hand) score were increased from 11.2±4.2 to
19.7±3.7 (P<0.05), the MAS wrist score decreased from
1.8±0.7 to 0.5±0.4 (P<0.05), and the ARAT increased
from 20.1±5.1 to 29.3±6.5 (P<0.05). Improved muscle co-
ordination was found by the decreasing in the muscle co-
contraction phase (Hu, Tong, Song, X. Zheng, & Leung,
2009) between muscle pairs of ECR&FCR, FCR&BIC,
and ECR&BIC (P<0.05).
JCR
151
Conclusions
A novel FES-robot system for post-stroke rehabilitation
on the wrist joint was developed. The FES-robot could
continuously interactive to the voluntary intention of a per-
son after stroke. The FES-robot assisted wrist training in-
troduced a faster recovery process and a better finger
functional recovery than the previous pure robot assisted
wrist training (Hu, Tong, Song, X. Zheng, & Leung,
2009).
references
Chan, M.K. Tong, K.Y., and Chung, K., "Bilateral upper
limb training with functional electric stimulation in pa-
tients with chronic stroke," Neurorehabilitation and Neural
Repair, vol. 23, pp. 357-65, 2008.
Farmer, J., Zhao, X., van Praag, H., Wodtke, K., Gage,
F.H., and Christie, B.R., "Effects of voluntary exercise on
synaptic plasticity and gene expression in the dentate
gyrus of adult mal Sprague-Dawley rats in vivo," Neu-
rosci, vol. 124, pp. 71-79, 2004.
Volpe, B.T., Ferraro, M., Lynch, D., Christos, P., Krol, J.,
Trudell, C., Krebs, H.I., and Hogan, N., "Robotics and
other devices in the treatment of patients recovering from
stroke," Current Atherosclerosis Reports, vol. 6, pp. 314-
319, 2004.
––––––––––––––––––––––––––––––––––––––––––––––
internet delivered images for exposure in specific pho-
bia, design Considerations for self-directed Therapy
Kenneth C. Kirkbya,1, Allison Matthewsa
and Joel Scanlana
a
Psychiatry, University of Tasmania, Australia
1
Corresponding author:
Ken Kirkby
Psychiatry, University of Tasmania
Private Bag 27
Hobart 7000, Australia
E-mail: ken.kirkby@utas.edu.au
abstract
Exposure to phobic stimuli in subjects with specific pho-
bias typically results in increased anxiety, ranging from
mild to severe, followed by gradual habituation. The In-
ternet is a candidate medium for the delivery of phobic
stimuli to phobic subjects, in the form of pictures, video
152
clips or computer animations. Delivery of such images in
home settings warrants careful attention to the range and
time course of anxiety responses elicited, and to tailoring
of progression through hierarchies of images. The agency
of the user is paramount and they need to have the final
say during all stages of exposure as to whether or not to
proceed. We have incorporated solutions to these require-
ments in the design of an Internet-based exposure program
(FEARDROP). This employs a database repository of pic-
tures and videos of phobic stimuli. Images are called up
by the user engaging a tracking circle with their mouse
and following it around the screen. The image fades out if
the circle is not followed, employing a form of "dead
man’s brake." Anxiety responses are measured at intervals
on a visual analogue scale and graphed for the user. Initial
results show substantial habituation to spider pictures
within minutes, with a controlled comparison to video im-
ages in progress.
Keywords: Specific Phobia, Exposure,
Anxiety, Design, Spider
introduction
Exposure to phobic stimuli is a standard component of
treatment of specific phobias. The most common method
of exposure is systematic desensitization using a graded
hierarchy ranging from lower to higher fear-eliciting stim-
uli. Exposure is typically preceded by anticipatory anxiety
and followed by a peak of anxiety that reduces with con-
tinued or repeated exposure, a process referred to as ha-
bituation. This anxiety response can be conveniently
assessed by asking the subject to rate their subjective dis-
tress on a visual analogue scale, at intervals.
The Internet contains many millions of images and men-
tions of phobic stimuli, easily located using a search en-
gine (for example by Googling “spider”) but lacks the
structure, assessments and outcome evaluation that anchor
systematic desensitization. A person undertaking self-ex-
posure and using the Internet to locate images that may
assist this purpose is to an extent taking pot luck and their
responses and outcomes go unreported.
Instructional programs have been developed that guide
participants through the requirements of home-based self
exposure, including formulating self-exposure homework
routines and reinforcing the completion of these actions
(Kenwright, Marks, Gega, & Mataix-Cols, 2004). Virtual
Reality (VR) research delivers exposure to virtual phobic
stimuli but is not as yet generally available for home-based
Abstracts from CT15
exposure (Krijn, Emmelkamp, Olafsson, & Biemond,
2004).
In order to investigate the utility of Internet delivery of
phobic stimuli in the treatment of specific phobias, we
have incorporated the methods of systematic desensitiza-
tion in the design and implementation of an internet pro-
gram for home-based exposure (www.feardrop.com).
method
Presentation of the stimulus. A database repository is used
to store image files, pictures and videos, which are down-
loaded to the user interface and shown in a screen window.
These images may be assigned as individual stages in a
systematic desensitization hierarchy by the investigator,
with optional tailoring algorithms determining progression.
Depending on the choice of images used, stimuli and hier-
archies relevant to diverse phobias may be delivered in this
way. Further, stimuli may be attenuated, realistic, hyper-
realistic, stationary or moving and so forth, essentially any
aspect of a phobic stimulus that can be conveyed by im-
ages, with enabling of sound available as a further option.
Measurement of anxiety. A standard rating, the Subjective
Units of Distress Scale (SUD) (Hope & Heimberg, 1993),
is presented on the screen at intervals for self rating of cur-
rent anxiety level. This is a visual analogue scale, scored
from 0 to 100. The time interval schedule is designated by
the investigator, for example a rating immediately before
exposure begins (designated "anticipatory anxiety"), and
at two-minute intervals during exposure. SUDS scores are
uploaded to the database and graphed for feedback online
to the user after each stage of exposure. The use of re-
peated measures at relatively brief intervals is of particular
interest in Internet delivery since it secures pertinent in-
formation about the treatment process and potential me-
diating outcomes (reduction of SUDS, suggesting
habituation) in short term or "casual" users.
Self-directed exposure. The program has been designed on
the premise that the user has the ability to direct whether
they wish to continue or not at all times. This is achieved
by three features – preview and selection of the image for
the next exposure stage, initiation of exposure by engaging
a tracking circle, and continuation of exposure by follow-
ing the tracking circle.
Each stage in the desensitization hierarchy is selected by
clicking on a thumbnail preview image. The current and
any previously completed stages are presented in a list,
JCR
Hsiao
each with a thumbnail preview so that the user has the op-
tion of repeating a stage or starting the next stage. A
"tracking circle" then appears on the screen. The tracking
circle is a see-through ring, 44 pixels in diameter (approx-
imately 10mm on a fifteen inch monitor). The size of the
circle can be preset by the investigator. When the user
moves the computer mouse over the tracking circle the
program is "engaged" and the phobic stimulus appears,
thus the user initiates exposure. The tracking circle moves
around the screen window, crisscrossing the phobic stim-
ulus on random straight paths. The user is required to fol-
low the tracking circle with the computer mouse and if
they fall more than a set amount behind the circle the pho-
bic stimulus fades. This device serves two purposes.
Firstly, it is an indication of treatment adherence and con-
firms that the user is observing the screen containing the
phobic stimulus. In other words, the stimulus is being de-
livered to the user and not merely their computer. Sec-
ondly, it acts as a safety device. Panic symptoms may be
anticipated in some users and the addition of the tracking
circle means that the phobic stimulus does not remain on
the screen unless continuously called up by the user
through tracking the circle. This is a form of "dead man’s
brake" that senses that the driver/user remains in control
or stops the train/exposure. These methods respect the
agency and autonomy of the user.
Treatment process and outcome measures. An aim of this
approach is to permit continuous process-outcome re-
search within the constraints of online-treatment delivery.
All users register and give informed consent. Session data
including exposure stages, SUDS scores and tracking cir-
cle accuracy are stored in the database for analysis. Ques-
tionnaires are administered online for pre, post, and
follow-up measures of symptom change. Randomization
to different online conditions, such as a comparison of still
versus moving phobic stimuli, can be set up by the inves-
tigator using a research interface.
results
In an online trial of self-directed home-based exposure,
78 high spider-fearful subjects who viewed a still picture
of a single spider for three minutes and completed SUDS
scores every 60 seconds showed the following anxiety re-
sponses. The mean(SD) anticipatory anxiety assessed by
SUDS immediately before exposure to the first spider
image was 35.9(28.3). These ratings rose following expo-
sure to 45.6(28.5) after one minute of exposure, then
showed evidence of habituation, falling to 25.8(26.6) after
three minutes of exposure.
JCR
53
However, adherence rates were low. Of the 220 partici-
pants in this sample who completed the anticipatory
SUDS, on their first attempt the numbers completing
SUDS ratings after one, two and three minutes were 140,
108 and 78, respectively.
Conclusions
Internet delivery of phobic stimuli is a practical proposi-
tion and can be designed to support self-directed expo-
sure, using measures such as those outlined above.
Currently the Internet can only deliver a limited range of
sensory inputs to most users – visual and auditory – and
online phobic stimuli are limited to those which are sym-
bolic, that is they represent but are not the real thing (for
example a video of a spider, not a real spider). Accord-
ingly, therapeutic effects are likely to be circumscribed,
although Internet delivery may play a useful and defin-
able role as a component or step in therapy. However,
with the enhanced precision of stimulus presentation and
the many possible variations in stimulus type, stimulus
timing, and tailoring of progression, enhancement of ef-
ficacy can be rigorously pursued. The Internet also ac-
cesses a segment of the population that has not previously
sought treatment, and such programs may form a useful
step in their pathway of care. As with all Internet inter-
ventions, adherence rates are a key issue (Christensen,
Griffiths, & Farrer, 2009). In principle this can be ad-
dressed systematically in future research, including ran-
domization to different motivational conditions and/or
different exposure tasks.
references
Christensen, H., Griffiths, K.M., Farrer, L., Adherence in
Internet Interventions for Anxiety and Depression: Sys-
tematic Review, J Med Internet Res 11 (2009) 2, e13.
Hope, D.A., Heimberg, R.G., Social Phobia and social
anxiety. In D. H. Barlow (Ed.), Clinical handbook of psy-
chological disorders (pp. 99-136). New York: The Guild-
ford Press, 1993.
Kenwright, M., Marks, I.M., Gega, L., Mataix-Cols, D.,
Computer-aided self-help for phobia/panic via internet at
home: A pilot study, British Journal of Psychiatry 184
(2004). 448-449.
Krijn., M., Emmelkamp, P.M.G., Olafsson, R.P.,
Biemond, R., Virtual reality exposure therapy of anxiety
disorders: A review, Clinical Psychology Review 24
(2004), 259-281.
154
––––––––––––––––––––––––––––––––––––––––––––––
psychophysiological indicators of acute stress disorder
and posttraumatic stress disorder: predictive Value of
peritraumatic dissociation
Dragica Kozaric-Kovacica,1, Andrea JambrosicSakomana
and Tanja Jovanovicb
a
Referral Centre for Stress Related Disorders of the Min-
istry of Health and Social Welfare of the Republic of
Croatia, Department of Psychiatry, University Hospital
Dubrava, Zagreb, Croatia
b
Department of Psychiatry and Behavioral Sciences, Emory
University School of Medicine, Atlanta, GA, U.S.A.
1
Corresponding author:
Dragica Kozaric-Kovacic
University Hospital Dubrava
10 000 Zagreb, Avenija Gojka Suska 6
Zagreb, Croatia
Tel: +385-1-290 26 18
E-mail: dkozaric_kovacic@yahoo.com
abstract
Abstract: Ever since the diagnosis of Acute Stress Disor-
der was introduced to the DSM-IV, research of acute re-
actions and their progression to Posttraumatic Stress
Disorder (PTSD) has increased. Peritraumatic dissociation
was recognized as one of the important predictors for
PTSD in many studies. Psychophysiological studies are
attempting to examine the activation of the autonomic
nervous system in individuals who develop PTSD after
ASD. The aim of this study was to examine the association
of dissociative experiences in ASD, psychophysiological
reactivity within the first month after trauma exposure,
and the development of PTSD and other psychiatric dis-
orders six months after the traumatic event. Standardized
diagnostic procedures based upon psychiatric standardized
interviews and scales were administered. In addition, psy-
chophysiological measures of electromyographic activity,
electrodermal activity, electrocardiogram activity, and res-
piration at baseline and during a startle procedure were
recorded. Results at the first point of measurement have
been analyzed, but are not final. The data from the first
psychophysiological recording, within one month after the
traumatic event, showed that individuals with ASD result-
ing from interpersonal assault trauma exhibited more sim-
ilarities in psychophysiological parameters with PTSD
patients than those individuals with ASD that resulted
from traffic-related trauma.
Abstracts from CT15
Keywords: ASD, PTSD, Psychophysiology,
Peritraumatic Dissociation
introduction
The diagnosis of Acute Stress Disorder (ASD) was intro-
duced to the DSM-IV (American Psychiatric Association,
1994) to emphasize acute stress reactions that could be pre-
dictive of Posttraumatic Stress Disorder (PTSD) (Bryant
& Harvey, 2007). ASD and PTSD share the same diagnos-
tic criteria, except for the time of the occurrence of the
symptoms and their duration, and the requirement for the
dissociative symptoms in ASD. Peritraumatic dissociation
within ASD was recognized as an important predictive fac-
tor for subsequent PTSD ( Koopman, Classen, & Spiegel,
1994; Marmar et al., 1994; Shalev, Peri, Canetti, &
Schreiber, 1996; Harvey & Bryant, 2002; Bremner et al.,
1992; Griffin, Resick, & Mechanic, 1997; Bryant, Harvey,
Dang, & Sackville, 1998), and not as an adaptive coping
mechanism as it was previously regarded (Koopman,
Classen, & Spiegel, 1994). Longitudinal psychophysiolog-
ical studies of ASD have attempted to clarify the questions
regarding autonomic nervous system activation during per-
itraumatic dissociation and its predictive value for PTSD,
but so far have not yielded conclusive results.
Undergoing a traumatic event sets off the a cascade of psy-
chological and biological sequelae, including activation of
sympathetic and parasympathetic nervous systems as an
integral part of the emotional response which can be meas-
ured through different peripheral targets of the body. Phys-
iological changes related to the activation of the autonomic
nervous system are evident in ASD and PTSD (Cacciopo,
Tassinary, & Bernston, 2004; Jovanovic et al., 2009;
Kozarić-Kovačić, & Pivac, 2007; Jovanovic et al., 2009).
One of the explanations of the peritraumatic dissociation
and its association to PTSD relates peritraumatic dissoci-
ation to regulation of the extreme hyper-arousal in the af-
termath of the traumatic event (Nixon & Bryant, 2003).
Results of some of the physiological studies have indi-
cated suppression of autonomic response (sympathetic and
parasympathetic) in individuals who developed high per-
itraumatic dissociation symptoms in the aftermath of
trauma (Griffin, Resick, & Mechanic, 1997).
aim
The aim of this study was to examine the association of
dissociative experiences in ASD, acute psychophysiolog-
ical responses and the development of PTSD and other
psychiatric disorders six months after the traumatic event.
JCR
Abstracts from CT15
Standardized diagnostic procedures based upon psychi-
atric standardized interviews and scales were applied. We
recorded electromyographic (EMG) activity, electroder-
mal activity (EDA), electrocardiogram (ECG) activity, and
respiration at baseline and during a startle procedure.
methods and participants
Forty-six individuals participated who had experienced a
traumatic event (traffic accident and violent attack) and
had subsequent ASD symptoms within one month of the
event. Psychiatric diagnostic procedure as well as basal
physiology and the startle procedure were recorded.
Thirty-five individuals returned for the same procedure
six months later.
The diagnoses of ASD, PTSD and other psychiatric dis-
orders were assessed by administering the Mini Interna-
tional Neuropsychiatric Interview, Croatian version
(MINI) (Lecrubier et al., 2006), Acute Stress Disorder
Structured Interview (ASDI) (Blake, 1990), Clinician Ad-
ministered PTSD Scale (CAPS) (Berstein & Putnam,
1986), CAPS Life Events Checklist C. The Dissociative
Experience Scale (Birmes et al., 2003) and The Peritrau-
matic Dissociative Experiences Questionnaire (Marmar,
Weiss, & Metzler, 1997) were used to evaluate the disso-
ciative experiences. Psychophysiology at baseline and
during auditory startle probe delivery was measured with
the Biopac MP150 system (Biopac Systems, Inc., Aero
Camino, CA). During the baseline phase the participants
were asked to relax for three minutes as the EMG, EDA,
ECG, and respiration data were acquired. The three-
minute resting phase was followed by a startle phase dur-
ing which seven 108dB startle probes were delivered.
Individuals who were diagnosed with PTSD were all on
similar pharmacotherapy consisting of selective serotonin
reuptake inhibitors (SSRI) when records were taken after
six months.
The healthy control group was comprised of 36 individu-
als, age and gender matched to the patient group. The
MINI was administered to this group to exclude psychi-
atric disorders, and the identical psychophysiological ses-
sion was recorded for the controls and the patients.
The study was approved by the Ethics Committee of the
University Hospital Dubrava. The participants entered the
study voluntarily and signed informed consent papers.
exclusion criteria
Exclusion criteria included substance abuse, suicidal behav-
JCR
155
ior, epilepsy, craniocerebral injuries, neurological disorders,
history of a prior psychotic episode, schizophrenia, bipolar
disorder, dementia, mental retardation, sight and/or hearing
impairment, and any major acute or chronic medical illness.
results
The data from the first psychophysiological recording,
within the first month following the traumatic event, were
analyzed. We found that ASD patients in general habitu-
ated to the startle probe to the same degree as healthy con-
trols. However, startle habituation was attenuated in ASD
patients who were victims of interpersonal assault. Skin
conductance levels during the startle phase increased for
ASD patients, but the increase was less pronounced in vic-
tims of interpersonal trauma compared to ASD patients
who survived traffic-related traumas. This result is con-
sistent with increased peritraumatic dissociation during in-
terpersonal trauma.
Basal heart-rate was elevated by approximately five beats
per minute in the ASD patients with interpersonal trauma,
which is consistent with PTSD. However, there were no
differences between ASD and PTSD patients in heart-rate
in response to startle probes.
These results are not final because of the follow-up design
of the study.
Acknowledgments
This research was supported by the Ministry of Science
and Technology of the Republic of Croatia, in the project:
Psychophysiological diagnostics of the stress related dis-
orders (198-0982522-0075).
Conclusion
Psychophysiological parameters can provide better clar-
ification between ASD and PTSD, as well as differentia-
tion between ASD as a result of interpersonal trauma
versus traffic-related trauma. Peritraumatic dissociation
may be more commonly associated with interpersonal
trauma.
references
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tical Manual of Mental Disorders 4th edn. American Psy-
chiatric Association, Washington DC, 1994.
Bernstein, E.M., Putnam, F.W., Development, reliability,
and validity of a dissociation scale, Journal of Nervous
and Mental Disease 174 (1986), 727-735. Birmes, P.,
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Brunet, A., Carreras, D., Ducassé, J.L., Charlet, J.P.,
Lauque, D., Sztulman, H., Schmitt, L., The Predictive
Power of Peritraumatic Dissociation and Acute Stress
Symptoms for Posttraumatic Stress Symptoms: A Three-
Month Prospective Study, Am J Psychiatry 160 (2003),
1337–1339.
Blake, D., Weathers, F., Nagy, L., Kaloupek, D., Klau-
minzer, G., Charney, D., Keane, T., Clinician-Adminis-
tered PTSD Scale (CAPS), National Center for
Post-Traumatic Stress Disorder, Behavioral Science Divi-
sion, Boston, 1990.
Bremner, J.D., Southwick, S., Bret, E., Fontana, A.,
Rosenheck, R., Charney, D.S., Dissociation and posttrau-
matic stress disorder in Vietnam combat veterans, Am J
Psychiatry 149 (1992), 328– 332.
Bryant, R.A., Harvey, A.G., Acute stress disorder: a criti-
cal review of diagnostic issues, Clin Psychol Rev 17
(1997), 757–773.
Bryant, R.A., Harvey, A.G., Dang, S., Sackville, T., As-
sessing acute stress disorder: Psychometric properties of
a structured clinical interview, Psychological Assessment
10 (1998), 215–220.
Cacciopo, J.T., Tassinary, L.G., Bernston, G.G, Handbook
of Psychophysiology. 2nd edn, Cambridge University
Press, Cambridge (MA), 2004.
Griffin, M.G., Resick, P.A., Mechanic, M.B., Objective
Assessment of Peritraumatic Dissociation: Psychophysi-
ological Indicators, Am J Psychiatry, 154 (1997), 1081–
1088.
Harvey, A.G., Bryant, R.A., Acute stress disorder: a syn-
thesis and critique, Psychol Bull 128 (2002), 886–902.
Jovanovic, T., Norrholm, S.D., Jambrošić Sakoman, A.,
Esterajher, S., Kozarić-Kovačić, D., Altered Basal Psy-
chophysiology and Startle Response in Croatian Combat
Veterans with PTSD, International Journal of Psychophys-
iology 71 (2009), 264-268.
Jovanovic, T., Norrholm, S., Fennell, J., Keyes, M., Fial-
los, A., Myers, K., Davis, M., Duncan, E., Posttraumatic
stress disorder may be associated with impaired fear inhi-
bition: Relation to symptom severity, Psychiatry Research
167 (2009), 151-160.
Abstracts from CT15
Koopman, C., Classen, C., Spiegel, D., Predictors of post-
traumatic stress symptoms among survivors of the Oak-
land/Berkeley, Calif, firestorm, Am J Psychiatry 151
(1994), 888–894.
Kozarić-Kovačić, D., Pivac, N., Novel Approaches to the
Diagnosis and Treatment of Posttraumatic Stress Disorder.
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Lecrubier, Y., Weiller, E., Hergueta, T., Amorim, P.,
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R., Sheehan, K.H., Knapp, E., Sheehan, M., Miniinterna-
tional neuropsychiatric Interview (MINI). Croatian ver-
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hrvatski jezik: N. Henigsberg, 2006.
Marmar, C.R., Weiss, D.S., Schlenger, W.E., Fairbank,
J.A., Jordan, B.K., Kulka, R.A., Hough, R.L., Peritrau-
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Marmar, C.R., Weiss, D.S., Metzler, T.J., The peritrau-
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Shalev, A.Y., Peri, T., Canetti, L., Schreiber, S., Predictors
of PTSD in injured trauma survivors: a prospective study,
Am J Psychiatry 153 (1996), 219–225.
––––––––––––––––––––––––––––––––––––––––––––––
using robotics Construction Kits as metacognitive
Tools: a research in an italian primary school
Filippo La Pagliaa,1, Barbara Cacib, Daniele La Barberaa
and Maurizio Cardacib,c
a
Dipartimento di Neuroscienze Cliniche, Università
degli Studi di Palermo, Italy
b
Dipartimento di Psicologia, Università degli Studi di
Palermo, Italy
c
Centro Interdipartimentale di Tecnologie della
Conoscenza, Università degli Studi
di Palermo, Italy
JCR
Abstracts from CT15
1
Corresponding author:
Filippo La Paglia
Dipartimento di Neuroscienze Cliniche
Università di Palermo, Italy
E-mail: filippolapaglia@gmail.com; laban@unipa.it
abstract
The present paper is aimed at analyzing the process of
building and programming robots as a metacognitive tool.
Quantitative data and qualitative observations from a
study using a sample of children attending an Italian pri-
mary school are described in this work. Results showed
that robotics activities may be implemented as a new
metacognitive environment that allows children to moni-
tor themselves and control their learning actions in an au-
tonomous and self-centered way.
Keywords: Educational Robotics,
Metacognition, Learning
introduction
Robotics kits are high tech toys that allow users to build
and program small mobile autonomous robots capable of
interacting with the surrounding physical environment
(Miglino, Lund, & Cardaci, 1999). While learning with
such kits, children first build the robot body and then cre-
ate a program in order to assign it an artificial intelligence
(e.g., create a robot able to move around a maze). Finally,
children test the robot's performance by evaluating its in-
teraction with the physical environment in order to verify
its success/failure. The final test is quite important because
users can instantaneously see the outcome of what they
have planned for the robot and verify if it behaves in the
way it was meant to.
A large amount of theoretical and empirical studies have
showed that playing with robots allows students of differ-
ent ages to improve their planning, reasoning and prob-
lem-solving abilities (Caci & D'Amico, 2002; Caci,
D'Amico & Cardaci, 2002; Caci, D'Amico & Cardaci,
2004) as well as develop social skills related to peer con-
flict resolution, group decision-making and so on (Bar-
furth, 1995). Moreover, children with mental retardation
and autism seem to benefit from rehabilitative activities
based on robotics (Dautenhahn, 2000; Michaud, &
Théberge-Turmel, 2002). However, there are no studies,
according to our knowledge, which have analyzed the pos-
sibility of using robotics kits as metacognitive tools. In
general, metacognition consists of two basic processes oc-
curring simultaneously. The first is monitoring the
JCR
157
progress of learning and the second is making changes or
adapting learning strategies when subjects perceive that
they are not successful (Winn & Snyder, 1996). Specifi-
cally, metacognitive skills include monitoring the progress
of learning, correcting errors, and changing strategies
when needed (Ridley, Schutz, Glanz, & Weinstein, 1992).
From this perspective, the whole experience of playing
with robots may be intended as a metacognitive process
that helps users become more aware and conscious of the
way they think, learn, and organize the game itself. With
the aim of analyzing the metacognitive strategies related
to error analysis and retrieval, we performed a study in a
sample of children attending a primary school interacting
with a robotics laboratory.
method
Twelve children, consisting of six males and six females
aged between 8-10 years old with a mean age of nine,
were randomly selected from all the third, fourth and fifth
forms of a primary School of Palermo. The whole group
was then divided into three subgroups consisting of four
children each, two males and two females, according to
forms and ages. In line with our previous studies (Caci &
D'Amico, 2002; Caci, D'Amico & Cardaci, 2002; Caci,
D'Amico & Cardaci, 2004), each group was provided with
a robotics kit to use during an extra-curricular hands-on
laboratory activity consisting of ten two-hour labs occur-
ring once a week.
After becoming familiar with the hardware and software
elements of the kit, the children were given four construc-
tion and programming tasks with an increasing level of
difficulty, as measured by the number of bricks which had
to be manipulated for constructing the robot body and by
the number of drives which had to be linked to create a
specific robot behavioral repertory (e.g., “create a robot
able to move along a linear route” – one command). Dur-
ing the construction and programming sessions the chil-
dren's metacognitive strategies were registered using two
observational grids that provided quantitative and quali-
tative indicators including number of errors, frequency of
error retrieving actions, self-corrections, help requests and
success/failure attributions.
results and conclusions
Results showed that the third-form children performed a
higher number of metacognitive actions based on control-
ling and retrieving errors than the other two groups during
the game process. However, during the construction phase
they preferred to request help from experimenters rather
158
than using self-corrections and tended to attribute their
failures to external causes (e.g., “It’s very difficult!”). On
the contrary, during the programming phase, they made a
higher number of self-corrections and were more focused
on their performance than on the robot's performance,
while at the same time emphasizing their own success
(e.g., “I know it” or “I’m able to program the robot!”)
The present study is a first attempt at investigating the pos-
sibility of using robotics activities as a metacognitive tool.
From this perspective, our results allow us to describe the
action of playing with robots as a kind of “thinking with
robots” which creates an autonomous and self-centered
learning environment and motivates children to monitor
and control their own actions.
references
Barfurth, M.A., Understanding the collaborative learning
process in a technology rich environment: the case of chil-
dren’s disagreements. In Schnase L. & Cunnius, E. L.
(Eds.), Proceedings of CSCL95: computer support for col-
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Abstracts from CT15
Ridley, D.S., Schutz, P.A., Glanz, R.S., & Weinstein, C.E.,
Self-regulated learning: the interactive influence of
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––––––––––––––––––––––––––––––––––––––––––––––
use of immersive Virtual reality for Treating anger
Sarah D. Miyahiraa, Raymond A. Folenb,
and Melba Stetzb
a
Pacific Islands Health Care System, Honolulu, Hawaii,
U.S.A.
b
Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.
1
Corresponding author:
Sarah D. Miyahira
Pacific Islands Health Care System
459 Patterson Road
Honolulu, Hawaii, U.S.A.
E-mail: sarah.miyahira@pacifichui.org
The views expressed in this abstract are those of the au-
thors and do not reflect the official policy or position of
the Department of Veterans Affairs, Department of the
Army, Department of Defense, or the U.S. Government.
abstract
Poorly managed anger response can be detrimental to
one’s physical and psychosocial well-being. Cognitive be-
havior therapies (CBT) have been found to be effective in
treating anger disorders. Exposure to anger stimuli is a key
component of CBT treatment. Virtual reality (VR) can
elicit potent reactions and may facilitate the treatment of
anger. An anger VR environment with six video vignettes
was developed by this study to examine the anger arousal
potential of VR. Outcome measures included assessment
of emotional reactivity, state anger, presence, blood pres-
sure, electrodermal response, heart rate, and respiration.
The results showed that significant anger arousal occurred
during exposure to the VR environment, and arousal was
greater when viewed in an immersive HMD than a non-
immersive flat screen. In addition, presence was found to
moderate the effects of VR. Low presence resulted in low
reactivity regardless of the display modality.
JCR
Abstracts from CT15
Keywords: Virtual Reality, Anger Treatment,
Cue Arousal, Presence
introduction
Anger is a powerful human emotion that has serious
health, social, and psychological consequences when not
appropriately managed. Research has documented its ad-
verse effects on cardiovascular disease (Chang, Ford,
Meoni, Wang, & Klag, 2002) domestic violence (Maiuro,
Cahn, Vitaliano, Wagner, & Segree, 1988) and Posttrau-
matic Stress Disorder (Jakupcak, 2007). Strong empirical
support was reported by a meta-analysis of the efficacy of
CBT in the treatment of anger (Becker & Fernandez,
1998). CBT involves relaxation training, cognitive re-
framing after exposure to anger-arousing stimuli, and re-
hearsal of adaptive thoughts and behaviors during
imaginal or role play exposure to anger-provoking situa-
tions. Reactivity to anger stimuli during exposure is criti-
cal to successful treatment outcomes that will generalize
to real life situations. Studies have shown that virtual re-
ality (VR) environments can elicit potent reactions to VR
stimuli that are experienced within such environments
(Hoffman, Patterson, & Carrougher, 2000; Lee et al.,
2003). The current investigation developed a VR environ-
ment with multiple anger-provoking video vignettes to ex-
amine the anger reactivity potential of VR. The effect of
display modality, i.e., immersive and non-immersive, on
anger arousal was also examined.
methods
Sixty male and female soldiers and veterans, ages 18-75
years, were enrolled in the study and randomly assigned
to either a head-mounted display (HMD- immersive) or a
flat-screen monitor (FSM-non-immersive) condition. Par-
ticipants in the immersive HMD condition viewed the vi-
gnettes in a 360° panoramic format through a high
resolution HMD. All participants viewed the same six
anger video vignettes of unpleasant encounters with a su-
pervisor. The order of presentation was counterbalanced
to control for sequencing effect. Outcome measures in-
cluded the ABC Anger Inventory (ABCI), Spielberger
State-Trait Anger Expression Inventory 2 (STAXI-2),
Emotional Assessment Scale (EAS), and a Presence visual
analog scale (P-VAS) that were administered before and
after viewing the videos, except for the P-VAS which oc-
curred only after viewing. Physiological measures (heart
rate, skin conductance, blood pressure, skin temperature)
were also obtained. Within and between group pre-post
data analyses were performed on the outcome and physi-
ological measures.
JCR
159
results
The results obtained demonstrated that the HMD group
reported greater differences between pre and post-anger
scores on the STAXI-2 and EAS, whereas no differences
were found for the FSM group. Greater presence was re-
ported by the HMD group during the video vignettes than
the FSM group. Analysis of high and low presence re-
vealed significant differences between the high presence
HMD group on the STAXI-2 and EAS and HMD low
presence group, and FSC low presence group, respec-
tively.
Conclusions
VR environments with anger-provocative stimuli will
elicit anger reactivity, and, when viewed in an immersive
HMD, will produce higher levels of presence than when
viewed on a flat screen monitor. Presence appears to mod-
erate the effects of VR on anger reactivity. If presence is
low, reactivity to VR anger stimuli is low regardless of
display type, i.e., HMD or flat-screen.
references
Becker, R., Fernandez, E. 1998. Cognitive-behavioral
therapy in the treatment of anger: A meta-analysis. Cog-
nitve Therapy & Research 22(1):63-74.
Chang, P.P., Ford, D.E., Meoni, L.A., Wang, N.Y., Klag,
M.J. 2002. Anger in young men and subsequent premature
cardiovascular disease: the precursors study. Arch Intern
Med 162(8):901-6.
Hoffman, H.G., Patterson, D.R., Carrougher, G.J. 2000.
Use of virtual reality for adjunctive treatment of adult burn
pain during physical therapy: A controlled study. Clinical
Journal of Pain 16: 244-50.
Jakupcak, M., Conybeare, D., Phelps, L., Hunt, S.,
Holmes, H.A., Felker, B., Kelvens, M., McFall, M.E.
2007. Anger, hostility, and aggression among Iraq and
Afghanistan War veterans reporting PTSD and subthresh-
old PTSD. J Trauma Stress 20(6):945-54.
Lee, J.H., Ku, J., Kim, K., Kim, B., Kim, I.Y., Yang, B.H.
2003. Experimental application of virtual reality for nico-
tine craving through cue exposure. CyberPsych & Behav-
ior 6: 275-80.
Maiuro, R.D., Cahn, T.S., Vitaliano, P.P., Wagner,
B.C., Segree, J.B. 1988. J of Consult & Clin Psy
56(1):17-23.
160
––––––––––––––––––––––––––––––––––––––––––––––
effectiveness of brief Vr Treatment for
pTsd in Warfighters
Sarah D. Miyahiraa, Raymond A. Folenb,
Hunter G. Hoffmanc, and Azucena Garcia-Palaciosd
a
Veterans Affairs Pacific Islands Health Care System,
Honolulu, Hawaii, U.S.A.
b
Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.
c
University of Washington, Seattle, Washington, U.S.A.
d
Universitat Jaume 1, Castellon, Spain
1
Corresponding author:
Sarah D. Miyahira
Pacific Islands Health Care System
459 Patterson Road
Honolulu, Hawaii, U.S.A.
E-mail: sarah.miyahira@pacifichui.org
The views expressed in this abstract are those of the au-
thors and do not reflect the official policy or position of
the Department of Veterans Affairs, Department of the
Army, Department of Defense, or the U.S. Government.
abstract
Warfighters exposed to combat are at high risk for devel-
oping Posttraumatic Stress Disorder (PTSD), a complex
and challenging condition to treat. Cognitive behavioral
therapies (CBT) have been empirically validated as effec-
tive treatment for PTSD resulting from sexual assault, ve-
hicular accidents, and disasters. Exposure, imaginal or in
vivo, to the traumatic event is a central component of suc-
cessful CBT treatment. Early studies indicate that CBT
with brief virtual reality exposure (VRE) is beneficial in
treating PTSD. The current work is a randomized con-
trolled study to examine the effectiveness of brief VRE in
treating combat-related PTSD. Preliminary results are
mixed. While PTSD symptoms are reduced by VRE,
warfighters may require more VRE treatment sessions
than anticipated to achieve remission.
Keywords: Virtual Reality, PTSD, Exposure
Therapy, Combat
introduction
Warfighters returning from Iraq (OIF) and Afghanistan
(OEF) report a high incidence of anxiety, depression, and
Abstracts from CT15
Posttraumatic Stress Disorder (PTSD) (Tanielian & Jay-
cox, 2008). Mental health research report PTSD rates
ranging from 12-19% in OIF/OEF veterans (Geppert,
2009). Treatment of PTSD in these warfighters is often
more challenging due to the presence of depression, trau-
matic brain injury (TBI) and serious physical injuries. Ex-
posure-based cognitive behavior therapy (CBT) has been
empirically validated to reduce PTSD symptoms (Institute
of Medicine, 208). Recall of the traumatic event is essen-
tial to successful CBT outcomes, but avoidance of these
memories is a common feature of PTSD. Virtual reality
exposure (VRE) can enhance a person’s memory retrieval
and overcome avoidance of traumatic events with visual,
auditory and other sensory experiences. This study com-
pares the reduction of PTSD symptoms in OIF/OEF
warfighters treated with CBT and VRE with a control
group.
methods
Participant enrollment and data collection are ongoing.
Thirty-four warfighters with PTSD were randomly as-
signed to VR exposure treatment (VRTx) or a minimal at-
tention control group (MA). VRTx consists of 10 sessions,
which includes nine VRE sessions where a well-trained
PTSD therapist controls visual, auditory, and kinesthetic
VR stimuli while participants ride in a virtual Humvee on
patrol in a Middle Eastern town. The VR environment is
viewed through a high resolution head-mounted display.
Outcome measures are administered pre and post-treat-
ment and MA conditions. They include the Clinician Ad-
ministered PTSD Scale (CAPS-criterion measure), PTSD
Diagnostic Scale (PDS), and measures of depression,
combat exposure, quality of life, guilt, and presence. Phys-
iologic measures are obtained during each VRTx session.
Preliminary analyses of within and between group data
were conducted of VRTx participants and the MA group
to examine the early effects of treatment.
results
VRTx and MA pre-treatment scores on the outcome meas-
ures and combat exposure showed no significant differ-
ences. However, post-treatment CAPS scores for the
VRTx were significantly lower compared to pre-treatment
scores, whereas no change was found for the MA group.
While significance was not attained, depression, symptom
severity, and trauma-related guilt scores were lower, and
quality of life scores were higher after VRTx. The MA
group reported an increase in depression.
JCR
Abstracts from CT15
Conclusions
Preliminary results indicate that VR exposure enhances
CBT treatment of PTSD in warfighters. PTSD symptoms
were substantially reduced after VRTx compared to no
change in symptoms in the control group. VRTx also con-
tributed to a decrease in depression, severity of PTSD
symptoms, and feelings of guilt while the control group
experienced an increase in depression. Quality of life also
improved for the VRTx group. However, remission from
PTSD was not attained in the brief 10-session VRTx ap-
proach. Additional treatment sessions may be needed to
achieve remission. Future research is needed to further re-
fine VRE treatment of PTSD in warfighters and civilian
populations.
references
Geppert, C.M.A. 2009. From war to home: Psychiatric
emergencies of returning veterans. Psychiatric Times
26(10):1-4.
Institute of Medicine. 2008. Treatment of posttraumatic
stress disorder: An assessment of the evidence. Washing-
ton (DC): National Academies Press.
Tanielian, T., Jaycox, L.H. 2008. Invisible Wounds of War.
Santa Monica (CA): RAND Corporation.
––––––––––––––––––––––––––––––––––––––––––––––
Virtual reality interoceptive exposure for the
Treatment of panic disorder and agoraphobia
M.A. Pérez-Araa,1, S. Queroa,c, C. Botellaa,c, R. Bañosb,c,
S. Andreu-Mateua, A. Garcia-Palaciosa,c, J. Bretón-Lópeza
Universidad Jaume I, Castellón de la Plana, Spain
a
b
Universidad de Valencia, Valencia, Spain
c
de Fisiopatología de la Obesidad y Nutrición
(CIBEROBN)
1
Corresponding author:
M.A. Pérez-Ara
Universidad Jaume I, Facultad de Ciencias Humanas y
Sociales, Departamento de Psicología Básica
Clínica y Psicobiología. Av. Vicente Sos Baynat s/n.
12071 Castellón de la Plana, Spain
E-mail: ara@psb.uji.es
abstract
The efficacy of cognitive-behavioral therapy (CBT) for
panic disorder and agoraphobia (PDA) has been widely
JCR
161
demonstrated. The main component of these programs is
the exposure technique and the interoceptive exposure (IE)
is also extremely important. The virtual reality (VR) pro-
gram for PDA developed by Botella’s group can simulate,
in a controlled way, bodily sensations like heart beats and
shortness of breath, and provoke visual effects like
blurred, double or tunnel vision while the person is inter-
acting with the VR environments in a consultation room.
This work examines the efficacy of the IE component in
two treatment conditions – the VR Interoceptive Exposure
Simultaneous Condition (VRIE-sim; N=14), and the In-
teroceptive Exposure Traditional Condition (IET; N=15).
Results obtained showed that both treatment conditions
significantly reduced the main clinical variables at post-
treatment and these results were maintained or even im-
proved at a three-month follow-up. Simultaneous VR
interoceptive and VR external stimuli exposure is a new
and effective way to apply PDA treatment.
Keywords: Cognitive-behavioral Therapy, Panic Disorder
and Agoraphobia, Interoceptive Exposure, Virtual Reality
introduction
The efficacy of cognitive-behavioral therapy (CBT) pro-
grams for panic disorder and agoraphobia (PDA) has been
widely demonstrated (Barlow, Raffa, & Cohen, 2002), with
the main component of these programs being the exposure
technique. In addition, these programs underline the effi-
cacy of the interoceptive exposure (IE) component (Ito et
al., 2001). In traditional CBT programs the exposure com-
ponent is applied in vivo and in a consultation room to ex-
pose the patient to agoraphobic situations. Exposure is
induced by producing different bodily sensations, using dif-
ferent exercises (e.g., hyperventilation) to provoke them.
VR is an alternative and effective way to apply the exposure
component and has demonstrated efficacy in the treatment
of PDA (Botella et al., 2007). The VR program for PDA de-
veloped by Botella et al. (2004) makes it possible to simul-
taneously apply VRIE to bodily sensations (heart beats,
shortness of breath and visual effects) while the person is
confronting the VR environments (e.g., bus, mall) in a con-
sultation room. The main contribution of the Botella et al.
study (2007) was to present long-term efficacy data of VR
exposure for PDA. However, the virtual interoceptive ex-
posure component was not studied in a controlled way. The
present work examines using a between group design and
studies the differential efficacy of CBT to treat PDA, where
the IE component is carried out using VR simultaneously
to the situational exposure, compared to the same CBT
where the IE component is applied in a traditional way.
162
method
Twenty-nine patients diagnosed with PDA (N=27) or Ago-
raphobia without Panic Disorder history (N=2) partici-
pated in the study. The mean age was 32.79 (SD=8.28)
with ages ranging from 21 to 53. After two assessment
sessions participants were randomly assigned to one of the
treatment conditions – VRIE-sim or IET. The outcome
measures included Fear and Avoidance Scales for the main
target behavior and sensation, the Anxiety Sensitivity
Index and the Panic Disorder Severity Scale. The treat-
ment was a CBT program adapted from Barlow’s group
(Barlow & Craske, 1994), Clark’s group (Salkovskis &
Clark, 1991) and Botella’s group (2007), including a max-
imum of eight sessions and applied in an individual for-
mat. Finally, participants were assessed again at
post-treatment and at a three-month follow-up.
results
The results obtained showed that both treatment condi-
tions significantly reduced all clinical variables at post-
treatment. However, no significant differences were found
between the two treatment conditions. Comparisons be-
tween post-treatment and a three-month follow-up re-
vealed that the treatment gains were maintained and
patients continued to improve significantly in six of the
outcome measures in both conditions.
Conclusions
The efficacy of IE carried out by VR was similar to the
efficacy of a program that included the gold standard IE
for this disorder (in vivo exposure). The present study em-
phasizes the utility of available new technologies to im-
prove psychological treatments.
references
Barlow, D.H. & Craske., M.G. Mastery of your anxiety
and panic (MAPII). Albany, New York: Graywind Publi-
cations, 1994.
Barlow, D.H., Raffa, S.D., & Cohen, E.M., Psychosocial
treatments for panic disorders, phobias, and generalized
anxiety disorder. In Nathan, P. E., and Gorman, J. M.
(Eds), A guide to treatments that work (2nd ed.). (pp. 301-
335). London: Oxford University Press, 2002.
Botella, C., Villa, H., García-Palacios, A., Baños, R., Per-
piñá, C., & Alcañiz. M. Clinically significant virtual en-
vironments for the treatment of panic disorder and
agoraphobia. CyberPsychology and Behavior 7 (5) (2004),
527-535.
Abstracts from CT15
Botella, C., García-Palacios, A., Villa, H., Baños, R.M.,
Quero, S., Alcañiz, M. & Riva. G. Virtual reality exposure
in the treatment of panic disorder and agoraphobia: A con-
trolled study. Clinical Psychology and Psychotherapy 14
(2007) 164-175.
Ito, L.M., De Araujo, L.A., Tess, V.L.C., De Barros-Neto,
T.P., Asbahr, F.R. & Marks, I. Self-exposure therapy for
panic disorder with agoraphobia. British Journal of Psy-
chiatry 178 (2001), 331-336.
Salkovskis, P.M. & Clark, D.M. Cognitive therapy for
panic disorder. Journal of Cognitive Therapy 5 (1991),
215-226.
––––––––––––––––––––––––––––––––––––––––––––––
Virtual object properties Can affect Target acquisition
Time in a reaching Task
Vaughan Powella,1, Brett Stevensa, Steve Handa,
and Maureen Simmondsb
a
School of Creative Technologies, University of
Portsmouth, UK
b
School of Physical & Occupational Therapy, McGill
University, Canada
Corresponding author:
1
Vaughan Powell
University of Portsmouth
Cambridge Road, Portsmouth
Hampshire PO1 2LF
United Kingdom
E-mail: vaughan.powell@port.ac.uk
abstract
Virtual Reality is being used increasingly for upper limb
rehabilitation. The type of virtual objects used for reach-
ing tasks varies widely, but there has been little work ex-
ploring the effect of different characteristics of objects
on target acquisition time. This study investigates how
target acquisition times vary for virtual objects with dif-
ferent visual cues. Results suggest that the visual prop-
erties of an object may have a notable effect on target
acquisition times. Simple (low polygon) objects with
richer depth cues are acquired more easily than a stan-
dard sphere.
Keywords: Virtual Reality, Virtual Rehabilitation,
Visual Cues, Depth Perception
JCR
Abstracts from CT15
introduction
Virtual Reality (VR) is being used with increasing success
for a wide variety of rehabilitation goals, facilitating in-
creased engagement with therapy (Rizzo & Kim, 2005)
and reduced perception of pain (Hoffman et al., 2004).
Upper limb rehabilitation often involves reaching and
grasping tasks, which lend themselves well to VR (Cros-
bie, Lennon, McNeill, & McDonough, 2006; Sveistrup et
al., 2003.)
The virtual objects used for these tasks vary from repre-
sentations of real-world objects to abstract shapes, com-
monly spheres. However, there has been little work
exploring the effect of these different visual object prop-
erties on target acquisition. This paper reports the results
of a preliminary study comparing target acquisition times
of a variety of virtual objects and visual cues.
method
Thirteen healthy subjects, 10 males and three females aged
between 22-43 years old, participated in the study. The
tasks were carried out in a VR laboratory with a stereo-
scopic Virtual Environment, an orchard, back-projected
onto a large (5m x 3m) display screen. The participants
were equipped with magnetic trackers on the acromion
process and the radial styloid of the dominant hand, and
their movements were tracked in the virtual world with a
virtual representation of the same hand.
Continuous position data from the sensors was recorded
throughout each test, and the time taken from object prox-
imity (20cm) to acquisition was recorded for each target
object. Ten target objects were presented sequentially for
each test, and this was repeated for each of six randomly
ordered conditions. The target objects were apples,
spheres or simple polyhedra (icosahedrons) of the same
diameter, in a 2 x 3 factorial design (shape x brightness),
with the objects either staying constant, or increasing in
brightness on "proximity" for each experimental condi-
tion.
Descriptive statistics of mean time-to-target for each con-
dition were calculated, and a two-way ANOVA was used
to determine if there was a difference between target ob-
jects at an alpha level of p<0.05.
results
Two-way ANOVA (shape x brightness) for time-to-target
showed a significant effect of object shape (F2,24 = 4.31
p< 0.05). Post hoc analysis demonstrated that the mean
JCR
163
times to target for the terminal stages of reaching were
lowest for the icosahedron conditions (1.6s) compared to
the acquisition of the spheres (2.2s) and the apples (2.1s).
Both these differences were significant at p<0.05. There
was no significant difference between the apple and the
sphere. Changing the brightness had no significant effect
on time-to-target, nor was there any significant interaction
between the brightness and object shape.
Conclusion and discussion
There was a large variance both within and between sub-
jects, and therefore these preliminary results should be
interpreted with caution. Nevertheless, they suggest that
the visual properties of an object may have a significant
impact on target acquisition, and this should be consid-
ered when designing timed reaching tasks for rehabilita-
tion or assessment. It is well documented that depth
perception is distorted in VR, potentially impairing spatial
reaching and grasping tasks (Armbruster et al., 2006;
Frenz, Lappe, Kolesenik, & Buhrmann, 2007). The find-
ings of this study indicate that a simple low-poly object
facilitates target acquisition, suggesting that it may not be
necessary to utilize a sophisticated computationally-in-
tensive solution. The results also suggest that VR envi-
ronments for rehabilitation should consider individual
preference. A larger study is now in progress to further
investigate these findings.
references
Armbruster, C., et al, Virtual Reality as a Research Tool
in Neuropsychology: Depth Estimations in the Periper-
sonal Space, Annual Review of CyberTherapy and
Telemedicine 4(2006) 183.
Crosbie, J., Lennon, S., McNeill, M., McDonough, S., Vir-
tual Reality Rehabilitation in Chronic Stroke: Two Case
Studies. Annual Review of CyberTherapy and Telemed-
icine 4 (2006).
Frenz, H., Lappe, M., Kolesenik, M., Buhrmann, T., Esti-
mation of Travel Distance from Visual Motion in Virtual
Environments, ACM Trans. Appl. Percept 4(1)(2007 )
Hoffman, H., et al. Modulation of Thermal Pain-Related
Brain Activity with Virtual Reality: Evidence from fMRI,
Neuroreport 15(8)(2004), 1245-1248.
Rizzo, A., and Kim, G., A SWOT analysis of the field of
virtual reality rehabilitation and therapy, Presence - Tele-
Operators and Virtual Environments 14(2)(2005), 119-
146.
164
Sveistrup, H., et al, Experimental studies of Virtual Real-
ity-Delivered Compared to Conventional Exercise Pro-
grams for Rehabilitation, CyberPsychology and
Behaviour 6(3), 245-249.
––––––––––––––––––––––––––––––––––––––––––––––
The influence of audio Cue Tempo on Walking in
Treadmill-mediated Virtual rehabilitation
Wendy Powella,1, Brett Stevensa, Steve Handa,
and Maureen Simmondsb
School of Creative Technologies, University of
a
Portsmouth, UK
b
School of Physical & Occupational Therapy, McGill
University, Canada
Corresponding author:
1
Wendy Powell
University of Portsmouth
Cambridge Road, Portsmouth
Hampshire PO1 2LF
United Kingdom
E-mail: wendy.powell@port.ac.uk
abstract
Music or sound effects are often used to enhance Virtual
Environments, but it is not known how this audio may
influence gait speed. This study investigated the influ-
ence of audio cue tempo on treadmill walking with and
without visual flow. The walking speeds of 11 individu-
als were recorded during exposure to a range of audio
cue rates. There was a significant effect of audio tempo
without visual flow, with a 16% increase in walking
speed with faster audio cue tempo. The audio with visual
flow resulted in a smaller but still significant increase in
walk speed (8%). The results suggest that the inclusion
of faster rate audio cues may be of benefit in improving
walk speed in virtual rehabilitation.
Keywords: Virtual Reality, Audio Cues, Gait Speed,
Treadmill Walking
introduction
Music can influence the mood of a participant, and these
mood changes can alter gait kinematics (Cluss, Crane,
Gross, & Frederickson, 2006). In addition, music can in-
fluence step frequency and effort in exercise (Ah-
maniemi, 2007), and there is some evidence that audio
cues can be used to improve walk speed in patients with
Abstracts from CT15
Parkinson’s disease (Suteerawattananon, Morris, Etnyre,
Jankovic, & Protas, 2004). However, to date there is little
investigation into the effects of audio cues in Virtual Re-
ality (VR). Despite this, music and sound effects are
often added to Virtual Environments (VE's) in an attempt
to enhance engagement or enjoyment, but it is not known
whether audio influences the way people walk in VE's.
This paper reports a preliminary study investigating the
influence of gait-referenced audio cue tempo on tread-
mill walking in VE's.
method
Eleven healthy adults, four males and seven females,
aged 23-54 years old, participated in the study. All par-
ticipants were familiarized with the self-paced motorized
treadmill placed in front of a large (5mx3m) display
screen. A virtual walkway lined with pillars was back-
projected on the screen. During the test conditions the
image of the walkway was either static on the screen (no
visual flow) or linked to the treadmill via a virtual cam-
era (VR condition – visual flow present). Previous work
had demonstrated that baseline cadence differs between
treadmill and overground walking (Powell, Stevens, &
Simmonds, 2009), therefore baseline walk speed and ca-
dence were recorded during treadmill walking. Partici-
pants then walked for three minutes in each of the test
conditions (Table 1).
results
A two-way ANOVA (audio x visual) for gait velocity
showed a significant main effect for audio cue tempo (F
3,30 = 4.69 p < 0.05). Participants walked fastest in the
125% audio condition, with a 12% increase in gait speed
compared to baseline (p <0.01), and a 10% increase com-
pared to matched audio cue tempo. There was no signif-
icant difference between the other conditions.
There was, however, a significant interaction between
the audio cues and visual flow (F3,30 = 3.45 p <0.05).
In both the fast and slow cue conditions, participants
walked significantly slower in VR than with audio alone.
However, the participants walked faster (8%) in the
125% VR condition, compared to baseline.
For cadence there was a significant effect for audio cues
(F3,30 = 2.89 p = 0.05), with a 6% increase in cadence
in the 125% audio condition compared to baseline and
matched audio conditions. There was no significant dif-
ference between the other conditions. There was also no
significant effect of visual flow on gait cadence.
JCR
Abstracts from CT15 165

Table 1
The combination of audio cue rate and visual flow used in the experimental conditions

audio Cue rate as % of none (base- none (base-

75% 100% 125% 75% 100% 125%
baseline cadence line) line)
Visual flow linked to
absent (no VR) present (VR)
treadmill motion

Conclusion and discussion University Hospital, Rehabilitation Instytution,

c

This is the first study to demonstrate that the frequency
of audio cues in treadmill-mediated VR can significantly
influence walk speed. Although the effects of audio
tempo were reduced by VR, even in the presence of vi-
sual flow the participants walked faster in the 125% con-
dition compared to baseline, suggesting that the addition
of gait-referenced fast audio cues may be of benefit in
increasing walk speed in virtual rehabilitation.
references
Ahmaniemi, T., Influence of Tempo and Subjective Rat-
ing of Music in Step Frequency of Running in 8th Inter-
national Conference on Music Information Retrieval.
2007. Vienna, Austria.
Cluss, M., Crane, E., Gross, M., Frederickson. B., Effect
of emotion on the kinematics of gait in American Society
of Biomechanics. 2006. Blacksburg, VA.
Powell, W., Stevens, B., Simmonds, M., Treadmill Inter-
face for Virtual Reality vs Overground Walking: A com-
parison of Gait in Individuals with and without Pain.
Studies in Health Technology and Informatics 144
(2009), 198-203.
Suteerawattananon, M., Morris, G., Etnyre, B., Jankovic,
J., Protas. E., Effects of Visual and Auditory Cues on
Gait in Individuals with Parkinson's Disease. Journal of
the Neurological Sciences 219(1-2) (2004), 63-69.
––––––––––––––––––––––––––––––––––––––––––––––
multimedia holistic rehabilitation method
for patients after stroke – efficiency analysis
Karolina Probosza,1, Rafał Wcislob, Jacek Kitowskib,
Renata Slotab , Janusz Otfinowskia, and
Artur Sobczykc
Jagiellonian University, Cracow, Poland
a
Cracow, Poland
1
Corresponding author:
Karolina Probosz
Wolnica Square 2/7
31-060 Cracow, Poland
E-mail:karolina.probosz@gmail.com
Keywords: Stroke, Aphasia, Rehabilitation, Multimedia
Rehabilitation, Cognitive Function, Cognitive Rehabilitation
introduction
Patients who have suffered a stroke need holistic care.
Dedicated computer systems equipped with proper soft-
ware to support the rehabilitation process are very helpful
in cognitive rehabilitation which requires a polisensoric
stimulation of a patient’s brain (Sveistrup et al., 2003; Ki-
towski et al., 2009). In this paper we describe a multimedia
rehabilitation method developed in our medical center, ex-
ercises implemented in the computer system (equipped
with special devices) and their applications for stroke pa-
tients. Results obtained by using standard tests are also
presented.
method
The proposed multimedia rehabilitation method consists of:
1.diagnostic phase,
2.main rehabilitation process and intermediate results as-
sessment phase (this phase uses specially developed mul-
timedia computer system),
3.final result assessment phase,
4.remote patient rehabilitation (optional).
––––––––––––––––––––––––––––––––––––––––––––––
understanding the psychological reasons
behind microblogging
Lin Qiua,1 and Jun Hao Hoa

Department of Computer Science, AGH University of

b a
Division of Psychology
Science and Technology, Cracow, Poland Nanyang Technological University

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1
Corresponding author:
Lin Qiu
Division of Psychology
14 Nanyang Drive, Singapore
E-mail: linqiu@ntu.edu.sg
abstract
This research aims to understand the psychological motiva-
tion behind microblogging. We conducted two studies to in-
vestigate if social exclusion and existential anxiety will lead
to a higher tendency to microblog. Our results suggest that
people who face social exclusion are more likely to mi-
croblog. Our studies are the first empirical ones that em-
ployed a between-subjects design to understand the
psychological motivation behind microblogging.
Keywords: Microblogging, Motivation, Social Exclusion,
Existential Anxiety
introduction
Microblogging has recently become a new form of commu-
nication that is rapidly changing everyone’s life. Through
services such as Twitter, millions of people can broadcast
short messages to their followers via instant messaging, SMS,
or web interfaces. Recent research has been conducted to un-
derstand this phenomenon. For example, Java, Song, Finin,
and Tseng (2007) found that the majority of messages posted
on Twitter are “pointless babbles” such as “I am eating a
salad” or “I am going to dinner with my parents tonight.”
These mundane messages describe day-to-day routines and
are often meaningless to others. However, they appear much
more often than messages for other purposes such as replying
to others’ posts, sharing information (URL), or reporting
news. While celebrities who have millions of followers may
post these messages to interact with fans, why do average
people want to post them? In this study, we aim to understand
the psychological motivation behind microblogging. We hy-
pothesize that when one faces social exclusion or existential
anxiety, one is more likely to microblog. We conducted two
studies to verify our hypotheses.
study 1
Study one tested the effects of social exclusion on microblog-
ging. Social exclusion was manipulated using the Cyberball
game (Williams, Cheung, & Choi, 2000). Participants were
asked to play a web-based ball tossing game on the computer.
They were led to believe that two other players in another
room were playing with them. Players indicated which player
they wished to throw the ball to by clicking on the correspon-
ding avatar. The game was set so that participants in the con-
Abstracts from CT15
trol group received the ball 10 out of 30 throws from others,
whereas participants in the experimental group only received
two out of thirty throws.
We recruited 60 undergraduates and randomly assigned them
to the control and experimental group. Participants were first
introduced to Twitter and given an account. They were told
that their tweets could be seen by thirty other Twitter users
online and they could use Twitter anytime during the study.
Then, participants played the Cyberball game. After the
game, the experimenter told the participant to wait for the
next task and left the room. The participant was left alone in
the room for three minutes. This three-minute break was used
to give participants opportunities to tweet if they want. After
the three-minute break, the experimenter came back to the
room and asked the participant to perform two trivial tasks
each with a three-minute break (the same as the one described
above). The first task was to place 20 pictures into 20 en-
velopes and the second task was to sort the envelopes into
three trays according to their colors (white, red, and yellow).
During each three-minute break, the experiment posted reg-
ular tweets (such as “helping my friend with her work” “feel-
ing pretty random right now”) from accounts that the
participant was following. This allowed the participant to see
that there were other users online and they could see each
other’s tweets. After the above tasks, participants completed
a battery of surveys and we collected all the tweets generated
by the participants.
Our results showed that the experimental group (M = 2.17,
SD = 2.21) generated more tweets than the control group (M
= 3.27, SD = 2.91) [t (58) = -1.65, p = .11], and the difference
is marginally significant. This suggests a trend that people are
more likely to microblog when they face social exclusion.
study 2
In study 2, we tested the effect of existential anxiety on mi-
croblogging. We hypothesize that existential anxiety will lead
to a higher tendency to microblog. Existential anxiety was
manipulated by making mortality salient (Schmeichel, Gail-
liot, Filardo, McGregor, Gitter and Baumeister, 2009). The
experimental group was asked to write a short essay about
death whereas the control group was asked to write about
dental pain.
We recruited 56 undergraduates and randomly assigned them
to the control and experimental group. We followed the exact
same procedure as described in Study 1 except that social ex-
clusion priming was replaced by existential anxiety priming.
Our results showed that while the experimental group (M=
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Abstracts from CT15
3.68, SD = 3.42) produced more tweets than the control group
(M = 5.46, SD = 7.07) [t (54) = -1.20, p = .23], the difference
was not statistically significant. This suggests that individuals
who face existential anxiety do not have a higher tendency
to microblog than others.
Conclusion
Microblogging has recently become a fast-growing phenom-
enon that has affected millions of people. While studies have
been conducted to understand why and how people partici-
pate in microblogging, they mostly rely on interviews, sur-
veys, or the analysis of the microblogging content. Our
studies are the first empirical ones that employed a between-
subjects design to understand the psychological motivation
behind microblogging. Results suggest that people are more
likely to microblog when they face social exclusion.
––––––––––––––––––––––––––––––––––––––––––––––
implementation of the multiple errands Test in a
neuroVr-supermarket: a possible approach
Simona Raspellia,1, Laura Carellia,b, Francesca Morgantib,
Patrice L. Weissd, Rachel Kizonyd,e, Noomi Katze,
Barbara Polettif, Barbara Corraf, Vincenzo Silanif,
and Giuseppe Rivaa,c
Applied Technology for Neuro-Psychology Lab, Istituto
a
Auxologico Italiano, Milan, Italy
b
Department of Human Sciences, University of Berg-
amo, Bergamo, Italy
c
Department of Psychology, Catholic University of
Milan , Milan, Italy
d
Department of Occupational Therapy, University of
Haifa, Haifa, Israel
e
Research Institute for the Health & Medical Profes-
sions, Ono Academic College, Kiryat Ono, Israel
f
Department of Neurology and Laboratory of Neuro-
science, “Dino Ferrari” Center, University of Milan,
IRCCS Istituto Auxologico Italiano, Milan, Italy
1
Corresponding author:
Simona Raspelli
Applied Technology for Neuropsychology Laboratory
Istituto Auxologico Italiano
Milano, Italy
E-mail: s.raspelli@gmail.com
abstract
Our goal was to develop a tool for the assessment of execu-
tive functions by customizing a virtual reality (VR) version
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167
of the Multiple Errands Test (MET) (Shallice & Burgess,
1991; Fortin et al., 2003). The MET is an assessment of ex-
ecutive functions in daily life which consists of tasks that
abide by certain rules. It is performed in an actual shopping
mall-like setting where there are items to be bought and in-
formation to be obtained. The specific goal of this study was
to conduct a pilot study using the virtual version of MET
(VMET) with both control subjects and patients with cogni-
tive impairment derived from stroke.
Keywords: Virtual Reality, Executive Functions,
Multiple Errands Test (MET)
introduction and methods
The goal of the present study was to develop a tool for the
assessment of executive functions, by customizing a virtual
reality (VR) version of the Multiple Errand Test (VMET)
(Shallice & Burgess, 1991; Fortin et al., 2003). The MET is
an assessment of executive functions in daily life which is
performed in a shopping mall-like setting where there are
items to be bought and information to be obtained. In the
present work the MET procedure, previously modified ac-
cording to the requirements of the NeuroVR software system,
was presented within a virtual supermarket. Subjects were
requested to select and buy various products presented on
shelves with the aid of a joy-pad.
results and conclusions
The clinical sample consisted of six patients with cognitive
impairment derived from stroke (mean age = 63 years,
std.dev = 8.05; mean number of school years = 15.33 years,
std.dev. = 2.58; MMSE = 28.13, std.dev. = 1.38). Patients
were selected according to the severity of the impairment, in
line with neuropsychological and physiatrist assessment. The
control group consisted of 14 healthy subjects (mean
age=64.9 years, std. dev.=9.1; mean number of school
years=12.3 years, std.dev.=4.03; MMSE=28.41,
std.dev.=1.25).
According to the Mann-Whitney Test, the mean rank for con-
trol subjects was significantly higher for time in executing
the task than for patients (Asym. Sig. = 0.06; M = 964.6 vs.
649; SD = 424.18 vs. 232.07) and the same result was also
found for the partial error “maintained task objective to com-
pletion” (Asym. Sig. = 0.08; M = 9.43 vs. 8.33; SD = 1.34
vs. 1.03).
With regard to patients, correlations between neuropsycho-
logical tests and the variables of the virtual test (Table 1) in
part support the content validity of the adopted procedure as
168 Abstracts from CT15

Table 1
Correlations between neuropsychological tests and the variables of the virtual test

searched item
sustained maintained no persevera-
Time errors in the correct
attention sequence tion
area
r p r p r p r p r p r p
TMT (BA) .96** .00
Corsi’s mem.span . 84* .04 . 84* .04 . 84* .04
Street Compl.Test - 86* .03 - 86* .03 - 86* .03
SemanticFluencies -.87* .02
Tol -.82* .05
Corsi’s supra-span
StateAnxietyIndex - 89* .02

the performances were correlated to the traditional tests aimed Instituto Salud Carlos III
at assessing memory, attention and executive functions. Neurology Service, Hospital Universitari La Fe,
c

As a whole, these results provide support for the feasibility of
using the VMET as an assessment tool of executive functions
in this clinical sample. Employing larger groups of both healthy
adults and patients will provide additional support for the use
of the VMET in assessment and rehabilitation intervention.
Acknowledgments
The work in preparing this paper was supported by the funded
project "Immersive Virtual Telepresence (IVT) for Experien-
tial Assessment and Rehabilitation”, IVT2010, RBIN04BC5C.
references
Fortin, S., Godbout, L., & Braun, C. M. J. , Cognitive struc-
ture of executive deficits in frontal lesioned head trauma pa-
tients performing activities of daily living, Cortex 39 (2003),
273-291.
Shallice, T., & Burgess, P.W., Deficits in strategy application fol-
lowing frontal lobe damage in man, Brain 114 (1991), 727-741.
––––––––––––––––––––––––––––––––––––––––––––––
analysis of Visual perception aspects of the Virtual re-
ality experience with Transcranial doppler monitoring
Beatriz Reya,b,1, Mariano Alcañiza,b, Valery Naranjoa,
Vera Parkhutikc and José Temblc
a
Instituto en Bioingeniería y Tecnología Orientada al Ser
Humano, Universidad Politécnica de Valencia, España
b
Ciber Fisiopatología Obesidad y Nutrición (CB06/03)
Valencia, España
1
Corresponding author:
Beatriz Rey
Instituto en Bioingeniería y Tecnología
Orientada al Ser Humano
Universidad Politécnica de Valencia
Camino de Vera s/n
46022 Valencia, España
E-mail: brey@labhuman.i3bh.es
abstract
Transcranial Doppler (TCD) is a tool to measure blood flow
velocity (BFV) in the main arteries of the brain that has been
used in previous studies to analyze brain activity during vir-
tual reality (VR) experiences. Increments in BFV were found
in comparison with baseline periods. However, due to the
complexity of VR experiences, several factors could be the
origin of these variations, so it is necessary to individually
analyze those different aspects. In this work, we describe our
results related to visual perception. A method based on spec-
tral analysis is used to analyze the magnitude and temporal
evolution of the maximum BFV signal. Results show that, in
the presence of visual stimuli, BFV quickly rises to a maxi-
mum that is achieved after a few seconds.
Keywords: Visual Perception, Virtual Reality,
Transcranial Doppler Monitoring
introduction
Transcranial Doppler (TCD) is a tool with high temporal res-

JCR
Abstracts from CT15 169

olution used to measure blood flow velocity (BFV) in cere-

bral arteries. In normal conditions, these BFV variations re-
flect changes in regional cerebral blood flow due to brain
activation in the areas supplied by the vessel under study.
TCD has been used to study brain activity during different
immersion and navigation conditions in VR experiences (Al-
cañiz, Rey, Tembl, & Parkhutik, 2009; Rey, Alcañiz, Tembl,
& Parkhutik). Percentage variations between the mean BFV
value during the baseline and the mean BFV value during the
activation period were calculated. The temporal variations in-
side the different experimental conditions were not analyzed.
BFV percentage variations were positive in all the experi-
mental conditions, and differences were found between con-
ditions. These positive variations can be explained by several
factors, such as the complex interaction between visuospatial
and attention tasks, the creation of a motor plan, emotions or Figure 1. Representation of the BFV and low-frequency
presence. Simpler experiments have to be proposed to ana- estimation during visual perception in a subject.
lyze individual variables that contribute to the VR experience. references
Furthermore, the kind of analysis that is applied to the BFV Alcañiz, M., Rey, B., Tembl, J., and Parkhutik, V. A Neuro-
signal should be improved to also study the temporal evolu- science Approach to Virtual Reality Experience Using Tran-
tion of the signal. scranial Doppler Monitoring. Presence: Teleoperators &
Virtual Environments, 18 (2009), 97-111.
method
In a recent study (Rey, Naranjo, Parkhutik, Tembl, & Alcañiz) Rey, B., Alcañiz, M., Tembl, J., Parkhutik, V. Brain Activity
we have focused on visual perception. Maximum BFV data and Presence: a Preliminary Study in Different Immersive
in Posterior Cerebral Arteries (PCA) was monitored during Conditions Using Transcranial Doppler Monitoring. Virtual
10 cycles of alternating darkness and illumination for 23 sub- Reality (in press).
jects. A spectral analysis of the BFV signal was performed
separately for the repose and activation periods. A peak was Rey, B., Naranjo, V, Parkhutik, V., Tembl, J., Alcañiz. M. A
located in the low-frequency band of the spectrum and the New Visually Evoked Cerebral Blood Flow Response Analy-
component of the maximum BFV signal at this frequency sis Using a Low-Frequency Estimation. Ultrasound in Med-
was estimated, as shown in Fig. 1. The percentage variation icine and Biology (in press).
was calculated between the initial value of the low-frequency
estimation signal and its peak. The response time was calcu- ––––––––––––––––––––––––––––––––––––––––––––––
lated as the elapsed time until the peak was achieved. The use of advanced Technologies in the
Treatment of Psychological Stress
results
Percentage variations were positive in the periods correspon-
ding to visual stimulation. A mean BFV percentage variation Giuseppe Rivaa,b,1, Davide Algeria, Federica Pallavicinia,c,
of 4.572% was observed in left PCA and 4.114% in right Claudia Repettoa,b, Alessandra Gorinia,d, and
PCA. Negative percentage variations were observed in re- Andrea Gaggiolia,b
pose periods. Mean response times ranged between 8.544 s
and 10.726 s. Applied Technology for Neuro-Psychology Lab., Isti-
a

tuto Auxologico Italiano, Italy

Conclusions
b
ICE-NET Lab., Università Cattolica del Sacro Cuore, Italy
The study has shown that in the presence of visual stimuli,
c
Centre for Studies in Communication Sciences, Univer-
BFV rises to a maximum that is achieved after a few seconds. sity of Milan-Bicocca, Italy
This increment in BFV has its origin in the brain activity that
d
Research Institute Brain and Behaviour, Maastricht
appears in the occipital lobe regions in response to visual per- University, The Netherlands
ception, as long as PCA are the vessels that supply this part
of the brain. Corresponding author:
1

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170 Abstracts from CT15

Giuseppe Riva
Istituto Auxologico Italiano
Via Pelizza da Volpedo 41
20100 Milan, Italy
E-mail: giuseppe.riva@unicatt.it

abstract
The term “psychological stress” describes a situation in which
a subject perceives that environmental demands tax or exceed
his or her adaptive capacity. According to the Cochrane Data-
base of Systematic Reviews, the best validated approach cov-
ering both stress management and stress treatment is the
Cognitive Behavioral Therapy (CBT) approach. We aim to de-
sign, develop and test an advanced ICT-based solution for the
assessment and treatment of psychological stress that is able to
improve the actual CBT approach. To reach this goal we will
use the “interreality” paradigm integrating assessment and
treatment within a hybrid environment, that creates a bridge
between the physical and virtual worlds. Our claim is that
bridging virtual experiences – fully controlled by the therapist
and used to learn coping skills and emotional regulation – with
real experiences will allow both the identification of any critical
stressors and the assessment of what has been learned. The use
of advanced technologies (virtual worlds, advanced sensors
and PDA/mobile phones) is the best way to address the above
limitations. To illustrate the proposed concept, a clinical sce-
nario is also presented and discussed with the participant Rosa,
a 55 year old nurse, with a mother affected by progressive se-
nile dementia.

Keywords: Interreality, Virtual Reality, Biosensors,

Stress, Stress Management

introduction
According to Cohen and colleagues (2007) “psychological
stress” occurs when an individual perceives that environmental
demands tax or exceed his or her adaptive capacity. In this view,
stressful experiences are conceptualized as person-environment
transactions, whose result is dependent on the impact of the
external stimulus.

According to the Cochrane Database of Systematic Reviews

(Bisson & Andrew, 2007; Thomson & Page, 2007) , the best
validated approach covering both stress management and stress
treatment is the Cognitive Behavioral Therapy (CBT) ap-
proach. Here we aim to design, develop and test an advanced
ICT-based solution for the assessment and treatment of psy-
chological stress that is able to address three critical limitations
of CBT–the therapist is less relevant than the specific protocol
used, the protocol is not customized to the specific character-

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Abstracts from CT15
istics of the patient and the focus of the therapy based more on
the top-down model of change (from cognitions to emotions)
than on the bottom-up (from emotions to cognitions).
The interreality approach
To reach this goal the project will use the “Interreality” par-
adigm that integrates assessment and treatment within a hy-
brid environment, bridging physical and virtual world. Our
claim is that bridging virtual experiences – fully controlled
by the therapist and used to learn coping skills and emotional
regulation – with real experiences that will allow both the
identification of any critical stressors and the assessment of
what has been learned. The use of advanced technologies
(virtual worlds, advanced sensors and PDA/mobile phones)
is the best way to address the above limitations.
By creating a bridge between virtual and real worlds, Inter-
reality allows a full-time closed-loop approach actually miss-
ing in current approaches towards the assessment and
treatment of psychological stress – the assessment is con-
ducted continuously throughout the virtual and real experi-
ences. It enables tracking of the individual’s psycho-
physiological status over time in the context of a realistic task
challenge, and the information is constantly used to improve
both the appraisal and the coping skills of the patient: it cre-
ates a conditioned association between effective performance
state and task execution behaviors.
To illustrate the proposed concept, a clinical scenario is also pre-
sented and discussed using the participant Rosa, a 55 year old
nurse, with a mother affected by progressive senile dementia.
references
Bisson, J., Andrew, M. Psychological treatment of post-trau-
matic stress disorder (PTSD). (2007) Cochrane Database of
Systematic Reviews, Issue 3. Art. No.: CD003388. DOI:
Cohen, S., Janicki-Deverts, D., Miller, G.E. (2007) Psycho-
logical Stress and Disease, JAMA, 298:1685-1687.
Gorini, A., Gaggioli, A., Vigna, C., Riva, G. (2008). A Second
Life for eHealth: Prospects for the Use of 3-D Virtual Worlds
in Clinical Psychology. J Med Internet Res, 10 (3), e21.
Riva, G. (2009). Interreality: A New Paradigm for E-health.
Stud Health Technol Inform. 2009;144:3-7.
Thomson, A.B., Page, L.A. (2007). Psychotherapies for
hypochondriasis. Cochrane Database of Systematic Reviews.
Issue 4. Art. No.: CD006520.
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using Virtual humans to alleviate social anxiety: pre-
liminary report from a Comparative outcome study
Geneviève Robillarda,1, Stéphane Boucharda, Stéphanie
Dumoulinaa, Tanya Guitarda, and Évelyne Klingerb
a
Université du Québec en Outaouais
Arts et Métiers ParisTech-LAMPA Angers-Laval
b
1
Corresponding author:
Geneviève Robillard
Université du Québec en Outaouais
283 boul. Alexandre-Taché, C.P. 1250
succursale Hull, Gatineau, Québec
Canada, J8X 3X7
E-mail: Genevieve.Robillard@uqo.ca
abstract
Empirical studies have consistently shown the effectiveness
of a multicomponent cognitive behavioral therapy (CBT)
treatment of social anxiety disorder (SAD). Previous outcome
studies on Virtual Reality (VR) and SAD have focused on
people suffering from fear of public speaking and not full
blown SAD. In this study, 45 adults receiving a DSM-IV-TR
diagnostic of social anxiety were randomly assigned to tra-
ditional CBT treatment (with in vivo exposure), CBT-VR
combined treatment, or a waiting list. Results show signifi-
cant reduction of anxiety on all questionnaires as well as sta-
tistically significant interactions between both treatment
groups and the waiting list.
Keywords: Social Anxiety, Virtual Reality, Anxiety
introduction
Social anxiety disorder (SAD) is characterized by a marked
and persistent fear of being judged negatively or humiliated
in social or performance situations and leads to avoidance of
social situations (American Psychiatric Association). Accord-
ing to Statistics Canada, SAD affected 750,000 Canadians in
2002 and its lifetime prevalence is estimated at 13.3%
(Kessler et al., 1994). SAD often results in a diminished qual-
ity of life, considerable emotional suffering, and significant
impairment in personal, occupational and social experiences.
Empirical studies over the past 20 years have consistently
shown the effectiveness of a multicomponent cognitive-be-
havior intervention in the treatment of SAD (Barlow, 2002;
Stein, 2006; Stangier, Heidenreich, Peitz, Lauterbach, &
Clark, 2006; Clark et al., 2006; Hofmann, 2005; Wilson &
172
Rapee, 2005.) CBT treatment packages typically include ex-
posure to the feared situation(s), social skills training and cog-
nitive-restructuring.
One significant limitation of the traditional in vivo exposure
is the difficulty for the therapist to provide adequate and con-
trolled social interactions (e.g., audience to conduct the ex-
posure, control on people’s reactions, variety of social
situations appropriate for exposure) in order to make progress
in a continuous and non-threatening way for the participant.
Virtual reality (VR) overcomes many of the shortcomings of
in vivo exposure, in addition to providing a treatment that is
more readily accepted by clients (Garcia-Palacios, Botella,
Hoffman, Villa, & Fabregat, 2004; Garcia-Palacio, Hoffman,
See, Tsai, & Botella, 2001) and allows the client to interact
with a phobic scenario in the safety and confidentiality of the
office.
Outcome studies for VR and SAD are more recent than those
on specific phobias, the latter having repeatedly confirmed the
efficacy of in virtuo exposure (Wiederhold & Wiederhold,
2004). Few studies have been published so far, and mostly
concentrating on fear a public speaking, a less severe form of
SAD (North, North, & Coble, 1998). Also, a previous study
conducted by Klinger and colleagues (2005) showed a signif-
icant effect of VR on SAD. Despite the limitations of that early
study (Klinger et al., 2005), we can safely propose that using
virtual humans to conduct in virtuo exposure would be a useful
alternative to traditional CBT in the treatment of SAD. This
present study aims to compare very similar CBT treatments
that differ only by the use, or absence of, of in virtuo exposure
versus a waiting list control condition. Our hypothesis is that
both treatments will be superior to the waiting list.
method
Forty-five adults (mean age 34.9 years old; 71% female) re-
ceiving a DSM-IV-TR diagnosis of social anxiety have com-
pleted the study and were randomly assigned to one of these
three conditions – traditional individual CBT treatment (CBT;
n=16), individual CBT combined with in virtuo exposure
(CBT-VR; n=14) and waiting list (WL; n=15). CBT group
and CBT-VR group participants received 16 individual ses-
sions of therapy. WL group participants were measured “pre
and post” and, for ethical reasons, were later treated for their
condition.
Both treatment groups had individual exposure sessions every
week that were done in various public speaking and social
situations (virtual or not, depending on the participant group
condition). For the CBT-VR group, the software used for ex-
Abstracts from CT15
posure were created by E. Klinger in the European VEPSY
Updated project or by Virtually Better Inc. The hardware used
was a HP xw4600 Workstation Intel® Core™2 Duo CPU
E6850 @ 3.00 GHz, 3.48 GB of RAM, with a NVidia
GeForce 8800 GTX graphic card, running on Windows XP
Professional (version 2002). An eMagin z800 3D Visor was
used as the virtual helmet.
results
This study compared 16 individual therapy sessions of tradi-
tional CBT with in vivo exposure, CBT with in virtuo expo-
sure and a waiting list control condition. Results on anxiety
rated scales and self-report questionnaires showed a signifi-
cant improvement in both treatment conditions comparing
the waiting-list (see Table 1). The ANOVAs revealed signif-
icant time effects on all measures (p< .001) and no significant
group main effects. Most importantly, statistically significant
group by time interactions were found, confirming that treat-
ments were superior to the waiting list. Further analyses of
treatment X contrast interactions revealed that both active
treatments were superior to the waiting list. First, for those
receiving CBT with in vivo exposure, the interactions con-
trasts between traditional CBT and the WL have been found
to be significant on the Liebowitz scale (F= -2.53, p<0.05),
the Social Phobia Scale (F= -3.07, p<0.01), the Appraisal of
Social Concerns (probability F= -2.53, p<0.05; consequence
F= -2.54, p<0.05), the Fear of Negative Evaluation (F= -2.42,
p<0.05), a Self-efficacy single-item measure (F=2.34,
p<0.05), the Beck Depression Inventory II (F=-2.97 p<0.01)
and the Trait-anxiety subscale of the STAI (F= -2.56, p<0.05).
Significant interaction contrast were also found for the CBT-
VR Group and WL Group on the Liebowitz Scale (F= -4.06,
p<0.001), the Social Phobia Scale (F= -5.12, p<0.001), the
Appraisal of Social Concerns (probability F= -3.67, p<0.001;
consequence F= -3.38, p=0.001), Fear of Negative Evaluation
(F= -3.36, p=0.001), the Self-efficacy single-item measure
(F= 2.59, p<0.05), the Beck Depression Inventory II (F=-
3.17, p<0.01) and the Trait-anxiety Inventory (F= -4.44,
p<0.001).
These significant interaction contrasts confirmed our hypoth-
esis that both treatment conditions were superior to the wait-
ing list. This is the first randomized controlled study that
includes a large sample of people suffering from severe social
anxiety (DSM-IV-TR criteria) using CBT treatment com-
bined with in virtuo exposure and compared to a waiting list.
This study is part of a broader project that will determine
whether the effects of the two treatments are sufficiently sim-
ilar to be considered equivalent and exploratory analyses will
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Abstracts from CT15 173

Table 1
Descriptive results and repeated measures ANOVA for pre post data. N = 45
CbT CbT-Vr Wl
mean (sd) – pre/post mean (sd) – pre/post mean (sd) – pre/post interaction f
72.44 (23.91) 82.93 (32.23) 79.60 (25.90)
LSAS 8.40***
50.38 (23.87) 47.50 (17.83) 77.93 (22.23)
30.25 (14.84) 38.29 (16.65) 33.53 (13.40)
SPS 13.31***
20.19 (10.51) 18.07 (10.87) 37.47 (15.28)
46.22 (24.49) 53.39 (16.99) 49.25 (12.89)
ASC-P 7.06**
26.88 (20.24) 23.84 (17.08) 50.24 (14.60)
62.40 (22.42) 70.32 (18.58) 55.15 (18.07)
ASC-C 6.06**
34.92 (24.43) 33.70 (23.63) 53.57 (15.71)
23.69 (6.23) 25.64 (6.13) 24.27 (4.51)
FNE 6.02**
18.50 (7.66) 18.00 (8.21) 24.73 (4.51)
50.31 (20.61) 46.79 (19.48) 42.83 (17.24)
SESM 4.08*
70.63 (14.59) 69.57 (13.25) 46.00 (19.48)
14.19 (12.88) 11.57 (7.35) 12.40 (7.48)
BDI-II 6.30**
7.75 (9.16) 4.07 (4.32) 16.13 (13.33)
49.40 (10.78) 53.71 (9.55) 49.33 (9.19)
STAI-Y2 9.94***
43.33 (10.71) 42.43 (11.22) 50.07 (9.96)

Note. LSAS= Liebowitz Social Anxiety Scale; SPS = Social Phobia Scale; ASC-P=Appraisal of Social Concerns – subscale
probability; ASC-C= Appraisal of Social Concerns – subscale consequence; FNE= Fear of Negative Evaluation; SESM= Self-
efficacy single measure; BDI-II=Beck Depression Inventory II= STAI-Y2= State-Trait Anxiety Inventory – form Y2 (Trait).
*p<0.05; **p<.01, **p<0.001.

assess variables that may contribute to the process of change
such as the therapeutic alliance, the sense of presence, im-
mersive tendency and cognitive variables.
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Stangier, U., Heidenreich, T., Peitz, M.,Lauterbach, W., Clark,
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(2005), 373-389.
––––––––––––––––––––––––––––––––––––––––––––––
development of a Computer based symmetry and
arrangement symptoms measures in
obsessive-Compulsive disorder
Daeyoung Roha,1, Kwanguk Kimb, Chan-Hyung Kima
Department of Psychiatry and Institute of Behavioral
a
Science in Medicine, Yonsei University
College of Medicine, Seoul
b
Department of Biomedical Engineering,
Hanyang University, Seoul, Korea
1
Corresponding author:
Daeyoung Roh
Department of Psychiatry and Institute of Behavioral
Science in Medicine
Yonsei University College of Medicine
Seocho2dong, Woosung APT 15-1303, SeochoGu
137-773 Seoul, Korea
E-mail: omydoc@naver.com
abstract
Background: Epidemiological studies indicated that compul-
sive ordering and arranging, and a preoccupation with sym-
metry are common presentations of obsessive-compulsive
disorder (OCD).
Abstracts from CT15
Objective: The goal of the current study was to develop and
obtain preliminary psychometric data for the objective and
quantitative measurement of symmetry and arrangement
symptoms in OCD.
Method: Twenty-eight normal volunteers were administered
computer-based assessment tasks with four different condi-
tions, with or without target and distraction. Primary depend-
ent variables included several indices of time and number of
clicks related to arranging behaviors. Construct validity for
the task was examined by comparing the novel behavioral
measures with standardized measures such as Symmetry, Or-
dering and Arranging Questionnaire (SOAQ), Obsessive
Compulsive Inventory-Revised (OCI-R), Beck depression
Inventory (BDI), Beck Anxiety Inventory (BAI) and Quality
of life scale (QOL)
Result: We found a significant positive correlation between
behavioral parameters and standardized scales for OCD (total
time and SOAQ: r2=0.623, P<0.001, total number of clicks
and "ordering" subscore of OCI-R: r2=0.541, P<0.01). There
was no significant correlation between behavioral parameters
and other scales measuring constructs less relevant to order-
ing and arranging. A main effect of target only was observed
on behavioral parameters.
Conclusion: This study therefore provides preliminary data
to support the use of this task as a novel behavioral measure
of compulsive symptoms related to symmetry, ordering and
arranging.
Keywords: Symmetry, Ordering,
Obsessive-Compulsive Disorder
introduction
Obsessive–compulsive disorder (OCD) is a severe psy-
chiatric disorder associated with considerable impairment.
Although in research settings the diagnosis of OCD can
be reliably obtained using structured clinical interviews in
private practice and other community-based treatment set-
tings, the diagnosis is often reached through idiosyncratic
clinical interviews and, at best, self-report inventories.
However, this approach is problematic, given that reliance
on one method of assessment (e.g., patient self-report)
may inadequately capture clinical phenomena. Further,
such an approach may be associated with poor reliability,
as evaluations may differ across even expert observers. In
light of the need to develop additional assessment meas-
ures for OCD that extend beyond self-report inventories
and clinical interviews, Kim et al. (2008) developed a
computer-based behavioral assessment of checking be-
JCR
Abstracts from CT15 175

havior in OCD and examine the validity of a novel behav- Table 1

ioral assessment. Correlations between behavioral parameters and other
variables in normal subjects
Given the results of epidemiological data indicating that or-
Total number of
dering and arranging is one of the more common presenta- Variable Total time
clicks
tions of OCD, in adults, and in children, the neglect is
surprising. The purpose of the present study was to develop
SOAQ 0.623† 0.536†
and obtain preliminary psychometric data for a computer-
based behavioral measure of symmetry and arrangement
OCI-R(ordering
symptoms. 0.495* 0.541†
subscore)

methods OCI-R(total score) 0.401 0.541†

The virtual environment, in which subjects were given the
task of rearranging objects on a desk, was designed to elicit
symmetry and arrangement symptoms. The virtual environ- BDI 0.145 0.157
ments and objects were constructed using 3D–MAX (Dis-
creet, USA), and were converted for rendering in the A6 BAI 0.095 0.020
GameStudio Engine (Conitec, Germany). Twenty-eight nor-
mal volunteers were enrolled with four different conditions,
QOL -0.247 -0.347
with or without target and distraction. Primary dependent
variables included several indices of time and number of
*:p<0.05, †:p<0.01
clicks relating to arranging behaviors. Construct validity for
the task was examined by comparing the novel behavioral J.J., Han, K., Kim, I.Y., Kim, C.H. Development of a com-
measures with standardized measures such as SOAQ, Ob- puter-based behavioral assessment of checking behavior in
sessive OCI-R, BDI, BAI and QOL. obsessive-compulsive disorder. Compr Psychiatry 2009;
doi:10.1016/j.comppsych.2008.12.001.
results
There was a significant positive correlation between behav- ––––––––––––––––––––––––––––––––––––––––––––––
ioral parameters and standardized scales for OCD (total time indoor orientation and mobility for
and SOAQ: r2=0.623, P<0.001, total number of clicks and learners Who are blind
"ordering" subscore of OCI-R: r2=0.541, P<0.01). There was
no significant correlation between behavioral parameters and Mauricio Sáenza,1 and Jaime Sáncheza
other scales measuring constructs less relevant to ordering
and arranging (see Table 1). Department of Computer Science, University of Chile
a

There was significant main effect of target only on total time 1

Corresponding author:
(F=22.00, p<0.001) and number of clicks (F=4.66, p<0.05). Mauricio Sáenz
Department of Computer Science
discussion University of Chile
To our knowledge, this is the first study to utilize VR tech- Blanco Encalada 2120
nology in a behavioral measure of symmetry and arrange- Santiago de Chile
ment symptoms in OCD. Construct validity was E-mail: msaenz@dcc.uchile.cl
demonstrated by the significant positive correlations between
task performance and both self-reported measures. Our find- abstract
ings indicate that the behavioral task is capable of measuring This study consisted of designing a mobile technology to
a range of parameters associated with symmetry and arrange- identify the position and orientation of people who are blind
ment symptoms in OCD. in closed environments such as a school, building or home,
and identifying the necessary infrastructure based on criteria
references of usability, reliability and accessibility, in order for PocketPC
Kim, K., Kim, S.I., Cha, K.R., Park, J., Rosenthal, M.Z., Kim, device interface developers to be able to define the technol-

JCR
176
ogy to be used at an early stage. The technology consisted of
using PocketPC devices with a data collecting application
and another application for the representation of space. We
evaluated its usability, accessibility, reliability, efficiency, and
availability. The results of the usability evaluation assured us
that the interface designed and developed is suitable for users
who are blind, which is reaffirmed through the accessibility
evaluation. The reliability, efficiency and availability evalu-
ations of the system show that a user who is blind can use the
system confidently, because it provides correct information
for more independent navigation.
Keywords: Orientation & Mobility, People Who are Blind,
Blind Navigation, Indoor Context
introduction
In this work we present technology for identifying the po-
sition and orientation of a user through the implementation
of a Pocket PC device. Such technology can be used in
order to assist users who are blind to achieve autonomy in
their navigation through indoor spaces such as corporate
buildings, schools, and residential buildings.
The system is based on the use of WiFi technology together
with a previous representation of the environment, which
admits fewer access points for determining the necessary
information. To these ends, the system consists of three ap-
plications – PYOMDatos, which captures the intensity of
the signal from the required points, PYOMAnalyses, which
analyzes the data collected and maintains the data organized
and structured for its future use, and PYOM, the user ap-
plication that captures the intensity of the signal from the
environment and compares the results with those that are
stored, being able to provide the user with information on
his/her position and orientation, on command.
The PYOM software, which is the application that the
users who are blind utilized, was designed and developed
with a user-centered methodology, in such a way as to
achieve fast, reliable and usable results. To create this soft-
ware, it was essential to learn end users’ opinions and their
apprehensions when navigating through unfamiliar envi-
ronments. In order to gather this information, a focus group
was implemented at the beginning of the study including
four people who are blind between 19-34 years of age. The
focus group was conducted by two interface experts and
one special education teacher specializing in visual disor-
ders. The data and information obtained was used to re-
design and improve different stages of the interface design
process.
Abstracts from CT15
usability evaluation of the pyom software
The sample was made up of five users, from Santiago, Chile,
with ages between 14 and 34 years old, two women and three
men, one totally blind user and four users with very poor vi-
sion, according to ophthalmologic diagnoses. An engineer
who is an expert in interfaces, as well as a special-education
teacher specializing in visual disabilities, guided the evalua-
tions. We used three instruments – a PYOM Evaluation
Questionnaire specially designed for this software which con-
sists of three open questions focusing on the problems directly
related to the use of the software, another evaluation ques-
tionnaire with open questions was also used, which contains
10 questions regarding the use of the software and its appli-
cability, and finally, for the end-user evaluation, the Software
Usability for Blind Children Questionnaire, designed by
Sanchez (2003), was used.
results
The results obtained from the PYOM software evaluation
questionnaire were clear and denoted a lack of information
from the system. Regarding the problems with position, users
pointed out that they needed more details on the room they
were in, or more specific information on their location within
the room. They pointed out that they had better ways of ori-
enting themselves, by means of key places or the clock tech-
nique that they already knew through the use of the aGPS
software.
In the first usability test the results were low compared to ex-
pected outcome. Of the maximum total of 10 points that each
category could receive, all were rated in the middle. If we
separate the sample by gender, the females gave a higher
evaluation of the software than the men, but the difference is
not statistically significant. The scores were higher than the
first test, and there was considerable improvement expected
for the changes made to the software based on the results of
the first evaluation. The final test received a higher evaluation
than the first, but without any statistically significant differ-
ences.
Although there were no significant differences in the usability
evaluations for both tests, including by gender differences,
the PYOM software was evaluated highly, achieving high re-
sults in the end-user evaluation guideline and the open ques-
tions guideline. The final usability evaluation achieved the
highest results of all three aspects evaluated, which were user
satisfaction, control and use and sound quality, which implies
an improvement in the system’s interface both in the way it
presents data and in the data itself. The entire process of the
design and development was carried out with a user-centered
JCR
Abstracts from CT15
methodology, for which reason the results were usable and
accessible for the end-users. The main application, PYOM,
has a touch screen and audio interface that allows simple ma-
nipulation by users who are blind, which is reflected in the
results of the usability evaluations.
references
Sánchez, J. 2003. End-user and facilitator questionnaire for
Software Usability. Usability evaluation test. University of
Chile, Santiago de Chile.
––––––––––––––––––––––––––––––––––––––––––––––
snss usage among Chinese internet users:
an empirical study
Junqi Shia,1 and Qikun Niua
a
Department of Psychology, Peking University
1
Corresponding author:
Junqi Sh
Department of Psychology
Peking University
No.5 Yiheyuan Road Haidian District
Beijing, P.R.China 100871
E-mail: junqi_shi@pku.edu.cn
abstract
Renren and Kaixin, which are Chinese versions of “Face-
book,” are the main Social Network Sites (SNSs) in China.
Although many researchers have been exploring SNSs usage
and have gained rich results, there are limited studies for the
understanding of SNSs usage in China. In this present study,
with 777 Chinese participants, we test variables influencing
Chinese SNSs usage based on the technology acceptance
model (TAM). Using structural equation modeling tech-
niques, the empirical results confirm that the perceived ease
of use significantly determines the perceived usefulness,
which in turn influences SNSs usage. Meanwhile, Internet
self-efficacy could affect perceived ease of use and further
determine SNSs usage indirectly. Overall, our results could
be used to describe and predict SNSs usage among Chinese
Internet users.
Keywords: Social Network Sites (SNSs), Technology Ac-
ceptance Model (TAM), Internet
introduction
Social Network Sites (SNSs) have been a hot topic in recent
years, as more and more Internet users are using these new
tools to communicate, such as keeping contact with their old
JCR
177
Figure 1. Model description and results.
friends, maintaining current relationships and exploring new
friendships. In some countries and areas, Facebook has been
one of the most popular SNSs. As SNSs usage will influence
Internet users’ social network, social capital, and even
lifestyle (Ellison, Steinfield, & Lampe, 2007), the usage of
Facebook has attracted researchers’ attentions in recent years.
Many findings have been made based on the technology ac-
ceptance model (TAM), which helps our understanding of
SNSs usage (Shin & Kim, 2008).
However, for reasons such as cultural differences and the way
in which people deal with SNSs, usage might differ between
Eastern countries, such as China, and Western countries, such
as the U.S. Therefore, the variables that influence Facebook
usage might not play important roles in the Chinese context.
Moreover, in previous studies, results might suffer method-
ological complications as multiple regression has been the key
tool in testing the relationship among variables, where statis-
tical errors may exist when a large number of variables are
taken into account at the same time. Overall, our contributions
in this present study include testing what variables might de-
termine Chinese Internet users’ SNSs use intensity based on
TAM and using structural equation modeling instead of mul-
tiple regression as a methodological improvement.
methods
With the help of 777 participants, we tested a model based
on TAM among Chinese Internet users. All the variables were
edited from former research in this field, and structural equa-
tion modeling was used to test the pathway relationship be-
tween the variables in our proposed model.
results
In short, our results are depicted in Figure 1. All the relation-
ships directly and indirectly are significant (dotted lines indi-
cate indirect effects), indicating our proposed model is
well-tested.
Conclusion
As described above, perceived ease of use might determine
178
perceived usefulness, which in turn influences SNSs usage.
Internet self-efficacy affects perceived ease of use directly,
and influences SNSs usage indirectly.
references
Ellison, N.B., Steinfield, C., & Lampe, C. The benefits of
facebook “friends”: Social capital and college students’ use
of online social network sites, Journal of Computer-Mediated
Communication 12 (2007), 1143–1168.
Shin, D. & Kim, W., Applying the technology acceptance
model and flow theory to Cyworld user behavior: Implication
of the Web2.0 user acceptance, Cyber Psychology & Behav-
ior 11 (2008), 378–382.
––––––––––––––––––––––––––––––––––––––––––––––
Teaching Tactical Combat Casualty Care using the
TC3 sim game-based simulation: a study to measure
Training effectiveness
Teresita M. Sotomayora,1
U.S. Army Research Development and Engineering
a
Command Simulation and Training Technology Center,
Orlando, Florida, U.S.A.
1
Corresponding author:
Teresita M. Sotomayor
U.S. Army Research Development and Engineering
Command Simulation and Training Technology Center
12423 Research Parkway
Orlando, FL, 32826
U.S.A.
E-mail: Teresita.Sotomayor@us.army.mil
abstract
The effectiveness of games as instructional tools has been de-
bated over the past several decades. This is due to the lack
of empirical data to support such claims. The U.S. Army de-
veloped a game-based simulation to support Tactical Combat
Casualty Care (TCCC) Training. The TC3 game-based sim-
ulation is a first person game that allows a Soldier to play the
role of a combat medic during an infantry squad mission in
an urban environment. This research documents results from
a training effectiveness evaluation conducted at the Depart-
ment of Combat Medic Training (Ft. Sam Houston) in an ef-
fort to explore the capability of the game-based simulation
as a potential tool to support the TCCC program of instruc-
tion. Reaction to training, as well as acquisition of knowledge
and transfer of skills, was explored using Kirkpatrick’s Model
Abstracts from CT15
of Training Effectiveness Evaluation. Results from the eval-
uation are discussed.
Keywords: Game-based Simulation, Training Effectiveness
Evaluation, Kirkpatrick’s Model, Medical Skills Training,
Trauma Care Training
introduction
Tactical Combat Casualty Care (TCCC) is the pre-hospital
care rendered to a casualty at the point of injury in the battle-
field (Center for Army Lessons Learned, 2006). TCCC prin-
ciples have proven highly effective and are a major reason
why combat deaths in Operation Iraqi Freedom and Opera-
tion Enduring Freedom are lower compared to other conflicts
in the history of the U.S. (Parsons, 2005). Providing the right
tools and training to Combat Medics assist in achieving the
ultimate goal of reducing mortality rate in the combat envi-
ronment. Current tools and methods used for initial skills and
sustainment training of combat medics throughout the Army
can be improved. New technologies are needed to provide
medics with greater opportunities to develop and test their
decision making and technical medical skills in multiple and
relevant training scenarios (Fowler, Smith, & Litteral, 2005).
The U.S. Army Research Development and Engineering
Command, Simulation and Training Technology Center
(RDECOM-STTC) developed the 68W Tactical Combat Ca-
sualty Care Simulation (TC3 Sim) for the U.S. Army Medical
Department (AMEDD) Center & School at Fort Sam Hous-
ton. The Army is considering the use of the TC3 Sim game
as a tool to improve the training of individual soldiers as well
as improve the readiness of combat medics. The potential of
using games to encourage learning has been the focus of
many published studies. In fact, for several decades, the ben-
efits of games have been debated (Clark, 1983; Kozma,
1994). Claims that games can increase the motivation and in-
terest of trainees, and improvement of learning and improve-
ment of attitudes towards a particular subject matter are
addressed in this research. Several authors (Bredemeier &
Greenblat, 1981; Dorn, 1989; Greenblat, 1973; Leemkuil,
Jong, & Ootes, 2007; Mitchell & Savill-Smith, 2007; Randel,
Morris, Wetzel, & Whitehill, 1992; Whitley & Faria, 1989)
have presented extensive reviews of the literature trying to
provide a better understanding of those claims in terms of
available empirical data. Recently, Hays (2005; 2007) and
Wiebenga (2005) updated those findings with more recent
data. Both agreed that little attempt is being made to conduct
empirical research regarding the effectiveness of games in
training resulting in a critical gap between theory and practice
that needs to be addressed. This research evaluated the effec-
tiveness of the TC3 Sim as an instructional game developed
JCR
Abstracts from CT15
to teach the concepts of tactical combat casualty care. Ex-
periments were conducted to evaluate the training effective-
ness of this tool in supporting the 68W10 Healthcare
Specialist Course program of instruction (POI). Evaluation
of the game was performed utilizing the Kirkpatrick Model
for evaluating training effectiveness.
methodology
In order to assess the effectiveness of the TC3 game-based
simulation in supporting the learning of tactical combat ca-
sualty care principles, three levels of Kirkpatrick’s Model
were evaluated – User Reaction (Level 1), Skills Acquisition
(Level 2), and Skills Transfer (Level III). The study was con-
ducted at AMEDD, Fort Sam Houston, Texas. The experi-
mental group consisted of 180 Soldiers participating in the
TCCC program of instruction at the U.S. Army Medical De-
partment Center and School, Department of Combat Medic
Training. Three defined media sets were available for in-
struction of TCCC principles – Multimedia, Interactive and
Experiential. The multimedia consisted of PowerPoint-based
training on three areas of TCCC – Hemorrhage Control, Air-
way Management, and Breathing. The interactive set con-
sisted of TCCC computer-based courseware on the same
three areas with a variety of interactive presentation methods
with immediate feedback and remediation. The experiential
set consisted of self-served computer-based courseware with
the TC3 Sim game-based simulation. The TC3 Sim is a first
person game where the trainee plays the role of a 68W Com-
bat Medic assigned to a squad conducting surveillance in a
Middle Eastern urban environment. The main goal of the
game is for the Soldier to stay safe, prioritize treatment and
treat casualties. Participation in the study was voluntary and
was conducted over a period of three months. Participants
were randomly assigned to one of the three training condi-
tions – TCCC PowerPoint Training, TCCC Interactive
Courseware, and TCCC Interactive Courseware and TC3Sim
game-based simulation. Reaction data was obtained via ques-
tionnaires, knowledge acquisition was measured using pre-
post tests and transfer of skills was assessed with a paper and
pencil scenario exercise.
results
The research described focused on assessing three different
training conditions to train combat medics three areas of
TCCC principles. One of those conditions involved the use
of a game-based simulation as a tool to augment more tradi-
tional content training. An experiment was designed that en-
abled to discern statistical differences in effectiveness
between treatments at α = 0.05 and β = 0.20. Statistically sig-
nificant findings were the following:
JCR
179
Trainee post-training reaction
Medic trainees rated training as “Very Good” regardless of
the training condition received. They also agreed that the
training objectives were met during training and that the tech-
nology should be incorporated into the program of instruc-
tion. They all agreed that the technology was easy to use
regardless of training media.
Knowledge acquisition
Acquisition of knowledge occurred for all participants and
pre-post test gain scores for the interactive TCCC interactive
courseware and TC3 Sim game-based simulation experimen-
tal conditions were found to be better than the pre-post test
gain scores achieved by participants in the multimedia TCCC
PowerPoint group.
skill Transfer
Participants that received TCCC interactive courseware train-
ing and TC3 Sim game-based simulation scored higher in the
transfer task (paper and pencil scenario exercise) than partic-
ipants in the TCCC PowerPoint group.
discussion and Conclusions
There has been an increasing trend advocating gaming
technologies to support training in recent years. This re-
search focused on a particular instructional game devel-
oped to support training of combat medics in the principles
of tactical combat casualty care. The reaction to training
using a game to augment traditional training was explored,
as well as knowledge acquisition and skill transfer. Results
from the study suggest that games that have been devel-
oped to support specific learning objectives could augment
current content training delivery mechanisms. Games ap-
peal to the younger generation that has been exposed to
their use since an early age. Motivation is a large factor
observed within the training audience. One area that was
not addressed in this study is to evaluate how effective it
would be to incorporate the game component in a particular
program of instruction. Future research should also ex-
plore whether or not trainees would use the game as a tool
to improve critical thinking skills after training hours dur-
ing down time. Finally, it would be of benefit to conduct
longitudinal studies to explore the impact of game-based
training on performance and retention of learning objec-
tives and skills.
references
Bredemeier, M.E. & Greenblat, C.S. (1981). The educational
effectiveness of simulation games. Simulation & Games,
12(3)(1981), 307-332.
180
Center for Army Lessons Learned (CALL). Handbook 06-
18 tactical combat casualty care handbook. (2006) Retrieved
May 30, 2006, from https://call2.army.mil/products/hand-
books/asp/06-18/fwd.asp.
Clark, R.E., Reconsidering research on learning from media.
Review of Educational Research, 53(4) (1983), 445-459.
Dorn, D.S., Simulation games: One more tool on the peda-
gogical shelf. Teaching Sociology, 17(1989), 1-18.
Fowler, S., Smith, B., & Litteral, D.J., A TC3 game-based
simulation for combat medic training. Proceedings of the In-
terservice/Industry Training, Simulation and Education Con-
ference (I/ITSEC) (2005), Orlando, FL.
Greenblat , C.S., Teaching with simulation game: A review of
claims and evidence. Teaching Sociology, 1(1)(1973), 62-83.
Hays, R.T., The effectiveness of instructional games: A liter-
ature review and discussion (Tech. Rep. No. 2005-004)
(2005) Orlando, FL: Naval Air Warfare Center Training Sys-
tems Division.
Hays, R.T., Instructional Gaming Handbook: How to select
and Use Instructional Games(2007). Technical Report Naval
Air Warfare Center Training Systems Division, Orlando, FL.
Kozma, R., Will media influence learning: Reframing the de-
bate. Educational Technology Research and Development,
42(2)(1994), 7-19.
Leemkuil, H., de Jong, T., & Ootes, S., Review of educational
use of games and simulations(2000).Retrieved July 15, 2007,
from http://kits.edte.utwente.nl/documents/D1.pdf.
Mitchell, A., & Savill-Smith, C., The use of computer and
video games for learning (2004). Retrieved June 7, 2007,
from http://www.lsda.org.uk/files/pdf/1529.pdf.
Parsons, D.L., Pre-hospital care in the U.S. Army. Military
Medica/CBRNl Technology(2005), 9, 37-38.
Randel, J.M., Morris, B.A., Wetzel, C.D., & Whitehill, B.V., The
effectiveness of games for educational purposes: A review of re-
cent research. Simulation & Gaming, 23(3) (1992), 261-276.
Whitley, T.R. & Faria, A. J., A study of the relationship be-
tween student final exam performance and simulation game
participation. Simulation & Games, 20(1) (1989), 44-64.
Abstracts from CT15
Wiebenga, S.R., Guidelines for selecting, using, and evalu-
ating games in corporate training. Performance Improvement
Quarterly(2005), 18 (4), 19-36.
––––––––––––––––––––––––––––––––––––––––––––––
studying Warfighters with…more than surveys
Melba C. Stetza,1, Raymond A. Folena
and Richard I. Riesa
Department of Psychology, Tripler Army Medical
a
Center, Honolulu, Hawaii, U.S.A.
1
Corresponding author:
Melba C. Stetz
Department of Psychology
1 Jarrett White Rd
Honolulu, Hawaii 96819
U.S.A
E-mail: Melba.Stetz@us.army.mil
abstract
Abstract. Warfighters keep coming back from theater with
combat stress. The typical means of assessing their problems
involves the use of paper-and-pencil surveys. This is the case
despite indications that new recruits gravitate toward tech-
nology. The purpose of this symposium is to share some of
the experiences encountered in studying warfighters with vir-
tual reality.
Keywords: Warfighters, Combat Stress,
Virtual Reality, Technology
problem
Despite applications of best practices, many warfighters still
return from theater with combat stress symptoms (Hoge,
Auchterloni, Milliken, 2006). Also, new recruits seem to
gravitate towards varied forms of technology as a part of their
lifestyles (Headquarters Department of the Army, 2009).
Therefore, researchers and clinicians should incorporate tech-
nology in sessions with warfighters.
non-technological studies
One way to study military stress is by obtaining archival in-
formation. In a study on 5,671 records of warfighters that had
been removed from the battle-zone, behavioral health prob-
lems accounted for about 7% of all cases (Stetz, McDonald,
Lukey, Gifford, 2005). In another study Stetz (author) admin-
istered surveys to aviators (n = 283) in order to learn about
their main stressors and coping strategies (Stetz et al., 2009).
JCR
Abstracts from CT15
Main stressors ranged from difficulty sleeping (21%) to an-
hedonia (12%). Some of their coping strategies were going
to the gym (66%), watching movies (62%), and playing com-
puter games (39%). Both of these studies were relatively easy
to run.
The gaming warfighter
Virtual Reality (VR) can be seen by the new warfighters as
congruent to their immersive “gaming” activities, since it typ-
ically involves a game pad and a computer screen. A benefit
of VR is that stressors can be systematically added and mon-
itored to virtual environments in sessions. Additionally, this
approach can easily be complemented by paper-and-
pencil/computerized surveys and physiological measurement
equipment (e.g., biofeedback).
Tools and results
Wiederhold and others have reported success when applying
VR to mitigate the negative effects of combat stress (Wieder-
hold, Bullinger, & Wiederhold, 2006). Similarly, Stetz,
Long, Wiederhold, and Turner (2008) examined the useful-
ness of VR technology with a sample of medics (n = 60).
This study examined the emotional levels of participants
who were in a group to either practice combat medical skills
(VR-only) under virtual stress, practice relaxation techniques
in a virtual environment (VR-coping), or both (VR-both).
The VR-only group showed higher levels of hostility than
the rest of the groups, suggesting immersion and possibilities
for ongoing inoculation in a VR world. One of the challenges
faced during this study was that the sample was composed
of medics attending a “Flight Medic” course with tight
schedules. This course is physically and academically rig-
orous and data collection had to take place during limited
work-free time.
During another VR study, preliminary data suggested that
participants (n = 30) watching videos of angry bosses yelling
at them while wearing head mounted displays showed higher
levels of presence/immersion and emotional reactivity to
anger than those watching the videos via a flat screen (n =
30) (Folen, Miyahira, & Stetz, 2009). A challenge faced dur-
ing this study protocol was that it was written a few years
prior to data gathering. Therefore, hardware and software had
to be upgraded and modifications submitted for more review
approvals.
More recently, Stetz, Bouchard, Wiederhold, and Folen
(2009) reported that individuals who practiced relaxation via
VR scenarios (n = 29 out of 30) would probably continue
practicing on their own after the study. A problem during this
JCR
181
study was that it took place in a location requiring excessive
travel time to the data collection site. Also, the VR and
biofeedback systems suffered excessive handling, leading to
equipment breakdown.
Conclusion
VR is a very useful tool for studying and treating
warfighters.
references
Folen, R.A., Miyahira, S. & Stetz, M. C. Immersive
Panoramic Video Display Compared to Flat Screen Display:
Psychological and Physiological Reactions to Anger Stimuli.
14th Annual CyberTherapy and CyberPsychology Confer-
ence, Lago Maggiore, Verbania-Intra, Italy, June 2009.
Headquarters Department of the Army. Field Manual 7.0
“Training for Full Spectrum operations” (2009).49.
Hoge, C.W., Auchterloni, J.L., Milliken, C.S. Mental health
problems, use of mental health services, and attrition from
military service after returning from deployment to Iraq or
Afghanistan. Journal of the American Medical Association
2006; 295:1023–32.
Stetz, M.C., McDonald, J.J., Lukey, B.J., & Gifford, R.K.,
(2005). Psychiatric Diagnoses as a Cause of Medical Evac-
uation. Aviation, Space, and Environmental Medicine, 76 (7),
C15-20.
Stetz, M.C., Long, C. P., Wiederhold, B. K., & Turner, D. D.
(2008). Combat Scenarios and Relaxation Training to Harden
Medics Against Stress. Journal of CyberTherapy & Rehabil-
itation, 239-246.
Stetz M.C., Bouchard, S., Wiederhold, B.K., & Folen, R.A.
The Receptiveness of Stress Management Techniques by
Military Personnel. 14th Annual CyberTherapy and Cy-
berPsychology Conference, Lago Maggiore, Verbania-Intra,
Italy, June 2009.
Stetz, M.C., Ganz, M., Jenkins, C.M., et al. Stressors and cop-
ing choices while in Operation Iraqi Freedom. Hawaii Psy-
chological Association (HPA), Honolulu, Hawaii., Nov. 9–10,
2009.
Wiederhold, B.K., Bullinger, A.H., Wiederhold, M.D., (2006)
Advanced technologies in military medicine. Novel ap-
proaches to the diagnosis and treatment of posttraumatic
stress disorder. Amsterdam: IOS Press, pp. 148–60.
182
––––––––––––––––––––––––––––––––––––––––––––––
Virtual/real Transfer of spatial learning: impact of
activity according to the retention delay
Grégory Walleta.1, Hélène Sauzéona, Jérôme Rodriguesa
and Bernard N’Kaouaa
a
Laboratoire Cognition et Facteurs humains,
Université Victor Segalen Bordeaux II
1
Corresponding author:
Grégory Wallet
Laboratoire Cognition et Facteurs humains (EA-487)
Université Victor Segalen Bordeaux II
146 rue Léo-Saignat - 33076
Bordeaux Cedex, France
E-mail: gregwallet@free.fr
abstract
Within the framework of cognitive rehabilitation using virtual
reality (VR), one of the major challenges is to study before-
hand the effectiveness of the virtual-real transfer of learning
and to define cognitive aids. The aim of this experiment was
to verify if, after learning spatial knowledge (i.e., a route) in
VR, performances can be transferred to reality, then main-
tained in real time, and improved with the aid of an active
navigation (i.e., using a joystick).
Sixty student volunteers from the University of Bordeaux 2
(30 men and 30 women) participated in the experiment. The
virtual environment (VE) used for learning was a replica of
an area of Bordeaux. The factors tested were the retention
delay (Immediate vs. 48 hours) and the type of navigation
(passive vs. active) using three recall tasks: wayfinding (i.e.,
a reproduction of the route in reality in order to study the vir-
tual-real transfer), freehand sketch (i.e., drawing a map of the
route) and photograph classification (i.e., putting photographs
of places in chronological order).
Our results on the wayfinding task showed that the virtual-
real transfer was as efficient 48 hours later as it was in im-
mediate recall. For the "sketch" task, the use of spatial
knowledge was even better when delayed by 48 hours. Fi-
nally, for the "classification" task, the performances were sim-
ilar regardless of the delay. Furthermore, active navigation
allowed performances to be optimised when reproducing the
route in reality (i.e., in the wayfinding task).
Keywords: Virtual Reality, Spatial Cognition, Knowledge
Transfer, Exploration Mode, Retention Delay, Recall Tasks
Abstracts from CT15
novelty/discussion
The study of virtual/real transfer allows to determine optimi-
sation situations for spatial learning and to propose recom-
mendations for constructing cognitive rehabilitation
programmes. Several factors can have an influence on the
transfer of knowledge. In this experiment, we tested the in-
fluence of retention delay and mode of navigation.
Retention delay is seldom studied within the framework of
spatial cognition in VE. The results obtained by Witmer et al.
(2002) indicate that spatial knowledge is mostly still present
one week after learning. Richards et al. (2003) showed that
configuration knowledge of a VE can be retained for a period
of one month. These authors stated that they tested configu-
rational knowledge by asking their subjects to remember the
spatial relationships between different places in the VE.
Our results concerning the retention delay agree with those
obtained by the few studies conducted on this factor. Indeed,
we show that the transfer is just as efficient after 48 hours of
retention. Performances are even improved by this delay for
the sketch task. Furthermore, active navigation is just as ef-
ficient at 48 hours as in immediate recall, and it is particularly
beneficial to the reproduction of the route in reality.
These results are important in the field of cognitive rehabili-
tation for spatial problems in VR. They show that spatial
knowledge can be transferred 48 hours after learning and that
active navigation might allow to optimise repercussions on
daily living activities.
references
Richards, J., Oman, C., Shebilske, W., Beall, A., Liu A., and
Natapoff, A., Training, transfer, and retention of three-dimen-
sional spatial memory in virtual environments. Journal of
Vestibular Research 12(5-6) (2003), 223-238.
Witmer, B.G., Sadowski, W.J. and Finkelstein, N., VE-Based
Training Strategies for Acquiring Survey Knowledge. Pres-
ence: Teleoperators and Virtual Environments, 11(1) (2002),
1-18.
––––––––––––––––––––––––––––––––––––––––––––––
Cost benefits of Virtual reality exposure Therapy with
arousal Control for the Treatment of Combat related
post Traumatic stress disorder: revisited
Dennis Patrick Wooda,1, Jennifer Webb-Murphyb, Robert
L. McLayc, James A. Spiraa, Scott Johnstonb,c,
Jeff M. Pyned, and Brenda K. Wiederholda
JCR
Abstracts from CT15
a
Virtual Reality Medical Center, San Diego, CA
b
Naval Center for Combat and Operational Stress Con-
trol, Naval Medical Center San Diego, San Diego, CA
c
Mental Health Directorate, Naval Medical Center San
Diego, San Diego, CA
d
Center for Mental Healthcare Outcomes Research,
Central Arkansas Veterans Healthcare System,
North Little Rock, AR
1
Corresponding author:
Dennis Patrick Wood
Virtual Reality Medical Center
6155 Cornerstone Ct. E., Ste. 210
San Diego, CA 92121
U.S.A.
E-mail: dpwcapt@aol.com
abstract
Important challenges confronting Department of Defense
(DOD)/military medical care are those of maintaining or in-
creasing quality of care and increasing the effectiveness of
treatments for warriors diagnosed with Posttraumatic Stress
Disorder (PTSD) secondary to their combat deployments to
Iraq or Afghanistan. One easily measured indicator of out-
patient mental health efficiency is the cost savings of reduced
training costs for replacing that Sailor, Marine, Soldier or
Guardsman who, without effective out-patient mental health
treatment for PTSD, would have been medically discharged
from active duty. Traditional PTSD therapy has been re-
ported as being effective with 37-54% of those treated. Vir-
tual Reality Exposure Therapy with Arousal Control
(VRET-AC) has demonstrated a treatment effectiveness rate
between 70% and 90% for warriors diagnosed with PTSD.
The cost-effectiveness of VRET-AC versus traditional treat-
ment for combat -related PTSD will be discussed.
Keywords: Virtual Reality Exposure Therapy with Arousal
Control (VRET-AC), Operation Enduring Freedom (OEF),
Operation Iraqi Freedom (OIF), Posttraumatic Stress Disor-
der (PTSD), Naval Medical Center San Diego (NMCSD),
Naval Hospital Camp Pendleton (NHCP)
introduction
A Department of Defense (DOD) Task Force report con-
cluded that 11-25% of Operation Iraqi Freedom (OIF) and/or
Operation Enduring Freedom (OEF) veterans have been di-
agnosed with Posttraumatic Stress Disorder (PTSD) and this
report recommended that DOD should aggressively develop
effective PTSD treatment programs (Arthur, MacDermid, &
Kiley, 2007). A RAND study concluded that half of those
JCR
183
U.S. service members who need treatment for combat-related
PTSD or depression seek such treatment and only slightly
more than half who receive treatment receive minimally ad-
equate care (Tanielian & Jaycox, 2008). Further, improving
access to high-quality care has been identified as cost-effec-
tive and can result in increased recovery rates (Tanielian &
Jaycox, 2008). Traditional treatments for combat-related
PTSD have resulted in recovery rates from 37-54% for all
those who entered or completed treatment (Bradley, Green,
Dutra, & Westen, 2005; Milliken, Auchterlonie, & Hoge,
2007). Conversely, for those warriors who have completed
Virtual Reality Exposure Therapy with Arousal Control
(VRET-AC), 70-90% have experienced significant reduc-
tions in PTSD symptoms (Wood et al., 2009; McLay et al.,
2009).
methods
Utilizing the effectiveness of traditional psychotherapy to
treat PTSD versus the effectiveness of VRET-AC, this pres-
entation will describe the estimated cost benefits of tradi-
tional psychotherapy as compared to VRET-AC with Navy
and Marine Corps participants diagnosed with combat related
PTSD.
results
Recently, 22 participants who had been diagnosed with PTSD
following their combat deployments completed VRET-AC.
Due to VRET-AC, the 22 participants experienced a signifi-
cant reduction in their PTSD symptoms. The training cost-
savings of VRET-AC was calculated and compared with the
cost-savings of traditional treatments for PTSD.
Conclusions
VRET-AC is a therapeutically effective exposure therapy and
a cost effective therapy to use with military personnel diag-
nosed with combat-related PTSD.
references
Arthur, D.C., MacDermid, S., Kiley, K.C. The achievable
vision: report of the Department of Defense Task Force on
Mental Health, June 2007. Defense Health Board, Falls
Church, VA.
Bradley, R., Green, J., Dutra, L., Westen, D. A multidimen-
sional meta-analysis of psychotherapy for PTSD. American
Journal of Psychiatry 2005; 162: 214 – 227.
McLay, R.N., Wood, D.P., Webb-Murphy, J.A., Spira, J.L.,
Wiederhold, M.D., et al. A randomized, controlled trial of
virtual reality exposure therapy with arousal control for post
184
traumatic stress disorder in active duty service members with
combat-related PTSD. Journal of the American Medical As-
sociation, 2009 (submitted for consideration for publication).
Milliken, C.S., Auchterlonie, J.L., Hoge, C.W. Longitudinal
assessment of mental health problems among active and re-
serve component soldiers return from the Iraq war. The Jour-
nal of the American Medical Association 2007; 298 (18):
2141 – 2148.
Tanielian, T. and Jaycox, L.H., Editors. Invisible wounds of
war: Psychological and cognitive injuries, their conse-
quences, and services to assist recovery, Rand Corporation
Monographs, 2008.
Wood, D.P., Murphy, J.A., Center, K.C., Johnston, S.L.,
McLay, R., Spira, J.L., Koffman, R., Wiederhold, B.K. Ef-
fectiveness of virtual reality graded exposure therapy with
physiological monitoring for combat related post traumatic
stress disorder. Presented during Medicine Meets virtual Re-
ality 17 Conference, Long Beach, CA, January 2009.
––––––––––––––––––––––––––––––––––––––––––––––
analysis of distributed-Collaborative activity during
augmented reality exposure Therapy for
Cockroach phobia
Maja Wrzesiena,1, Jean-Marie Burkhardtb,
Mariano Alcañiz Rayaad, Cristina Botellac,d,
and Juana Maria Bretón Lópezc
a
Instituto Interuniversitario de Investigación en Bioinge-
niería y Tecnología Orientada al Ser Humano, Universi-
dad Politécnica de Valencia, Valencia, España
b
Paris Descartes University, Laboratoire Adaptation Tra-
vail Individu, Paris, France
c
Departamento de Psicologia Basica y
Psicobiologia (UJI)
d
CIBER Fisiopatología Obesidad y Nutrición (CB06/03)
Instituto Carlos III
1
Corresponding author:
Maja Wrzesien
Instituto Interuniversitario de Investigación en Bioinge-
niería y Tecnología Orientada al Ser Humano
Universidad Politécnica de Valencia
Camino de Vera s/n
46022 Valencia
Spain
E-mail: mwrzesien@labhuman.i3bh.es
Abstracts from CT15
abstract
Recent research presents Augmented Reality Exposure Ther-
apy (ARET) for treatment of phobia of cockroaches as a po-
tentially effective technique. However, to the authors’
knowledge no studies have been published concerning the
Human-Computer-Interaction issues of such a system. The
aim of this paper is to report some preliminary data on ARET
activity. The results show that the therapeutic process is dis-
tributed between individuals, consisting of the patient and
therapist, and artifacts, for example the AR cockroaches, a
computer screen, a Head Mounted Display (HMD), a key-
board, a swatter, and therapists’ notes on paper. The results
are discussed in terms of possible improvement of the ARET
system.
Keywords: Augmented Reality Exposure Therapy,
HCI, Distributed Cognition
introduction
In vivo exposure therapy is considered to be standard therapy
for specific phobias (Emmelkamp, 2004), however, other ef-
fective therapies such as Augmented Reality Exposure Ther-
apy (ARET) can also be used. Although some preliminary
studies have been performed on the ARET in order to show
its clinical effectiveness such as the work done by Botella and
colleagues (2005), to the authors’ knowledge, no studies of
Human Computer Interaction (HCI) issues have been pub-
lished. There are several reasons that justify research on HCI
in the ARET field. First, little is known about HCI in this field.
Second, a multidisciplinary analysis framework is needed in
order to fully understand the therapeutic context and third,
the interpretation of the therapeutic activity in terms of col-
laboration should be addressed since the relationship between
the patient and the therapist is defined in these terms.
The aim of this paper is to report some pilot data on how the
patient, the AR system, and the therapist collaborate together
during ARET for cockroach phobia, and how the design of
ARET effectively supports such mixed (both mediated and
direct) collaborative interactions.
method
The analysis was based on the Distributed Cognition (DCog)
framework (Hutchins, 1995). Two different therapists per-
formed a single therapeutic session. In order to preserve the
patients’ privacy, the data were recorded and analyzed
(viewed and coded) afterward.
results
The results show that the therapeutic process is distributed
JCR
Abstracts from CT15
Figure 1. The distributed therapeutic process.
between individuals and artifacts (Figure 1). The results also
show an existence of a consistent therapeutic pattern that cor-
responds to the therapeutic treatment protocol, and a frequent
presence of a patients’ instantaneous fear. The researchers ob-
served as well that the therapists often hesitated before choos-
ing a function to apply on the keyboard.
discussion and conclusions
The DCog allows ARET activity to be presented from a mul-
JCR
185
tidisciplinary perspective. The analysis allowed us to propose
the following improvements – a more structured and concep-
tually easy to remember set-up of the functions on the key-
board and improved spacial set-up of the individuals and the
artifacts in order to diminish the therapists’ discomfort. Fi-
nally, the presence of a patients’ instantaneous fear led us to
conclude that the AR cockroaches produce true tension and
anxiety in patients just as real cockroaches do. The DCog
seems to be a valuable framework. This holistic design ap-
proach, which does not give preferential treatment to any of
the actors or artifacts, can offer a great contribution to the im-
provement of ARET activity.
references
Botella, C., Juan, C., Baños, R.M., Alcañiz, M., et al., Mixing
Realities? An application of Augmented Reality for the treat-
ment of cockroach phobia. CyberPsychology and Behavior
8, 2 (2005), 161-171.
Emmelkamp, P.M.G., The treatment of phobic disorders: Is
exposure still the treatment of choice? Evidence and experi-
ence in psychiatry7 (2004), 220-223.
Hutchins, E., Cognition in the wild, MIT Press, Cambridge
Massachusetts, 1995.
 Volume 13, Number 1 t Februar y 2010 t 1SSN: 2152-2715

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Special Issue on
Posttraumatic Stress Disorder
Lessons Learned from VR Sessions with
Warriors with Combat-Related PTSD
NOW AVAILABLE ONLINE! Behavioral Treatment of Earthquake
Special Issue on PTSD Survivors

visit www.liebertpub.com/cpb PTSD Due to Motor Vehicle Accident

to download this issue for FREE! Therapeutic Alliance in Telepsychotherapy
Virtual Reality in Iraq
And More...

posTer presenTaTion absTraCTs
––––––––––––––––––––––––––––––––––––––––––––––
Virtual reality environments to Treat pTsd for
Criminal Violence Victims
Georgina Cárdenas-Lópeza,1 and Anabel De La Rosaa
National Autonomous University of Mexico,
a
Ciudad de México, Mexico
1
Corresponding author:
Georgina Cárdenas López
Universidad Nacional Autónoma de México
Facultad de Psicología
Laboratorio de Enseñanza Virtual y Ciberpsicología
Ciudad de México
Mexico
E-mail: mgcl@servidor.unam.mx
abstract
Criminal violence has been linked to mental health prob-
lems such as depression and substance use and abuse.
However, one of most important psychological problems
linked with victims of violence is posttraumatic stress dis-
order (PSTD). In Mexico, according to the ENSI-5 in
2008, 11% (6,800/for each 100 thousands of habitants) of
the population over 18 years of age experienced a crime.
One in four victims of violence develops PSTD symp-
toms. Due to this socially relevant problem and based on
efficacy treatments, it is important to design treatments in-
volving the use of Virtual Reality (VR), because it can
help overcome some of the limitations of traditional ther-
apy using exposure. The present paper expounds on the
framework and preliminary description of four virtual en-
vironments developed for treatment programs for social
violence victims suffering from PTSD.
Keywords: Virtual Reality, PSTD Treatment, Criminal
Violence, Kidnapping, Assault
introduction
Violence is an issue of great importance for the general
population, due to resulting health and economic implica-
tions. Assaults in the public streets create an atmosphere
187
of danger and vulnerability. According to the World Health
Organization (WHO) (2002), violence has important im-
plications – both psychologically and physically, such as
depression, alcohol use and substance abuse. The most im-
portant psychological difficulties experienced by victims,
are related to posttraumatic stress disorder (PTSD).
In Mexico, according to data reported by the National Sur-
vey on Insecurity (2007), 11% (6,800 / per 100 thousand
inhabitants) of the population over 18 years old of age was
the victim of a crime. Of these cases, one in four exhibited
PTSD symptoms. Contemplating this background, it is
important to note the great impact of violence on mental
health. PTSD requires attention because who sufferers of
this disorder experience elevated degrees of anxiety, fear
and avoidance, which could be presented in different ways
that interfere in personal development and everyday life
of these patients. For this reason, this paper contemplates
a treatment using Virtual Reality (VR), because it can help
overcome some of the limitations of traditional therapy
using exposure. It could simulate the traumatic event with
a high degree of realism and thus help patients, regardless
of their ability to imagine the situation. This innovative
treatment has many benefits such as simple procedures.
Recent studies reported effectiveness of VR in treating
anxiety disorders, eating disorders, addictions, pain man-
agement, palliative care and rehabilitation (Rizzo, 2006).
The present paper expounds on the framework and offers
a preliminary description of virtual scenarios to develop a
treatment program to help people overcome stressful and
disturbing traumatic events.
Virtual environments: design and development
The current study is arranged in two phases. The first
phase consists of the development of four virtual environ-
ments related to traumatic events for exposure treatment
of PTSD, such as a streets of Mexico City scenario (Fig.
1), which includes a pedestrian bridge (Fig. 2), a vehicle
(taxi / wagon) (Fig. 3), and a kidnapping room (Fig. 4),
with the aim of exposing the patient to the memories of
the trauma. The second phase will address the clinical va-
lidity of VR exposure treatment for victims of criminal vi-
olence suffering from PTSD.
JCR
188
Figure 1. City view Figure 2. Bridge view
Figure 3. Taxi view Figure 4. Kidnapping room
pTsd scenario settings
We report on a preliminary basis the development of vir-
tual environments for the treatment of PTSD. The envi-
ronments, created in Studio Max, are dynamic, 3-D and
highly acoustical and tactile, modeled through a computer-
oriented simulation of situations or real world variables.
In order to achieve the immersion of the participant, each
scenario is navigable and interactive. Note that virtual en-
vironments are designed considering the social and cul-
tural context appropriate for the target users of the system.
The VR models contain exteroceptive variables such as
number of people, physical characteristics of virtual char-
acters (type of clothing, gestures), environmental sounds
(sound of beating or shooting a firearm, activation of car
alarms, etc.), and interoceptive variables such as environ-
mental sounds. Internal physiological functions (palpita-
tions, rapid breathing) are controlled by the therapist, thus
exposing the patient to their own symptoms, teaching
them to confront and manage them.
preliminary conclusions
The combination of new technologies for psychological
treatment seems to be a promising alternative for the care
of PTSD in victims of criminal violence, which has a great
impact on our country, supporting the spread of empirically
validated treatments in the Mexican mental health field.
references
Instituto Ciudadano de Estudios sobre la Inseguridad, A.C.
(ICESI). La percepción de inseguridad en las principales
regiones urbanas de México. Gaceta Informativa. (2007).
Disponible en: www.icesi.org.mx.
Abstracts from CT15
––––––––––––––––––––––––––––––––––––––––––––––
online psychotherapy:
from Training to dissemination
Georgina Cárdenas-Lópeza,1 and Lorena Flores-Platab
a,b
Laboratory of Virtual Education and Cyberpsychology
Faculty of Psychology
National Autonomous University of Mexico (UNAM)
1
Corresponding author:
Georgina Cárdenas López
Universidad Nacional Autónoma de México
Facultad de Psicología
Laboratorio de Enseñanza Virtual y Ciberpsicología
Ciudad de México
Mexico
E-mail: mgcl@servidor.unam.mx
abstract
The current work describes the development, implemen-
tation and evaluation of the project Online Psychother-
apy that aims at three objectives – providing a practical
training scenario for the clinical formation of students
from the last semesters of Psychology at UNAM, devel-
oping a platform for offering services and creating an
electronic patient’s profile, and providing cognitive-be-
havioral treatments via the Internet to patients suffering
from anxiety, depression and adaptive disorders. In this
study, 17 students were trained and 50 patients were as-
sisted. Results obtained from pre and post evaluations
and follow-ups show positive changes in five students
and 28 patients. In addition, patients and therapists re-
ported satisfaction using the available resources and in-
struments. The implemented platform facilitates
therapeutic work by providing an electronic profile as
well as assessment instruments and files available for
download to mobile phones or iPods.
Keywords: Psychotherapy, depression, anxiety, CBT
introduction
The potential of Information and Communications Tech-
nologies (ICT) and its application to health and educa-
tion services generated the need to create research spaces
in the behavioral field and specifically, offered the op-
portunity to develop and implement new therapeutic al-
ternatives. The evolution of ICT and particularly the
growth of the Internet have changed the way in which
we communicate and relate to each other.
JCR
Abstracts from CT15
Some of the original motivations for offering services
through technologies such as the Internet were a diffi-
culty in accessing psychological services (bodily prob-
lems, for instance), a preference for preserving
anonymity, and comfort and familiarity with electronic
modalities, among others.
Literature shows a number of investigations about online
treatment services and their effectiveness (Barak, Hen,
Boniel-Nissim & Shapira, 2008) in disorders such as de-
pression and anxiety (Marks, Cavanagh, & Lina, 2007),
addictions (Finfgeld-Connett, 2006) and eating disor-
ders, mainly, under Cognitive Behavioral Treatment
(CBT) (Barak, Hen, Boniel-Nissim & Shapira, 2008).
method
The program was executed in three phases. First, 17 stu-
dents were trained in the acquisition of therapeutic skills
(theory and practice) under a competence model, meas-
uring their performance through pre, post and follow-up
evaluations. Second, a CBT-based therapeutic service
platform was developed. Finally, the third phase con-
sisted of treating 50 patients with anxiety, depression and
adaptive disorders, and recording their changes with pre
and post evaluations and follow-ups (with Beck anxiety
and depression inventories), of up to one year in some
cases.
results
From the obtained results the following is observed.
In students. In participants with post evaluations con-
cluded, 10 students had an increase in therapeutic skills,
as observed by having a pre-qualification of 16%, 85%
for post and 85% for follow-ups.
In patients. At the end of treatment, anxiety and depres-
sion measurements decreased with respect to those ob-
tained in pre-evaluation in the following form: the
pre-test average was 14, which corresponds to moderate
symptoms, while the
post-test average was 5,
corresponding to minimal
symptoms. In patients
with 6 and 12 month fol-
low-ups, an average of 4
persisted.
Figure 1. Screenshot of Both students and pa-
Psychological services tients reported high satis-
platform. faction in using the
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189
technology as a therapeutic means and taking into ac-
count the tools that facilitated providing this service.
The platform consists of software undergoing constant
modification and improvement for users (Figure 1).
references
Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N.,
A comprehensive Review and a Meta-Analysis of the
Effectiveness of Internet-Based Psychotherapeutic In-
terventions, Journal of Technology in Human Services
26 (2008), 109-160.
Finfgeld-Connett, D., Web-Based Treatment for Prob-
lem Drinking, Journal of Psychosocial noursing, 44
(2006), 20-27.
Marks, I., Cavanagh, K., & Lina, G., Hands-on Help.
Computer-aided Psychotherapy, Psychological Press,
New York, 2007.
––––––––––––––––––––––––––––––––––––––––––––––
Clinical Virtual environments for oCd Treatment
Georgina Cárdenas-Lópeza,1, Sandra Munoza,
and Paola Oviedoa
a
Faculty of Psychology, National Autonomous
University of Mexico (UNAM)
1
Corresponding author:
Georgina Cárdenas López
Universidad Nacional Autónoma de México
Facultad de Psicología
Laboratorio de Enseñanza Virtual y Ciberpsicología
Ciudad de México
Mexico
E-mail: mgcl@servidor.unam.mx
abstract
Obsessive Compulsive Disorder (OCD) constitutes a
chronic anxiety disorder that is characterized by the emer-
gence of obsessions that are persistent ideas or thoughts,
experienced as intrusive and cause marked anxiety. OCD
affects 2.6% of the population in Mexico, and severely af-
fects the quality of life of people who suffer from it. Cog-
nitive-Behavioral Treatment (CBT) for this disorder has
had such an impact on efficiency, which is currently con-
sidered the treatment of choice for OCD. On the other
hand, Virtual Reality (VR) environments have been used
for the treatment of diverse anxiety disorders, achieving
good results in the symptom reduction, for this reason we
190
propose the use of virtual environments for the treatment
of OCD. In this paper we describe the three-dimensional
VR models developed and data usability in a brief clinical
sample compared with non-clinical population.
Keywords: Virtual Reality, Cognitive Treatment,
Obsessive-compulsive Disorder
introduction
There are studies on various treatments for Obsessive
Compulsive Disorder (OCD) – these include exposure
treatment, response prevention and cognitive therapy.
Treatment may be perceived as aversive since between 25-
35% of patients stop treatment because of anxiety they ex-
perience in traditional treatments.
For these reasons, it is essential to develop and implement
tools for the treatment of OCD and to reduce prevalence
and improve the quality of life of patients with ADHD. In
this way, the Virtual Learning Lab and Cyberpsychology
Faculty of Psychology of UNAM, in collaboration with
the Ixtli Observatory, are developing a treatment based on
Virtual Reality (VR) technologies for obsessive-compul-
sive patients. The virtual scenarios show the trigger stim-
ulus in a gradual and controlled way to reduce anxiety for
an exposure treatment.
obsessive-Compulsive disorder
OCD constitutes a chronic anxiety disorder that is
characterized by the emergence of obsessions that are per-
sistent ideas, thoughts, sounds or images experienced as
intrusive and inappropriate and that cause marked anxiety
or stress.
Cognitive-Behavioral Treatment (CBT) for this disorder
has had such an impact on efficiency, which is currently
considered the treatment of choice for OCD. However,
treatment may be perceived as aversive because it is based
on prolonged exposure to feared stimuli and may cause
discomfort. At least 25-30% or patients who seek psycho-
logical intervention refuse treatment or drop out prema-
turely (Franklin et al., 1998; Franklin et al., 2000) due to
fear and anxiety they experience when they stop carrying
out their rituals, strategies of neutralization or compulsive
behaviors due to the belief that the dreaded consequences
will occur.
Virtual environments for oCd
The potential of VR as a therapeutic tool for OCD has
been considered. Taking into count the nature of this tech-
Abstracts from CT15
nology, it has the advan-
tage that the clinician can
modify different variables
in everyday life situations
which would be difficult
to manage and control,
besides being less aver-
Figure 1. Dirty toilet for sive environments for pa-
cleaning obsessions. tients than in vivo
exposure therapy.
The complete treatment protocol include sessions of psy-
choeducation, breathing training, cognitive restructuring
and exposure techniques using VR scenarios like a public
restroom, a bus, a bedroom and a Mexican restaurant. Each
one of these scenarios was developed in order to include
triggers that a patient can find in everyday life and are con-
textualized to their culture, so the therapist can expose pa-
tients to such environments and control the variables within
them The variables or elements included were developed
with the aim to act as triggers for specific obsessive fears
such as contamination, disorder and symmetry.
references
Franklin, M., Kozak, M., Cashman, L., Coles, M., Rhein-
gold, A., & Foa, E., Cognitive-Behavioral Treatment of
Pediatric Obsessive-Compulsive Disorder: An Open Trial,
American Academy of Child and Adolescent Psychiatry,
37 (1998).
Franklin, M., Abramowitz, J. S., Kozak, M., Levitt, J., &
Foa, E., Effectiveness of exposure and ritual prevention
for obsessive-compulsive dosorder randomized compared
with nonrandomized samples, Journal of Consulting and
Clinical Psychology, 68 (2000),594-602.
––––––––––––––––––––––––––––––––––––––––––––––
a Vr Tool for assisting geological field Trip
Chun-Yen Changa,b,1, Ming-Chao Linb,
Chau-Fu Yanga and Chun-Yen Linb
Science Education Center and Graduate Institute of
a
Science Education, National Taiwan Normal University,
Taiwan, ROC
b
Department of Earth Sciences, National Taiwan Normal
University, Taiwan, ROC
Corresponding author:
1
Chun-Yen Chang
JCR
Abstracts from CT15
No. 88, Sec. 4, Ting-Chou Rd.
Wunshan District, Taipei
Taiwan 11677
E-mail: changcy@ntnu.edu.tw
abstract
The 3-D Compound Virtual Field Trip (3D-CVFT) sys-
tem was built using the technology of the Graphic-based
Virtual Reality (VR) and 3-D Stereo-Vision effect. Past
research has shown that multi-media computer-assisted
instruction could significantly help students grasp earth
science concepts and greatly improve their attitudes to-
ward science (AAAS, 1993; Chang, C. Y., 2004; NRC,
1995; Smith D.G.W. & Abley M.W., 1996). Some re-
searchers further suggest that virtual field trips will very
likely have a place in the curriculum of the 21st century
(Kent etc., 1997). The 3D-CVFT can serve as a prepara-
tory work for students to familiarize themselves with ac-
tual field sites.
Keywords: 3-D Virtual Reality, Field Trip
introduction
We built the 3-D Compound Virtual Field Trip (3D-
CVFT) system by combining the technology of Graphic-
based Virtual Reality (VR) and 3-D Stereo-Vision effect.
We took the Graphic-based VR as the main design, and
built the Virtual field trip screen to free users from vari-
ous physical hazards and time restrictions (such as being
present at the time of a volcanic eruption).
method
It is envisioned that users can use a Wiimote to explore
the environment in the compound VR field-trip instruc-
tional system. This system was created by using a Digital
Terrain Model (DTM). Users can trigger several kinds of
3DVR interfaces through the interaction between user
and objects in the system. For example, swinging the Wi-
imote in the proper direction will allow the user to pick
up a rock on the ground and activate the testing mecha-
nism.
We used two projectors, both with polarizing lenses in
front of them. The projection surface was specially made
so that it did not harm the polarization (silver stripe
screen). The user had to wear a special set of glasses with
two polarizing lenses and with the polarization directions
adjusted to a 90-degree difference. The human brain will
integrate these two images into one three-dimensional
picture. The key element in producing the stereoscopic
JCR
191
Figure 1. Screenshots of Figure 2. Inspecting
Hsiaoyukeng the site
Figure 4. Swinging the
Figure 3. Picking up
the stone Wiimote
depth effect is parallax, which is the horizontal distance
between corresponding left and right image points.
results
In Figure 1, the student is exposed to the graphic-based
VR site. With the aid of stereoscopic glasses the student
will experience 3-D stereo-vision. The student can further
inspect the site, including specific rocks, with the help of
the Wiimote controller as detailed in Figure 2. The con-
troller allows the student to virtually pick up a stone for
further inspection, as shown in Figure 3. Students may
also pick up virtual tools such as a hammer to interact with
their virtual environment as demonstrated in Figure 4.
Conclusion
While actual field trips are essential in allowing learners
to have real life interaction with objects they are learning
about, due to the many restrictions and issues related to
weather, distance and safety, actual field trips are not al-
ways feasible. The 3-D Compound Virtual Field Trip (3D-
CVFT) can serve as preparatory work for students to
familiarize themselves with actual field sites. In our future
studies, students will be supplied with virtual-visual in-
formation about a post-volcanic activity area using a 3-D-
CVFT before taking a physical trip to the actual site.
During that investigation, students will acquire relevant
knowledge regarding the area of Hsiaoyukeng and finish
their preparatory work off site. Students will then physi-
cally visit Hsiaoyukeng to expose themselves to the sul-
furous smells of the site and to complete the required
manual tasks. We look forward to sharing the results of
our ongoing research and development of the 3D-CVFT
with you in the near future.
192
references
Kent, M., Gilbertson, D. D., Hunt, C. O., Fieldwork in ge-
ography teaching: A critical review of the literature and
approaches, Journal of Geography in Higher Education
21(3) (1997), 313–332.
––––––––––––––––––––––––––––––––––––––––––––––
utilizing Vr to improve geological
field Trip learning
Chun-Yen Linb, Chun-Yen Changa,b,1, Yueh-Hsia
Changa,b, Chau-Fu Yangb and Chung-Wen Choa
Science Education Center and Graduate Institute of
a trip (module to the Hsiaoyukeng area in northern Taiwan).
Science Education, National Taiwan Normal University,
Taiwan, ROC
b
Department of Earth Sciences, National Taiwan Normal
University, Taiwan, ROC
1
Corresponding author:
Chun-Yen Chang
No. 88, Sec. 4, Ting-Chou Rd.
Wunshan District, Taipei
Taiwan 11677
E-mail: changcy@ntnu.edu.tw
abstract
This pilot study explores students’ perceptions and experi-
ence in a 3D field trip curriculum module. It is our intention
to understand how the system can facilitate field trip learn-
ing in earth science.
Keywords: Virtual Environment, Field trip
introduction
Earth science researchers have indicated that multimedia
technologies could enhance students’ understanding on
earth science concepts and thus improve their attitudes to-
wards science, as shown by the work done by Chang
(2004) and Smith and Abley (1996), for example. The use
of multimedia technologies such as virtual reality (VR) is
seen to have great potential for developing new or alterna-
tive field trip activities in earth science teaching (Kent,
Gilbertson, & Hunt, 1997). Due to issues such as time,
budget, and safety concerns, field trips have not been fully
employed as an instructional strategy for earth science
teaching (Tuthill & Klemm, 2002). Responding to the calls
for engaging students with more field work experience in
earth science learning, a virtual field trip reality program
Abstracts from CT15
Figure 1. Using The 3-D Virtual Field
Trip System. Figure 2 (right) Tools.
named 3-D Virtual Hsiaoyukeng Field Trip System was re-
cently developed as an undergraduate earth science field
A pilot test study was conducted to investigate students’ per-
ceptions and experience in field trip learning through this
3-D system. The data collected from this study could pro-
vide information useful for better integration of multimedia
3-D modules into earth science teaching and learning.
method
For the purpose of providing students with an authentic
learning context, 3-D projection technologies were used to
create a 3-D immersive virtual field trip environment for
earth science learning (Fig. 1). The 3-D projection tech-
nologies require users to wear stereoscopes so that the
users’ right and left eyes receive separate images from dif-
ferent projectors thus producing the virtual reality scenes
(Fig. 2). A total of 18 undergraduate earth science students
at the National Taiwan Normal University participated in
this study. Interviews and student learning reflection data
was collected.
results
Enhancing Learning and Understanding—According to
the interviews, the majority of the participating students
reported they were familiar with multimedia technologies
and appreciated the effectiveness and flexibility of tech-
nologies in meeting their individual learning needs at
their own paces. In addition, nearly 80% of the partici-
pants also expressed positive feedbacks on using this 3-
D system as a helpful tool in “motivating their learning”
and “enhancing understanding” in the earth science learn-
ing of this study.
3-D Virtual Reality as Field Trip Facilitation—Seeing the
3-D virtual field trip system as an effective tool in enhanc-
ing their understanding in the actual field work, nearly half
of the participating students thought that working on the
3-D system could facilitate field trip learning activity when
JCR
Abstracts from CT15
it was employed after an actual field trip (for learning re-
view/assessment). The other half of the students reported
that they prefer using it before the actual field trip (as prior
knowledge acquisition). Data analysis from the student re-
flections revealed that it could be either that they saw the
3-D system as a game or a tool, or they felt that, as one stu-
dent pointed out, “it is just different from the real scenes.”
Issues of Dizziness and Focus—More than one third of the
participating students in this study experienced slight dizzi-
ness when they were working on this 3-D VR system while
wearing the stereoscopes – two out of the 18 students re-
ported difficulty in focusing on the screen while using the
system.
Conclusions
The results of this study indicate that the vast majority of
these undergraduate earth science students thought the 3-
D VR system helped enhance their field trip learning ef-
fectively. Whether employing it before or after an actual
field trip, the 3-D system tested in this study was perceived
as a useful tool to effectively facilitate the field trip learning
activity and for prior knowledge acquisition. As light dizzi-
ness and focus difficulty were observed when using the 3-
D system in this pilot study, adjustments will be made by
improving the hardware configuration (perhaps by using a
single projector for those students with difficulties) before
the issues are addressed by further studies.
references
Kent, M., Gilbertson, D.D., & Hunt, C.O. Fieldwork in ge-
ography teaching: A critical review of the literature and ap-
proaches, Journal of Geography in Higher Education,
21(1997), 313-332.
Smith, D.G.W. and Abley, M. Multi-media computer- as-
sisted instruction in mineralogy. Journal of Geoscience Ed-
ucation 44 (1996), 189-196.
Tuthill, G. and Klemm, E. B., Virtual field trips: Alterna-
tives to actual field trip, International Journal of Instruc-
tional Media 29(4) (2002), 453–468.
––––––––––––––––––––––––––––––––––––––––––––––
a Comparison of the 3-d Vr field Trip
with actual geological field Trip
Chun-Yen Changa,b,1 and Ming-Chao Linb
a
Science Education Center and Graduate Institute of
JCR
193
Science Education, National Taiwan Normal University,
Taiwan, ROC
b
Department of Earth Sciences, National Taiwan Normal
University, Taiwan, ROC
1
Corresponding author:
Chun-Yen Chang
No. 88, Sec. 4, Ting-Chou Rd.
Wunshan District, Taipei
Taiwan 11677
E-mail: changcy@ntnu.edu.tw
abstract
This article delineates an online 3-D Compound VR
Field Trip (3D-CVFT) system developed by us and com-
pares the 3D-CVFT with the actual geological field trip.
Some possible educational implications in terms of the
use of virtual reality (VR) technology as alternative to
field trips in the field of earth science are also discussed.
Keywords: 3-D Virtual Reality, Geological Field Trip
introduction
A 3-D Compound Virtual Field Trip (3D-CVFT) was de-
veloped not only functioning as a multimedia Virtual Re-
ality (VR) software which supplies close-to-real-field
trip experiences (Lin & Chang, 2007, 2008) but also try-
ing to tailor the 3D-CVFT to diverse students’ learning
needs by leveraging on auto grading and feedback inter-
faces in the system.
method
The online 3-D Compound Virtual Field Trip (3D-
CVFT) system is built by integrating the 3D-CVFT Sys-
tem with a streaming video server, an instant message
server, an auto-grading server and a feedback system as
shown in Fig.1.
194
results
We compare the actual field trip with the online 3D-
CVFT System as shown below in terms of their major
functions before, during, and after the geological field
trip.
Conclusion
Several pilot studies have been conducted using the
3D-CVFT System, either as a teaching material to sup-
plement lecture teachings, or as a preparation before
an actual field trip. The results have revealed that the
system indeed functioned well as an effective tool to
assist students’ learning and students in general re-
sponded positively towards the system (Ling & Chang,
2007, 208). The system resulted in positive outcomes
and responses. Our future work includes supplying
more streaming films on the environmental character-
istics of Hsiaoyukeng into the streaming video server.
We will also examine how the online 3D-CVFT Sys-
tem can function most effectively in facilitating stu-
dents’ learning.
references
Lin, M.C. and Chang, C.Y. (2007): The Pilot Study on
the Impacts of 3D Virtual Reality Field Trip toward Stu-
dents’ Academic Achievements. Paper presented at the
11th Global Chinese Conference on Computers in Edu-
caion (GCCCE 2007). May 26-30, 2007. Guangzhou,
China. (in Chinese)
Ling, M.C. and Chang, C.Y. (2008) The application of
the 3D Virtual Reality on field trip: Taking the Example
of Hsiaoyukeng. Paper presented at the National Asos-
ciation of Research in Science Teaching (NARST) (Bal-
timore, Marriott, U.S.A.)
Abstracts from CT15
––––––––––––––––––––––––––––––––––––––––––––––
minimizing the extraneous Cognitive load in
learning: integrating interactive functions into
instructional animation
Yu-Ta Chiena and Chun-Yen Changb,1
a
Department of Earth Sciences,
National Taiwan Normal University, Taiwan
b
Education Center and Graduate Institute of Science
Eduation, National Taiwan Normal University, Taiwan
Corresponding author:
1
Chun-Yen Chang
No. 88, Sec. 4, Ting-Chou Rd.
Wunshan District
Taipei, Taiwan 11677
E-mail: changcy@ntnu.edu.tw
abstract
In this study, we integrated interactive functions into ani-
mation (Interactive Animation Group, IAG) for the purpose
of minimizing extraneous cognitive load in learning. This
investigation compared IAG with a static illustrations
group (SIG) and a continuous animation group (CAG).
The results of statistical analysis showed that IAG could
significantly decrease the amount of mental effort invested
by learners in complex learning. The design of IAG could
be the strategy to enhance the effectiveness of animation-
based instruction.
Keywords. Computer-assisted learning, multimedia,
interactive animation
introduction
In recent years, within the framework of cognitive load the-
ory (CLT), the instructional multimedia comparison be-
tween animation and static graphics has been intensively
investigated (Höffler & Leutner, 2007; Ploetzner & Lowe,
2004). The basic point of CLT emphasizes the ‘free space’
of an individual’s limited working memory (WM) so that
he/she can easily process information associated with
schema (Sweller & Chandler, 1994). Extraneous cognitive
load (ECL) reflects the mental effort required a learner to
process as determined by the instructional design (Sweller,
van Merriënboer, & Paas, 1998). Based on previous em-
pirical research, the transitory nature of animation imposes
highly ECL on a learner, so that animation often over-
whelms his/her WM (Höffler & Leutner, 2007; Mayer,
Hegarty, Mayer, & Campbell, 2005). For comprehending
JCR
Abstracts from CT15
Table 1
A Comparison of Students’ Perceptions and Experiences between Different Instructional Conditions
Note. Values are expressed as mean plus/minus standard deviation; * p < 0.05
the science subject matter depicted in animation/graphics,
students have to develop mental representations of said ob-
jects; in addition, they must manipulate their mental rep-
resentations of external objects as well as project their
inferences onto the objects being represented. The tradi-
tional supporting strategies, such as segmenting animation
into smaller parts (Mayer & Chandler, 2001) or providing
user-pacing functions (Hasler, Kersten, & Sweller, 2007),
i.e., stop and play, can only share the burden of developing
mental representations with learners. The ECL of manipu-
lating mental representations may still be an impediment
to learning. In this study, we integrated interactive func-
tions into animation to allow students to manipulate the
representations directly and externally through animation,
rather than through students’ own mental images. The pilot
evaluation compared students’ perceptions and experiences
between three media forms.
methods and results
The learning content included two topographic measure-
ments: horizontal leveling and trigonometric leveling.
Trigonometric leveling is more complex than horizontal lev-
eling, because it is based on the triangulation. The instruc-
tional conditions included the following: (1) Static
Figure 1. Screenshots of IAG.
JCR
195
Illustrations Group (SIG): Static graphics next to correspon-
ding text; (2) Continuous Animation Group (CAG): Contin-
uously dynamic demonstrations synchronized with
explanations; (3) Interactive Animation Group (IAG): Inter-
active functions allowed learners to physically manipulate
the virtual hand level mechanism using animation rather than
only passively observe images. As shown in Figure 1, the il-
lustrations in IAG become animated only during the time
when students regulate the virtual hand level mechanism. The
changes of spatial relations caused by the learner can be seen
instantly and directly in IAG. All media forms provide equiv-
alent information and user-pacing functions, such as ‘pause’,
‘play/next’ and ‘backward’ buttons. Twenty-seven 10th grade
students were randomly divided into three groups. After the
students finished each tutoring lesson, they were asked to es-
timate the mental efforts encountered in learning. The mental
effort scale, originally developed by Paas (1993), was re-
sponded by circling 1 (very, very low) through 9 (extremely
high). The user information, such as time-spans and frequen-
cies of backtracking, was collected online.
Table 1 presents the results of ANOVA statistical analysis
on students’ perceptions and experiences between different
instructional conditions, and the effect sizes are described
as η2 (eta-squared). The study went on Tukey’s HSD tests
to further investigate the significant differences notified in
Table 1.
novelty/discussion
Manipulating the mental representations requires that the
196
learner temporarily holds previously presented information
in their WM and later connect it with his/her inferences.
IAG allows students to directly manipulate the representa-
tions externally rather than mentally, and serves to aid in
the productive process of “representational holdings”.
Hence, students no longer need to use the backward func-
tion of recalling previous mental image information repeat-
edly. When the learning task becomes complex, such as in
trigonometric leveling, IAG could significantly decrease
the amount of mental effort invested by students. As our
research continues, further studies will investigate a larger
sample size as well as the impact of IAG on students’ learn-
ing outcomes.
references
Hasler, B.S., Kersten, B., & Sweller, J., Learner control,
cognitive load and instructional animation, Applied Cog-
nitive Psychology 21 (2007), 713-729.
Höffler, T.N., & Leutner, D., Instructional animation ver-
sus static pictures: A meta-analysis, Learning and In-
struction 17 (2007), 722-738.
Mayer, R.E., & Chandler, P., When learning is just a click
away: Does simple user interaction foster deeper under-
standing of multimedia messages? Journal of Educa-
tional Psychology 93 (2001), 390-397.
Mayer, R.E., Hegarty, M., Mayer, S., & Campbell, J.,
When static media promote active learning: Annotated
illustrations versus narrated animations in multimedia in-
struction, Journal of Experimental Psychology-Applied
11 (2005), 256-265.
Paas, F., & van Merrie¨nboer, J. J. G., The efficiency of
instructional conditions: an approach to combine men-
tal-effort and performance measures, Human Factors 35
(1993), 737–743.
Ploetzner, R., & Lowe, R., Dynamic visualisations and
learning - Introduction to the special issue, Learning and
Instruction 14 (2004), 235-240.
Sweller, J., & Chandler, P., Why some material is diffi-
cult to learn, Cognition and Instruction 12 (1994), 185-
233.
Sweller, J., van Merriënboer, J. J. G., & Paas, F., Cogni-
tive architecture and instructional design, Educational
Psychology Review 10 (1998), 251-296.
Abstracts from CT15
–––––––––––––––––––––––––––––––––––––––––––––
pseudoneglect regulation using optokinetic
stimulation in a Virtual environment
Ara Choa,1 and Jang Han Leea
a
Clinical Neuro-Psychology Lab, Department of
Psychology, Chung-Ang University, Seoul,
Republic of Korea
1
Corresponding author:
Ara Cho
Clinical Neuro-Psychology Lab, Department of
Psychology, Chung-Ang University
221 Heukseok-Dong Dongjak-Gu
Seoul, Republic of Korea
E-mail: ara1003@hotmail.com
abstract
Healthy individuals show a small leftward bias known as
"pseudoneglect," similar to hemispatial neglect. Optoki-
netic stimulation (OKS) is an effective technique used in
the treatment of neglect patients. In this study, we applied
OKS to a virtual environment. Participants conducted a
line-bisection task and an erase test after receiving OKS
treatment with six versions differing in speed and orien-
tation. Participants revealed corrections of their leftward-
bias after receiving rightward-OKS.
Keywords: Pseudoneglect, Hemispatial Neglect,
Optokinetic Stimulation (OKS)
introduction
Hemispatial neglect is the difficulty in detecting or react-
ing to sensory stimuli presented in the visual hemispace
contralateral to the lesioned cerebral hemisphere (Kerk-
hoff, Keller, Ritter, & Marquardt, 2006). Healthy individ-
uals also show a small leftward bias known as
"pseudoneglect" (Bultitude & Aimola Davies, 2006). Al-
though visual scanning training (VST) has been success-
ful in treating neglect, it has some drawbacks. Optokinetic
stimulation (OKS) is a visual display of numerous stimuli
all moving coherently towards the neglected side of the
field of view, and is a technique that makes up for the
weaknesses of VST (Kerkhoff, Keller, Ritter, & Mar-
quardt, 2006). In this study, we applied OKS to a virtual
environment which allows control of the participant’s vi-
sual field and also increases immersion relative to the
stimuli. Another advantage is that it is easier to generalize
the treatment to daily life because this OKS treatment
JCR
Abstracts from CT15
uses a background of typical city streets, allowing partic-
ipants to experience a realistic treatment environment.
The aim of this study was to examine the effects of this
new OKS program for hemispatial neglect by testing its
effectiveness on pseudoneglect.
method
Prior to the treatment, 31 neurologically healthy, right-
handed participants received a baseline assessment using
a paper-based line-bisection task, followed by a com-
puter-based line-bisection and erase task. Participants re-
ceived leftward and rightward-OKS treatment in a virtual
environment at random speeds of slow, medium, and fast.
All individuals received a six-session treatment. After
each rightward and leftward session, participants con-
ducted a line-bisection test and an erase test. Treatment
was conducted using the GDS Side View Neglect pro-
gram, which we created for OKS treatment in a virtual
environment, presented using a see-through head
mounted display with a head motion-tracking device.
Figure 1. Erase task in a Figure 2. OKS in a vir-
virtual environment. tual environment.
results
Participants showed a correction of their leftward bias
[M=-0.49, SD=9.56] after receiving rightward-OKS. All
presentation speeds were effective, especially the slow
speed [M=5.15, SD=11.13, F(1,30)=7.51, p<.05]. Com-
pletion speeds of the erase task were reduced after both
versions of OKS. Initial erasing directions also shifted
from right to left after receiving leftward-OKS [M=-.32,
SD=.75, F(1,30)=4.67, p<.05].
Conclusion
This study examined the influence of OKS on pseudone-
glect in a virtual environment. We expect that these re-
sults will help provide a valuable treatment method for
hemispatial neglect patients.
Acknowledgements
This work was supported by National Research Founda-
tion of Korea Grant funded by the Korean
Government(KRF-2006-332-H00021).
JCR
197
references
Bultitude , J.H. & Aimola Davies, A.M., Putting attention
on the line: Investigating the activation-orientation hypoth-
esis of pseudoneglect, Neuropsych 44(2006), 1849-1858.
Kerkhoff, G., Keller, I., Ritter, V., & Marquardt, C.,
Repetitive optokinetic stimulation induces lasting recov-
ery from visual neglect, Restorative Neurology and Neu-
roscience 24(2006), 357-369.
––––––––––––––––––––––––––––––––––––––––––––––
development of a Virtual avatar-based
application for audiology Training
Andreas Duensera,1, Alexandre Heitza,
and Catherine Moranb
The HIT Lab NZ, University of Canterbury,
a
Christchurch, New Zealand
b
Department of Communication Disorders,
University of Canterbury, Christchurch, New Zealand
1
Corresponding author:
Andreas Duenser
The HIT Lab NZ, University of Canterbury
Private Bag 4800
8140 Christchurch, New Zealand
E-mail: andreas.duenser@hitlabnz.org
abstract
Current educational practices in applied research fields
show certain limitations to training students because of
expense and poor access to training opportunities. This
project aims to develop a virtual-patient-based desktop
Virtual Reality (VR) system to address these limitations.
The system is expected to result in increased efficiency in
teaching, increased capability (more student completions)
and innovative teaching methods. We are developing an
educational platform that will provide a realistic virtual
learning environment to deliver educational content for
audiology students. Using virtual clients the students will
be able to practice assessment and clinical examination
skills. The usefulness of the system will be evaluated using
a combination of different evaluation methods.
Keywords: Audiology, communication disorders, train-
ing, education, immersive learning, virtual patient
project aim
The aim of the project is to create virtual clients that can
198
be used in the training of students in the Master of Audi-
ology program. The simulator will allow students to prac-
tice assessment and rehabilitation of hearing disorders
with a realistic virtual human. For instance, students of
audiology would conduct the standard assessment battery
and the human-like virtual client would provide varying
responses, which the students must interpret and use to
plan rehabilitation. The project arose from the recognition
of both needs and opportunities for the development of a
virtual environment for training audiologists.
development
We build upon a VR platform developed by the Virtual
Patients Group1 and adapted this system for our purposes.
The initial platform was upgraded to work as a standalone
application. This was necessary to make the system as ac-
cessible and easy-to-use as possible. The intended use-sce-
nario is for students to utilize the application on a standard
desktop computer.
In coordinated meetings application designers, developers
and domain experts in audiology and communication dis-
orders worked on the requirement analysis and discussed
what aspects the new learning platform should encompass.
As a result, a prototype simulation aimed at audiology stu-
dents was designed and implemented.
We conducted an initial pilot study with students to gather
feedback on the platform and to inform the design and im-
plementation of the training platform. The feedback was
very encouraging and the students were very positive
about the proposal of integrating this technology into their
curriculum. They also were confident that it would help
them to develop and train essential practical skills. In an
upcoming formal study we plan to corroborate and extend
on this.
expected outcomes and future work
The next step is to have audiology researchers work along-
side the application de-
velopers to design
content and meaning-
ful scenarios for the
simulation. We also
plan to gather more
data for the application
development through a
study with communi-
cation disorders and
audiology students. Fi-
Figure 1. First prototype.
Abstracts from CT15
nally, we will conduct a set of studies to evaluate how this
system can support learning activities.
With this system we expect to develop an advanced desk-
top-VR-based training environment for students allowing:
–Control over the clinical cases examined by students in
order to train for low frequency events. In actual clinical
practice students mainly train using patients suffering from
similar or very common conditions. A simulation will
allow students to also practice on clients with hearing dis-
orders that are not very common.
–Timesaving both during training and review of the stu-
dents’ performance.
–Self-assessment through formative and summative feed-
back, enabling students to reflect on learning progress dur-
ing and after completion of the simulation
––––––––––––––––––––––––––––––––––––––––––––––
mindfulness influence on sense of presence in
Virtual environment: an exploratory study
Paloma Rasala, Ernestina Etchemendya,1, Ausiàs
Cebollab, Rosa María Bañosa,b,c, Cristina Botellaa,b,
Azucena García-Palaciosa,b and Berenice Serranob
CIBER de Fisiopatología de la Obesidad y Nutrición
a
(CIBEROBN), Spain
b
Universidad Jaume I, Spain
c
Universidad de Valencia, Spain
1
Corresponding author:
Ernestina Etchemendy
CIBER de Fisiopatología de la Obesidad y Nutrición
Av Blasco Ibañes 21 3º P
46010 Valencia, Spain
E-mail: ernestina@labpsitec.es
abstract
This paper focuses on exploring the relationship between
sense of presence in virtual environments and mindful-
ness. Fifty participants completed a questionnaire that
evaluates mindfulness (FFMQ), then walked through a
virtual environment (VE) and completed two question-
naires on presence (SUS and ITC-SOPI). This work is in
progress at this moment. It is expected to obtain a positive
correlation between sense of presence and mindfulness.
Also, it is expected to find positive correlations between
the “Non-judging of inner experience” (FFMQ) factor and
those factors related to the ecological validity of virtual
environments, as measured in the questionnaires relating
JCR
Abstracts from CT15
to presence. If results are positive, this study highlights
the importance of taking the variable of mindfulness into
account when working with virtual environments.
Keywords: Presence, Mindfulness,
Virtual Environments, Virtual Reality
introduction
Literature points out that to understand the sense of pres-
ence in virtual environments (VE), it is necessary to con-
sider not only the technological aspects involved, but
psychological aspects such as consciousness, memory, at-
tention, emotions or personality (Botella, Baños, & Al-
cañiz, 2003), as well. Specifically, several authors
highlighted the role of consciousness and attention as fun-
damental variables to promote the sense of presence
(Botella, Baños, & Alcañiz, 2003; Ijsseslsteijn, 2002). The
degree of presence in virtual environments depends in part
on the allocation of attentional resources. On the other
hand, mindfulness has been defined as “consciousness that
encompasses both attention and awareness; it is paying re-
flexive attention to the present moment. It is an intentional
way, with a purpose but no judgement and none interfering
the sensations and perceptions of experience moment to
moment” (ZinKabat-Zinn, 1994). This definition outline
three notable components consistently addressed in the
mindfulness literature – the conscious attempt to regulate
attention, a focus on present experience, and the mainte-
nance of a nonjudgmental attitude toward current experi-
ence. Taking into account these aspects, it could be
hypothesized that a relationship exists between mindful-
ness and presence and people with a high mindfulness dis-
position could be more open to immerse themselves in a
VE, and their sense of being present at the VE will be
higher than people with a low mindfulness disposition.
The aim of this work focuses on exploring the relationship
between mindfulness and sense of presence. To do so, all
participants will complete a mindfulness questionnaire and
after they will be exposed, for approximately 20 minutes,
to a 3-D Park that induces joy or sadness. Afterward, they
will respond to questionnaires that evaluate sense of pres-
ence. Correlations between the questionnaires scales will
be analyzed.
method
participants
The sample is composed of around 50 participants with
an approximate age range from 18-26 years old. All of
them are recruited from the Valencia University in Spain.
Following ethical requirements, participants with high
JCR
199
scores in depression (BDI score > 18) are excluded. Par-
ticipants in this study take a walk through a VE that sim-
ulates a park and contains emotional inductions of sadness
exercises or emotional inductions of joy exercises.
measures
All participants completed the following questionnaires:
Beck Depression Inventory (BDI) (Sanz & Vázquez,
1998): This questionnaire consists of 21 items designed
to assess symptoms of depressive disorders. Each item
represents a characteristic symptom. It is scored on a scale
from 0 to 3 depending on the degree to which the person
has felt those symptoms in the last week.
The Five Facets of Mindfulness Inventory (FFMQ) (Baer,
Smith, Hopkins, Krietemeyer, & Toney, 2006): This ques-
tionnaire consists of 39 items assessing five facets of
mindfulness – observing, describing, acting with aware-
ness, non-judging of inner experience, and non reactivity
to inner experience. Items are rated on a Likert scale rang-
ing from 1 (never or very rarely true) to 5 (very often or
always true).
ITC- Sense of Presence Inventory (ITC-SOPI) (Lessiter,
Freeman, Keogh, & Davidoff, 2001): This questionnaire
is a post-test subjective presence measure composed of 44
items that evaluate four facets of presence – spatial pres-
ence, engagement, ecological validity and negative effects.
Their items are divided into two parts. Part A (six items)
which refers to respondent impressions/feelings after a
media experience has finished. Part B (38 items) which
refers to respondent impressions/feelings during a media
experience. A 1- to 5-point Likert scale (from strongly dis-
agree to strongly agree) it is used for responding to both
parts.
SUS Presence Questionnaire (Slater, Usoh, & Steed,
1995): This is a post-hoc questionnaire that consists of six
questions, all of which were variations on one of three
themes – the sense of being in the VE, the extent to which
the VE becomes the dominant reality, and the extent to
which the VE is remembered as a “place.” Each is rated
on a 1 to 7 scale, and the presence score it is taken as the
number of high scores (6 or 7).
procedure
All the participants are provided with a informed consent
to take part in the study and complete a short screening in
order to determine exclusion criteria (BDI score >18).
Once participants have signed informed consent and the
200
presence of clinical symptoms in depression have been
discarded, the FFMQ questionnaire is administered. Af-
terward, all participants do a walk through a VE (repre-
sented by a "Sad Park" or "Happy Park"), which last
approximately 20 minutes. Finally, all participants com-
plete the following ITC-SOPI and SUS Presence Ques-
tionnaires.
results
It is expected to find that participants who show high
scores on the FFMQ questionnaire also show a greater
level of presence in the VE, regardless of the type of emo-
tion induced (sadness or happiness). Also, it is expected
to find a positive correlation between the non-judging fac-
tor of inner experience (FFMQ) and those factors related
to the ecological validity of VE, captured in the question-
naires regarding presence.
Conclusion
The findings of the present study could have both theoret-
ical and practical implications towards the understanding
of the sense of presence. Firstly, results of this study will
provide new insight into the construct of presence and its
connection with specific psychological processes and ex-
periential profiles. The investigation on presence could
benefit from an analysis of the concept of mindfulness.
Furthermore, if results show that mindfulness and pres-
ence are related, it could be useful to consider mindfulness
when working with VE and to explore if teaching people
mindfulness techniques before a virtual experience would
increase their sense of presence and, as a consequence,
improve their virtual experience.
Acknowledgments
This study was funded in part by Ministry of Education
and Science, Spain, Projects Consolider-C (SEJ2006-
14301/PSIC), “CIBER of Physiopathology of Obesity and
Nutrition, an initiative of ISCIII and the Excellence Re-
search Program PROMETEO (Generalitat Valenciana.
Conselleria de Educación; 2008/157).
references
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., &
Toney, L. (2006). Using self-report assessment methods
to explore facets of mindfulness. Assessment, 13, 27-45.
Botella, C., Baños, R.M. And Alcañiz, M, (2003). A psy-
chological approach to presence. Paper presentado en
PRESENCE 2003, 6th Annual International Workshop on
Presence. http://www.presence-reserach.org/paper.html.
Abstracts from CT15
Damoiseaux, J.S., Rombouts S.A., et al., Consistent rest-
ing-state networks across healthy subjects, PNAS 103
(2006), 13848–13853.
Ijsseslsteijn, W.A. (2002). Elements of a multinivel theory
of presence: Phenomenology, mental processing and neu-
ral correlates. Proceding of Presence 2002, pp. 245-259.
Universidade Fernando Pessoa, Porto, Portugal.
Kukolja, D., Popović, S. et al., Real-time emotional state
estimator for adaptive virtual reality stimulation,
LNCS/LNAI 5638 (2009), 175–184.
Lessiter, J., Freeman, J., Keogh, E. and Davidoff, J. (2001)
A Cross-Media Presence Questionnaire: The ITC-Sense
of Presence Inventory. Presence Teleoperative Virtual En-
vironment, 10, 282-2998.
Marrelec, G., Bellec, P., et al., Exploring large-scale brain
networks in functional MRI, Journal of Physiology-Paris
100(4) (2006), 171–181.
Nardo, D., G. Högberg, G. et al., Gray matter density in
limbic and paralimbic cortices is associated with trauma
load and EMDR outcome in PTSD patients, J. Psychiatr.
Res. (2009 Nov 24).
Sanz, J, and Vázquez, C. (1998) Fiabilidad, Validez
y Datos Normativos del Inventario para la Depresión
de Beck. Psicothema, 1998. Vol. 10, nº 2, pp. 303-
318.
Tanielian, T., L.H. Jaycox, L.H., editors, Invisible wounds
of war: psychological and cognitive injuries, their conse-
quences, and services to assist recovery. RAND Corpora-
tion, 2008.
Slater, M., Usoh, M. and Steed, A. (1995). Taking steps:
The influence of a walking metaphor on presence in nvir-
tual environment. ACM Transactions on computer Human
Interaction, 2(3), 201-219.
Wiederhold, B.K., Wiederhold, M.D., Virtual reality for
posttraumatic stress disorder and stress inoculation train-
ing, Journal of Cybertherapy & Rehabilitation 1 (2008),
23–35.
ZinKabat-Zinn, J. (1994). Wherever you go, there you are:
mindfulness meditation in everyday life. New York: Hy-
perion.
JCR
Abstracts from CT15
––––––––––––––––––––––––––––––––––––––––––––––
using music and mental practice to
learn a lay-up shot in basketball
Andrea Gaggiolia,b,1, Luca Morgantib
and Alessandro Antoniettib
ATN-P Lab, Istituto Auxologico Italiano, Milan, Italy
a
b
Department of Psychology, Catholic University of
Milan, Italy
1
Corresponding author:
Andrea Gaggioli
Istituto Auxologico Italiano
Via Pelizza da Volpedo 41
Milan, Italy
E-mail: andrea.gaggioli@auxologico.it
abstract
There is compelling evidence that training with motor im-
agery, or mental practice (MP) improves motor perform-
ance when combined with physical practice. The purpose
of this experiment was to investigate if the efficacy of MP
can be further enhanced by providing rhythmic music
feedback. To test this hypothesis, 27 female basketball
players were randomly assigned to one of three training
conditions–MP and music (MMP), MP, and physical train-
ing alone (PT). The target motor task was the lay-up shot,
one of the most commonly used techniques in basketball.
Participants’ performance was assessed before and after a
four-week training period, in which players practiced three
times a week. Results showed an overall performance im-
provement after training, but no significant differences
were found between training conditions. However, analy-
sis of results within each experimental condition showed
training-specific effects on selected variables. MMP play-
ers improved both coordination and rhythm, while players
assigned to MP improved coordination skills. These re-
sults suggest that MP (either with or without music) may
be used in combination with physical training to enhance
the acquisition and performance of specific motor skills
components.
Keywords: Motor Skills Learning, Motor Imagery,
Mental Practice, Music, Basketball
introduction
mental practice with motor imagery
Motor imagery is the mental rehearsal of a movement in
absence of gross muscular activation (Jeannerod, 1994).
JCR
201
Mentally-simulated movements can include visual, audi-
tory, tactile and kinesthetic components. There is com-
pelling evidence that training with motor imagery, or
mental practice (MP) improves motor performance when
combined with physical practice (Driskell, Copper, &
Moran, 1994). Consequently, MP is increasingly used in
sports training for the acquisition and performance of
complex motor skills. Another well-known intervention
for athletes undergoing training is the use of music. It has
been suggested that listening to music provides several
benefits in sports training, including increased positive
mood/reduced negative mood, enhanced acquisition of
motor skills when rhythm or association is matched with
required movement patterns, and extended work output
through synchronization of music with movement (Kara-
georghis & Terry, 2001). However, no study so far has in-
vestigated the combined effect of MP and music in
training a motor skill. To test this hypothesis, 27 female
basketball players were randomly assigned to one of three
training conditions–MP and music (MMP), MP, and phys-
ical training alone (PT). The target motor task was the lay-
up shot, made by leaping from below, laying the ball up
near the basket, and using one hand to bounce it off the
backboard and into the basket. The lay-up shot was se-
lected because it is one of the most commonly used tech-
niques in basketball.
Players in the MP group received a mp3 file containing
audio instructions that guided the participant in perform-
ing a mental rehearsal of the target movement. In the
MMP group, the audio instructions were accompanied
by a music trace whose rhythmic component simulated
the rhythm of the target movement. Finally, participants
assigned to the control group received only conventional
physical training. Players performance was independ-
ently assessed by three basketball coaches (Cronbach
alpha >.90) before and after a four-week training period,
in which players practiced three times a week. Findings
showed an overall improvement of performance after
training (p<.05), but no significant differences were
found between training conditions. However, Wilcoxon
analysis carried out within each experimental condition
showed training-specific effects on selected variables.
MMP players improved both coordination (p<.05) and
rhythm (p<.05), while players assigned to MP improved
coordination skills (p<.05). Overall, these results suggest
that MP (either with or without music) may be used in
combination with physical training to enhance the acqui-
sition and performance of specific motor skills compo-
nents.
202
references
Driskell, J.E., Copper, C., and Moran, A., Does Mental
Practice Enhance Performance?, Journal of Applied Psy-
chology 79 (4) (1994), 481-492.
Jeannerod, M., The representing brain: Neural correlates
of motor intention and imagery, Behavioural and Brain
Sciences 17 (2) (1994), 187-245.
Karageorghis, K., Terry, P.C. (2001). The magic of music
in movement. Sport and Medicine Today 5 (2001), 38-41.
––––––––––––––––––––––––––––––––––––––––––––––
Coping with stress: new Technologies to support
Teachers in managing Work stress disease
Alessandra Grassia,1, Elena Radici, and Giuseppe Rivaa,b
a
Department of Psychology,
Catholic University of Milan, Italy
b
Applied Technology for Neuro-Psychology Lab, Isti-
tuto Auxologico Italiano, Milan, Italy
Corresponding author:
1
Alessandra Grassi
Dipartimento di psicologia
Università Cattolica del Sacro Cuore
Milan, Italy
E-mail: alessandra.grassi@unicatt.it
abstract
This aim of this study is to create and verify the effective-
ness of a protocol expected to manage work stress disease
in an high school teachers’ sample. Specifically, the work
investigated the effectiveness of audio and video content
in the emotion induction process and in the emotion reg-
ulation process by using different media (mobile phone,
DVD, mp3 player and audio CD). The protocol is based
on Stress Inoculation Training (SIT) (Meichenbaum,
1972; Forman, 1982; Long, 1988; Cecil & Forman, 1990;
Salami, 2007) and consists of three main phases. The first
one is focused on acquiring cognitive relaxation compe-
tences on physical and psychological reactions, the second
phase is based on learning coping strategies, and the third
phase progressively exposes the subject to stressful situa-
tions in a controlled setting, in order to practice the previ-
ously acquired relaxation techniques. With this
background to support the present study, the authors de-
fined a protocol based on Stress Inoculation Training to
support teachers in managing work stress disease.
Abstracts from CT15
Keywords: Emotion Induction, Emotion Regulation,
Stress, Work Stress Disease, New Technologies, Mobile
Phones, mp3 Player
introduction
High school teachers' stress as a result of their work is the
focus of this study. Usually, teachers experience symptoms
such as anxiety, anger and depression during daily work
stress situations, which can be complicated by relation-
ships with school principal, colleagues and students
(Coates & Thoresen, 1976). With this in mind, this project
is meant to achieve two aims. First, authors want to stim-
ulate an emotional change in the participating sample
through relaxing techniques such as Progressive Muscular
Relaxation (Jacobson, 1938) and Autogenic Training
(Schultz, 1977), to induce a deep sense of relaxation and
to decrease negative emotions, such as anxiety and anger.
Secondly, the protocol is designed to investigate the sense
of presence (Riva, 2008) as a fundamental variable to un-
derstand the sense of engagement in the video content pro-
posed by using different media.
Specifically the intervention is structured into two phases:
1.Stress level evaluation: in this part of the study subjects
are asked to complete a questionnaire to record the level
of stress of the participants. This first phase is aimed at
creating an homogenous sample.
2. Intervention: the second phase of the study is aimed at
promoting a protocol to enhance emotion regulation and
to teach relaxation techniques to increase coping abilities.
The project investigates the effectiveness of five minutes
of audio and video content in the emotion induction
process by using different media including a UMTS mo-
bile phone, DVD, mp3 player and audio CD. The protocol
is made up of eight sessions and a mood induction is in-
cluded in each session. The first three sessions are based
on psycho-physiological reactions to stress at work, the
second set of three sessions are based on psycho-physio-
logical reactions and on coping strategies, and the seventh
and eighth sessions present the stressful situation (a class-
room) in order to evaluate the acquired competencies. The
intervention lasted four weeks.
methods
This study has a mixed design (5x2). The first independent
variable refers to the experimental intervention and is
measured between subjects on five levels – video and
audio content on a mobile phone (MP), video and audio
content on a DVD (DVD), only audio content on the mp3
JCR
Abstracts from CT15
player (M3) (Nonar), only audio content on an audio CD
(CD), and the control group (Ctrl). The second independ-
ent variable refers to time as a unit of measure – pre and
post-intervention. The two dependent variables are emo-
tional state dimension and sense of presence. The MSP
(Mesure du Stress Psychologique) (Di Nuovo, Rispoli &
Genta, 2000) questionnaire was administered to 125 high
school teachers to select only participants who suffer from
work stress disease.
From this sample, 75 teachers (M= 42,56, sd= 1,65) were
selected to participate in the study. Each participant com-
pleted the following questionnaires before and after each
virtual experience – State questionnaire, STAI (Spiel-
berger, Gorush, & Lushene, 1970) (State Trait Anxiety In-
ventory, state version), and Vas (Gross & Levenson, 1995)
(Visual Analogue Scale). and the Presence questionnaire:
Itc-Sopi (Lessiter, Freeman, Keogh, & Davidoff, 2001).
expected results
At the moment the study is in progress. Results are ex-
pected on two subjects. First, authors aim to evaluate the
effectiveness of the Stress Inoculation Training, imple-
mented using new media, to enhance wellbeing, to pro-
mote relaxation and to decrease anxiety. Secondly, authors
want to understand if the audio/video contents are more
effective than only audio contents in the emotion regula-
tion and emotion induction process. Final results will be
presented at the 2010 CyberTherapy Conference.
references
Cecil, M.A. & Forman, S. (1990), Effects of Stress Inoc-
ulation Training and Coworker Support Groups on
Teacher’s Stress, Journal of School Psychology, 28, 105-
118.
Coates, T.J. & Thoresen, C.E. (1976), Theacher anxiety:
A review with recommendations, Review of Educational
Research, 46, 159-184.
Di Nuovo, S., Rispoli, L., Genta, E. “Misurare lo stress. Il
Test M.S.P. e altri strumenti per una valutazione integrata”
FrancoAngeli, Milano, 2000.
Forman, S. (1982), Stress management for teachers: A
cognitive-behavioral approaches, Journal of school Psy-
chology, 20, 180-187.
Gross, J.J., & Levenson, R.W. (1995). Emotion elicitation
using films. Cognition and Emotion, 9, 87
JCR
203
Jacobson, E., “Progressive Relaxation”, The University of
Chicago Press, Chicago, 1938.
Lessiter, J., Freeman, J., Keogh, E., Davidoff, J. (2001) A
cross-media presence questionnaire: The ITC-Sense of
Presence Inventory, Presence: Teleoperators & Virtual En-
vironments, 10, 282-298.
Long, B.C. (1988), Stress management for school person-
nel: Stress-Inoculation Training and execise, Psychology
in the school, 35, 314-324.
Meichenbaum, D., (1972), Cognitive Modification of test
anxious college students. Journal of Consulting Clinical
Psychology, 39, 370-380.
Riva, G. “Psicologia dei nuovi media” Il Mulino, Bologna,
2008.
Salami, S.O., (2007), Management of Stress among
Trainee-Teachers Through Cognitive Behavioral Therapy,
Pakistan Journal of Social Science, I, 4 (2), 299-307.
Schultz, J.H. “Il Training Autogeno”, Feltrinelli, Milano,
1977.
Spielberger, C.D., Gorush, R.L., Lushene, R.E. (1970)
State Trait Anxiety Inventory manual, Palo Alto, CA: Con-
sulting Psychologists Press.
––––––––––––––––––––––––––––––––––––––––––––––
feasibility of a new ambulatory
rehabilitation system for acquired brain
injury patients
J. Guixeresa,b,1, D. Castillac, M. Alcañiza,b, J. Saiza,
R, Bañosb,d, and C. Botellac,d
Instituto en Bioingeniería y Tecnología Orientada al Ser
a
Humano, Universidad Politécnica de Valencia,
Valencia. Spain
b
Ciber Fisiopatología Obesidad y Nutrición (CB06/03)
Instituto Salud Carlos III, Spain
c
Departamento de Psicología Básica,
Clínica y Psicobiología,
Universidad Jaume I,
Castellón de la Plana, Spain
d
Departamento de Personalidad, Evaluación y
Tratamientos Psicológicos, Universidad de Valencia,
Valencia, Spain
204
1
Corresponding author:
Jaime Guixeres
Instituto en Bioingeniería y Tecnología Orientada al Ser
Humano, Universidad Politécnica de Valencia
Camino de Vera s/n, 46022
Valencia, Spain
E-mail: jguixeres@i3bh.es
abstract
There is a need for new tools to treat patients with Ac-
quired Cerebral Damage, in order to make global and con-
tinuous rehabilitation plausible. The first needed element
is a new platform for ambulatory rehabilitation. This de-
vice makes use of inertial sensors for tracking patient
motor exercises and a software platform for motivational
reinforcement, an aspect as important as rehabilitation it-
self. A mobile platform and computer platform control and
set reinforcement stimuli for the patient, adapting the mes-
sages for the rehabilitation process. A study has been de-
signed with ten patients for testing the usability for
patients with different degrees of cerebral damage to ver-
ify the functional validity of the tool and the possibility of
autonomous use on the part of the patients.
Keywords: Virtual Rehabilitation, Wireless Inertial Sen-
sors, Persuasive Computing, Ambient Intelligence
Introduction
In Spain there are 300,000 people affected by Acquired
Brain Injury (ABI), making it a social problem of utmost
importance. It is important to note that rehabilitation hap-
pens in different contexts, that is to say, in different places,
with different people and different tasks, during the day.
Patients should be able to take advantage of any opportu-
nity to complete exercises that foment rehabilitation. For
that reason their rehabilitation should be global and con-
tinuous. [Alvaro Bilbao. Neuropsychologist]
method
The first element of a new platform for ambulatory reha-
bilitation is discussed in this paper. The key points of this
development are:
–Rehabilitation Wireless Sensor Node (RWSN): The first
element of a body area network (BAN) where each one of
the sensor elements will collect the mobility of each one
of the members involved in the rehabilitation sessions.
–Tracking algorithm: The device will obtain the orienta-
tion of the sensors with a high degree of accuracy by
Abstracts from CT15
fusing gyroscope, accelerometer, and magnetometer sig-
nals (Luinge, 2004; Roetenberg, 2005).
–Two working modes (autonomous or distributed): In au-
tonomous mode, all signals are gathered and processed in-
ternally, whereas in the distributed mode, signals are sent
directly through Bluetooth or ZigBee link to the RWCN,
or directly to the PC or PDA .
–User Interface: The device must be able to work in au-
tonomous mode. It has been equipped with a vibration
motor, a multicolor LED and buzzer as RWSN interface.
An interface code protocol with color lights, sounds and
vibrations will let the patient complete the exercise cor-
rectly. This will be validated in the case study.
–Reinforcement and Motivation Platform: It has been de-
signed two software applications for the user. The first
one on a computer will let the patient see a“virtual ther-
apist”, and the exercise will be completed with the help
of an animation. Next to the virtual therapist, the patient
will see a virtual representation of themselves who per-
forms movements that the subject makes. In this way the
patient can compare himself to the “virtual therapist.” In
addition, the patient will be able to visually compare the
virtual representation of a month ago to the present one,
and note resulting improvements from the treatment. This
kind of technique will generate behavioral reinforcement
for the patient at a time when they are confronting their
problem, calling for a continuous fight and restoration of
a series of positive habits. The other application, running
on mobile devices, will send the patient and relatives au-
tomatic messages relating to the rehabilitation and show-
ing the results obtained. One of the main difficulties that
physicians found when they implemented ambulatory ex-
ercises was maintaining the motivation of the patients
when the therapist is not present and motivation still has
not been generated intrinsically (generated by the own
subject). The virtual avatars would represent the therapist
role when they are not present in real life, generating re-
inforcement messages and stimulating the subject when-
ever an objective conduct is fulfilled. These systems
allow the subject to always feel accompanied and com-
pletion of objectives is positively reinforced, increasing
this way the effectiveness of the treatment. The virtual
use of avatars or virtual agents is becoming a powerful
tool to increase the motivation of patients, particularly
children (De Freitas & Levene, 2004; Garris, Ahlers, &
Driskell, 2002; Rebolledo-Mendez, de Freitas, & Burden,
2008).
JCR
Abstracts from CT15
results
The prototype is under development and the first study
will take place with ten patients under the supervision of
physicians for validating two hypotheses:
1. Is it possible for ABI patients to use these tools alone
and what is the maximum level of satisfaction that can be
obtained?
2. Does the patient accomplish the exercises planned by
therapist with this platform?
Patients and relatives will learn about the use of the system
and will complete a motor exercise in an isolated room
with video control. The observer will score accomplish-
ment based on usability and functional point of view for
the experiment.
discussion
Our first conclusions aim to answer:
–It is necessary to develop new ambulatory rehabilitation
programs that focus on a global and continuous stimulus.
Do you think it is possible to implement these kinds of sys-
tems for ABI patients?
–As important as motor rehabilitation is to help the patient
to confront its situation and to reinforce its behavioral mo-
tivation. What do you think about that?
references
De Freitas S., & Levene, M., (2004) An investigation of the
use of simulations and video gaming for supporting ex-
ploratory learning and developing higher-order cognitive
skills?. IADIS International conference in cognition and
exploratory learning in the digital age. Lisbon, Portugal.
Garris, R., Ahlers, R., Driskell, J., Games , motivation and
learning: a research and practice model. Simulation and
Gaming 33 (2002), pp. 441-467.
Luinge, H. J. "Inclination Measurement of Human Move-
ment Using a 3-D Accelerometer with Autocalibration",
IEEE Transactions on Neural Systems and Rehabilitation
Engineering, 2004 vol. 12, no. 1, pp. 112-121.
Rebolledo-Mendez, G., de Freitas, S., Burden, D. (2008)
"A model of motivation for virtual world avatars". Ac-
cepted as poster to the Eight International Conference on
Intelligent Virtual Agent, IVA 2008.
JCR
205
Roetenberg, D., "Compensation of magnetic disturbances
improves inertial and magnetic sensing of human body
segment orientation", IEEE Transactions on Neural Sys-
tems and Rehabilitation Engineering, 2005 vol. 13, no. 3,
pp. 395-405.
––––––––––––––––––––––––––––––––––––––––––––––
Variation of egocentric reference in
neglect patients by head movement
Kiwan Hana, Jeonghun Kua,1, Hyeongrae Leea, Jinsick
Parka, Deog Young Kimb, In Young Kima,
and Sun I. Kima
Department of Biomedical Engineering,
a
Hanyang University, Seoul, Korea
b
Department and Research Institute of Rehabilitation
Medicine, Yonsei University College of Medicine,
Seoul, Korea
1
Corresponding author:
Jeonghun Ku
Neuro-mechanism on Virtual Environment Lab
Department of Biomedical Engineering
Hanyang University
Seoul, Korea
E-mail: kujh@bme.hanyang.ac.kr
abstract
Neglect patients have biased egocentric reference and it
influences their capability to be aware of or acknowledge
items on their contralesional side. It is revealed that spatial
attention (or egocentric reference) is closely linked with
eye movement. Moreover, it is known that eye movement
and head movement are mutually influenced. In conclu-
sion, it is considered that egocentric reference would in-
fluence head movement. In this study, we investigated
head movement effect on egocentric reference in neglect
patients.
Keywords: Spatial Attention, Head Movement,
Egocentric Reference
introduction
Hemispatial neglect is a common disabling condition fol-
lowing unilateral brain damage, particularly of the right
hemisphere (Parton, Malhotra, & Husain, 2004). Neglect
patients often fail to orient, report, and respond to stimuli
toward the contralesional (left) side of space (Butler,
Lawrence, Eskes, & Klein, 2009). Several bedside screen-
206
Table 1
Deviation angles in each position between egocentric reference and actual center position by head movement in
head-unrestrained viewing conditions. Negative deviation angle indicates that the ball was placed right-hand side
and the egocentric reference was on the right-hand side.
ing tests have revealed biased spatial attention field and
egocentric reference in hemispatial neglect. However,
these studies were carried out in a controlled head/re-
strained condition, different from real life. In this investi-
gation we examined a variation of egocentric references
of neglect patients by head movement in unrestrained
viewing conditions.
methods
Four stroke patients at Yonsei University Rehabilitation
Hospital were recruited for this experiment. They were di-
agnosed with hemispatial neglect by conventional bedside
tests and did not have any problem understanding the task
and were able to control the experimental apparatus. Par-
ticipanst wore a HMD (head mounted display) that was
used to present stimuli in a unrestrained-head condition.
A position tracker was used to control the viewing angle
for placing the ball at egocentric reference positions and
to acquire deviation angles between egocentric reference
and the actual center position. In each test trial, a ball ap-
peared in one of seven arched positions. The seven ball
positions were placed at 11°, 22°, and 28° to the left or
right side of the actual center position and 0°. Participants
were instructed to find a ball and place the ball at the cen-
ter of the screen. In each trial, when participants made a
response after the ball was placed at an egocentric refer-
ence position, deviation angles were recorded. Participants
performed 42 trials in a random order, consisting of six
repetitions in each ball position.
results
There were significant biased egocentric references at 11°
to the left, 0°, and 11°, 22°, and 28° to the right. However,
there were no shifted egocentric references at 28° and 22°
to the left.
Conclusion
In this investigation we examined the effect of head
movement on egocentric reference in neglect patients.
Eye movements have the potential to show where atten-
Abstracts from CT15
tion is deployed since the direction of gaze is generally
considered to be tightly coupled with the orienting of at-
tention (Hoffman & Subramaniam, 1995). Moreover,
head movement also corresponds with eye movement
(spatial attention) in searching with the head in an unre-
strained position (Khan, Blohm, McPeek, & Lefe`vre,
2009). In this experiment the positions at 28° and 22° to
the left and right were outside of the field of view. Ego-
centric references were shifted by head movement to the
left-hand side that offset existing rightward egocentric
references at 28° and 22° to the left. On the other hand,
egocentric references were shifted ightward along with
existing rightward egocentric references at 28° and 22°
to the right. Moreover, for positions at 11° to the left and
right and 0°, there was insufficient head movement and
existing rightward egocentric references remained. In
conclusion, neglect patients may have a rightward-biased
spatial attention field or egocentric reference that would
be influenced by head movement, while eye movement
is tightly coupled with spatial attention induced by head
movement.
references
Butler, B.C., Lawrence, M., Eskes, G.A., and Klein, R.,
Visual search patterns in neglect: Comparison of periper-
sonal and extrapersonal space, Neuropsychologia 47
(2009), 869-878.
Hoffman J.E., and Subramaniam, B., The role of visual
attention in saccadic eye movements, Perception & Psy-
chophysics 57 (1995) 787–795.
Khan, A.Z., Blohm, G., McPeek, R.M., and Lefe`vre, P.,
Differential Influence of Attention on Gaze and Head
Movements, Journal of Neurophysiology 101 (2009), 198-
206.
Parton, A., Malhotra, P., Husain, M., Hemispatial neglect,
Journal of Neurology, Neurosurgery and Psychiatry 75
(2004), 13-21.
JCR
Abstracts from CT15
––––––––––––––––––––––––––––––––––––––––––––––
effects of the bas and bis on decision-making
using a simulated gambling Task
Deok-Yong Kima and Jang-Han Leea,1
Clinical Neuro-pSychology Lab., Department of
a
Pschology Chung-Ang University, Seoul,
Republic of Korea
1
Corresponding author:
Jang-Han Lee
Clinical Neuro-pSychology Lab
Department of Pschology
Chung-Ang University
Seoul, Republic of Korea
Tel: +82 2 820 5751
E-mail: clipsy@cau.ac.kr
abstract
The aim of the study was to investigate how the Behav-
ioral Approach System (BAS) and the Behavioral Inhibi-
tion System (BIS) affect decision-making following
different feedback types. In accordance with the joint sub-
system hypothesis, participants were divided into four
groups depending on the relative strength of their
BAS/BIS scores. A modified Game of Dice Task (GDT)
examined repeated decision-making processes under ex-
perimentally manipulated winning and losing experi-
ences, while participants were aware of the rules of the
task. Results revealed that the high BAS/low BIS group
made risky decisions after winning experiences, while the
low BAS/high BIS group made non-risky decisions after
losing experiences, which revealed that personality and
decision-making interplayed between the BAS and BIS
in a realistic gambling game.
Keywords: Decision-making, Game of Dice Task,
Behavioral Approach System,
Behavioral Inhibition System
introduction
Gambling consists of continuous decision-making
processes while being provided information about gain
and loss probabilities. Personality traits, such as impul-
sivity or anxiety, affect decision-making processes during
gambling tasks (Martin & Potts, 2009). Gray (1981) pro-
posed the Reinforcement Sensitivity Theory (RST),
which suggests an independent relationship exists be-
tween the BAS and BIS, to explain impulsivity. There are
JCR
207
some limitations of the RST, which appear when stimuli
contain hyper-active BAS/BIS in experimental situations
without mixed reward and punishment. Conversely, the
joint subsystem hypothesis (JSH) (Corr, 2002) assumes
the mutual interplay of the BAS / BIS effects. It is argued
that the BAS and BIS make use of two effects, which are
facilitation and antagonism. According to the JSH, high
BAS/low BIS groups, whom are impulsive individuals,
are the most sensitive to reward. Hence, the purpose of
this study was to investigate how the relative strength be-
tween the BAS and BIS affect decision-making under risk
situations following gambling experiences.
methods
participants and materials
Fifty-one undergraduates (29 female) were divided into
four groups based on relative BAS/BIS scores, and con-
ducted the modified GDT, a modified version of the orig-
inal GDT (Brand, 2005). The task examines repeated
decision-making processes during experimentally-manip-
ulated winning and losing experiences, while participants
are aware of the rules.
procedure
An experimenter explains the task, the interface, and in-
formation regarding choices and winning probabilities.
Before starting the task, participants conducted an eight-
block exercise trial. After the task, participants were de-
briefed, and paid according to how much money they
won or lost during the task.
results
Results revealed that the high BAS/low BIS group
showed relatively more risky decision-making than both
the high BAS/high BIS group, F(1,44)=12.64, p=.001,
and the low BAS/low BIS group, F(1,44)=11.59, p=.001,
after winning experiences. On the other hand, the low
BAS/high BIS group made more safe decisions than the
high BAS/high BIS group after feedback from losing,
F(1,44)=5.80, p<.05.
Conclusion
The present study found that differences of the relative
BAS and BIS levels affected decision-making in relation
to winning and losing experiences during a realistic gam-
bling task. The modified GDT, which activated the sen-
sitivity of both reward and punishment through winning
or losing experiences, provided valuable information re-
garding the relative characteristics between the BAS and
the BIS.
208
Acknowledgement
This work was supported by the National Research Foun-
dation of Korea (NRF) grant funded by the Korea govern-
ment (MEST) (No. 2009-0084146).
references
Brand, M., Fujiwara, E., Borsutzky, S., Kalbe, E., Kessler,
J., & Markowitsch, H. J. Decision-making deficits of Ko-
rsakoff patients in a new gambling task with explicit rules
– associations with executive functions, Neuropsychology
19(2005), 267-277.
Corr, P. J. J. A. Gray’s reinforcement sensitivity theory:
Test of the joint subsystem hypothesis of anxiety and im-
pulsivity, Personality and Individual Differences
33(2002), 511-532.
Martin, L. E., & Potts, G. F. Impulsivity in decision-mak-
ing: An event-related potential investigation, Personality
and Individual Differences 46(2009), 303-308.
––––––––––––––––––––––––––––––––––––––––––––––
how alcohol Cravings of heavy social drinkers are
influenced by Virtual Covert senstization
Hyo Kyung Kima, Kiho Kima, and Jang-Han Leea,1
Clinical Neuro-Psychology Lab, Department of
a
Pschology Chung-Ang University, Seoul,
Republic of Korea
1
Corresponding author:
Jang-Han Lee
Clinical Neuro-pSychology Lab
Department of Pschology
Chung-Ang University
Seoul, Republic of Korea
Tel: +82 2 820 5751
E-mail: clipsy@cau.ac.kr
abstract
Covert sensitization (CS) is imagery-based aversive treat-
ment aiming to decrease cravings and induce aversion to
abused drugs. Although an advantage of CS is that its ef-
fectiveness relies mainly on an individual’s ability to use
their imagination, this can also be a limitation. In the pres-
ent study, we will use Virtual Reality (VR) to enhance the
effects of CS. VR-CS should be effective in reducing al-
cohol cravings by offering a vivid experience, which
should also make up for the possibility of one’s poor
Abstracts from CT15
imagination. The alcohol-Stroop task, an eye movement
task, and self-report questionnaires about cravings will
be administered to measure the efficacy of the treatment.
Keywords: Alcohol Craving, Covert Sensitization,
Virtual Reality
introduction
In many cultures, alcohol abuse is the most prevalent type
of substance abuse. Despite harmful effects of excessive
consumption, cessation of risky drinking is difficult. This
kind of alcohol abuse is associated with alcohol cravings,
which play a critical role in triggering substance use and
relapse. Therefore, we aim to decrease the intensity of
cravings using covert sensitization (CS), which is im-
agery-based aversive therapy designed to decrease crav-
ings and induce aversion towards abused substances.
However, the effectiveness of covert sensitization relies
highly on an individual's ability to use their imagination.
Thus, in 2008 we designed a Virtual Reality (VR) pro-
gram to compensate for the possibility a lowered ability
to use imagination, which was expected to help increase
treatment effects. In a preliminary study, the VR program
revealed several disadvantages including a lack of realism
and that the program consisted of only two virtual envi-
ronments. In the present study, we will modify the VR
program by adding additional aversive environments. We
will also increase the sample size to enhance validity and
reliability.
Substance abusers tend to have an attentional bias for
stimuli related to the relevant substance, which is known
to be caused by cravings. Therefore, by decreasing crav-
ings using VR-CS, attentional bias should also decrease,
and to test this, we will measure attentional bias using the
alcohol-Stroop task and an eye-movement task. If atten-
tional bias is decreased, we may be able to suggest that
cravings have decreased as well.
method
Participants will conduct the AUDIT (Alcohol Use Dis-
orders Identification Test) along with a questionnaire
about unpleasant experiences likely to occur as a result
of excessive drinking. Using the AUDIT results, 20 harm-
ful drinkers will be assigned to the Harmful Drinkers
(HD) group, and 20 non-harmful drinkers will be as-
signed to the Non-Harmful Drinkers (NHD) group, which
is also the control group. Based on a preliminary study, a
VR-CS scenario was designed to include a virtual hospi-
tal and a virtual subway using the NeuroVR software. The
JCR
Abstracts from CT15
alcohol-Stroop task, an alcohol image-related eye move-
ment task, and the Alcohol Urge Questionnaire (AUQ)
will be administered before and after six sessions of treat-
ment to test the effectiveness of the treatment. The alco-
hol-Stroop task will be presented using E-prime 2.0., and
an SMI iView Red-IV will be used to track eye move-
ments. Afterwards, VR-CS treatment will be conducted.
Immediately after each session, participants will be asked
to complete the AUQ a total of seven times. Following
the final AUQ, they will be asked to perform the alcohol-
Stroop task and the eye-movement task.
expected results
We expect that VR-CS will decrease cravings in the HD
group, which will suggest a decrease in attentional bias
as well. We also expect that before VR-CS the HD group
will show slower reaction times in the alcohol-Stroop
task, and attend more to alcohol-related cues in the eye-
movement task due to an attentional bias towards alcohol.
However, the HD’s attentional bias will be decreased in
both the alcohol-Stroop task and the eye-movement task
after VR-CS treatment. It is also predicted that no signif-
icant change will be observed in the NHD group.
Conclusion
These results will demonstrate that a decrease in atten-
tional bias suggests a decrease in cravings. This will allow
us to assume that cravings were decreased due to the VR-
CS treatment. This will show the effectiveness of VR-CS
for treating substance abusers to help them decrease their
cravings.
Acknowledgements
This work was supported by the National Research Foun-
dation of Korea (NRF) grant funded by the Korea gov-
ernment (MEST) (No. 2009-0084146) (No.
2009-0083866).
references
Kearney, Albert J., A Primer of Covert Sensitization, Cog-
nitive and Behavioral Practice 13 (2006), 167–175.
Moon, J., & Lee, J. H. (2008). Development of virtual
aversive environment: Preliminary study of covert sensi-
tization for alcohol craving. 13th Annual Cyber Therapy
Conference, San Diego, CA.
––––––––––––––––––––––––––––––––––––––––––––––
analysis of brainwave Characteristics during a
Computer-based deception simulation Task
JCR
209
SuJin Kima Kyu Hee Junga and Jang-Han Leea,1
Clinical Neuro-Psychology Lab, Department of
a
Pschology Chung-Ang University, Seoul,
Republic of Korea
1
Corresponding author:
Jang-Han Lee
Clinical Neuro-pSychology Lab
Department of Pschology
Chung-Ang University
Seoul, Republic of Korea
Tel: +82 2 820 5751
E-mail: clipsy@cau.ac.kr
abstract
The present study investigated whether Event-Related
Desynchronization (ERD) could discriminate between
deceptive responses and truthful responses. To motivate
participants to lie spontaneously, we developed a com-
puter-based deception simulation task. Subjects were
shown a dice roll on a monitor and had to decide whether
to keep the presented number rolled (truthful response)
or lie and select a different number (deceptive response).
Giving a truthful response involved a small reward but
no risk, while a deceptive response increased the possi-
bility of achieving the goal of the task but also a monetary
risk. We expect that more alpha ERD will be measured
during deception responses compared to truthful re-
sponses, allowing us to differentiate between truthful and
deceptive responses.
Keywords: Deception, Computer-based Deception
Simulation Task , Event-Related Desynchronization
introduction
In daily life, people tell various lies. However, deception
can be damaging to society in forensic or business situa-
tions. Therefore, detecting deception has been recognized
as an important issue in our modern society. To study the
discrimination between telling the truth and lying, it is es-
sential to present a situation which provokes the need to
lie. We developed a computer-based deception simulation
task to provoke natural deception in a controlled experi-
mental situation.
Our deception task encourages participants to lie sponta-
neously because deceptive responses are necessary to
achieve the goal of the task, which is compensated with
a financial reward that further motivates the participants.
210
Task immersion is also increased by presenting immedi-
ate feedback based on participant response during the de-
ception task. An advantage of the task is that it allows a
comparison between spontaneous deception and in-
structed deception within the same experimental session.
We measured Event-Related Desynchronization (ERD)
during the task. Alpha band ERD is the percentage of de-
crease in alpha power from a reference (prestimulus pe-
riod) to an activation interval (task performance). EEG
alpha power desynchronizes when individuals are men-
tally active, and reflects increasing task demands (Fink,
Grabner, Neuper, & Neubauer, 2005). When lying, rela-
tively more cognitive complexity is experienced, and this
phenomenon should be reflected as alpha band ERD. In
this context, our study assumed that more cognitive effort
during deception leads to increased alpha ERD.
method
Participants signed an informed consent form. After a
baseline EEG measurement, they performed the “Jack’s
beanstalk” task. We developed a program where a dice
is rolled and Jack climbs up the number of steps rolled
on the dice. Participants had to decide whether to enter
the rolled number (truthful response) or a different num-
ber (deceptive response). The computer played the role
of a second player, but the participants believed they
were playing against a real person. The goal of the task
was to reach the top of the beanstalk. Telling the truth
involved a small reward but no risk, whereas lying in-
creased the probability of reaching the top of the
beanstalk but also involved a monetary risk. EEG and
skin conductance data was acquired using a Laxtha Poly-
G-I monitoring device.
expected results
We predict that deceptive responses will represent more
alpha band ERD than telling the truth, allowing us to be
able to discriminate between deceptive responses and
truthful responses.
Conclusion
These results would suggest that alpha band ERD could
detect deceptive responses, therefore also suggesting that
ERD may be a valuable tool in measuring deception. In
addition, these results would imply that our task is able
to naturally provoke spontaneous deception in a con-
trolled experimental situation.
Acknowledgements
This work was supported by the National Research Foun-
Abstracts from CT15
dation of Korea (NRF) grant funded by the Korea gov-
ernment (MEST) (No. 2009-0084146)
references
Fink, A., Grabner, R.H., Neuper, C.,& Neubauer,
A.C.,(2005). EEG alpha band dissociation with increas-
ing task demands. Cognitive Brain Research 24, 252-259.
––––––––––––––––––––––––––––––––––––––––––––––
Computer-aided Vicarious exposure (CaVe) for
obsessive-compulsive disorder, implementation of a
non-immersive Virtual reality approach
Kenneth C. Kirkbya, Allison Matthewsa
and Joel Scanlona
a
Psychiatry, University of Tasmania, Australia
1
Corresponding author:
Ken Kirkby
Psychiatry, University of Tasmania
Private Bag 27
Hobart 7000, Australia
E-mail: ken.kirkby@utas.edu.au
abstract
Exposure with response/ritual prevention is an established
treatment for obsessive-compulsive disorder (OCD). In
vicarious exposure scenarios the subject observes another
person modeling this treatment and learns the techniques
involved and expected outcomes. This may have direct
therapeutic benefit or prepare the subject for in-vivo ex-
posure with response prevention, pertinent to their OCD
sympomatology. Computer-aided vicarious exposure
(CAVE) uses computer graphics to depict a person un-
dertaking exposure with response prevention. The behav-
ior of the observed person, a screen figure, is controlled
by the “point and click” method, in the manner of a com-
puter game. An “anxiety thermometer” depicts the rise
and fall of the anxiety response to exposure. A target score
is reached by cumulative enactments of therapeutic be-
haviors. These features facilitate exploratory skill learn-
ing. Previous research studies on CAVE used a version
with black and white perspective drawings and simple
draw-redraw animations. A new version of CAVE has
been developed using non-immersive virtual reality (VR)
to provide greater verisimilitude to the treatment process.
The features of this are demonstrated. Due to current con-
straints in delivery of VR approaches on the Internet, a
hybrid Internet site has been designed for clinical research
JCR
Abstracts from CT15
whereby the CAVE program is downloaded, whereas
screening and assessment is Internet-based.
Keywords: Response Prevention, Obsessive
Compulsive, Virtual Reality
introduction
Computer-aided vicarious exposure (CAVE) is based on
the social learning theory as expounded by Bandura
(1986). By observing another person or persons modeling
a behavior and the consequences of that behavior, the ob-
server is able to incorporate or omit that behavior from their
repertoire. This is an adaptive mechanism that serves to by-
pass the need to learn only through personal trial and error.
method
We have utilized this approach in a series of interventions
taking the form of computer games, modeling exposure
therapy for spider phobia, agoraphobia and obsessive-
compulsive disorder (OCD). The user directs the actions
of a “person”, a screen figure, through a scenario where
they approach or avoid phobic stimuli, with the anxiety
response of the screen figure depicted on an “anxiety ther-
mometer.” Repeated exposure results in reduction of the
anxiety response, simulating habituation. The desired ap-
proach behaviors are reinforced by a feedback score that
augments towards a target of 2000 points.
results
In previous research the CAVE programs used were eval-
uated in clinic-based research and were based on simple
draw-redraw animations in black and white HyperCard
on a nine-inch screen. A series of RCTs in spider phobics
(Smith, Kirkby, Montgomery, & Daniels, 1997;
Gilroy, Kirkby, Daniels, Menzies, & Montgomery, 2000;
Dewis, 2001; Heading, 2001; Fraser, Kirkby, Daniels,
Gilroy, & Menzies, 2001; Gilroy, Kirkby, Daniels, Men-
zies, Montgomery, 2003) indicated efficacy and long term
maintenance of treatment effect, and pilot studies have
been reported in agoraphobia (Harcourt, Kirkby, Daniels,
& Montgomery, 1998; Kirkby, Daniels, Harcourt, Ro-
mano, 1999) and OCD (Clark, Kirkby, Daniels, & Marks,
1998; Kirkby, 2000.)
Conclusions
Internet-based computer games are increasingly avail-
able. These are generally in the non-immersive virtual re-
ality (VR) genre where the user watches and directs
action in a 3-D computer world on the computer screen.
However, the platforms for these online games are gen-
JCR
211
erally proprietary and not (as yet) accessible to research
groups wishing to develop programs. Accordingly, we
have developed a color 3-D animated version of CAVE
for desktop computer use, deliverable by Internet down-
load, for evaluation in settings including home-based
treatment.
references
Bandura, A., Social foundations of thought and action: A
social cognitive theory, Prentice Hall, Englewood Cliffs,
NJ, 1986.
Clark, A., Kirkby, K.C., Daniels, B.A., Marks, I.M., A
pilot study of computer-aided vicarious exposure for ob-
sessive-compulsive disorder, Australian and New Zealand
Journal of Psychiatry 32 (1998), 268-275.
Dewis, L.M., Kirkby, K.C., Martin, F., Daniels, B.A.,
Gilroy, L.J., Menzies, R.G., Computer-aided vicarious ex-
posure vs. live graded exposure for spider phobia in chil-
dren, Journal of Behavior Therapy and Experimental
Psychiatry 32 (2001), 17-27.
Fraser, J., Kirkby, K.C., Daniels, B.A., Gilroy, L.J., Men-
zies, R.G., Three versus six-sessions of computer-aided
vicarious exposure treatment for spider phobia, Behav-
iour Change 18 (2001), 213-223
Gilroy, L., Kirkby, K.C., Daniels, B.A., Menzies, R.G.,
Montgomery, I.M., A controlled comparison of computer-
aided vicarious exposure versus in vivo exposure in the
treatment of spider phobia, Behavior Therapy 31 (2000),
733-744.
Gilroy, L.J., Kirkby, K.C., Daniels, B.A., Menzies, R.G.,
Montgomery, I.M., Long-term follow-up of computer-
aided vicarious exposure versus live graded exposure in
the treatment of spider phobia, Behavior Therapy 34
(2003) 65-76.
Harcourt, L., Kirkby, K.C., Daniels, B.A., Montgomery,
I.M., The differential effect of personality on computer-
based treatment of agoraphobia, Comprehensive Psychi-
atry 39 (1998), 303-307.
Heading, K., Kirkby, K.C., Martin, F., Daniels, B.A.,
Gilroy, L.J., Menzies, R.G., Controlled comparison of
single session treatments for spider phobia: live graded
exposure versus computer-aided vicarious exposure, Be-
haviour Change 18 (2001), 103-113.
212
Kirkby, K.C., Daniels, B.A., Harcourt, L., Romano, A.,
Behavioral analysis of computer-administered vicarious
exposure in agoraphobic subjects: The effect of person-
ality on in-session treatment process, Comprehensive
Psychiatry 40 (1999) 386-390.
Kirkby, K.C., Berrios, G.E., Daniels, B.A., Menzies,
R.G., Clark, A., Romano, A., Process-outcome analysis
in computer-aided treatment of obsessive-compulsive dis-
order, Comprehensive Psychiatry 41 [2000], 259-265.
Smith, K.S. Kirkby, K.C., Montgomery, IM., Daniels,
B.A., Computer-delivered modeling of exposure for spi-
der phobia: relevant versus irrelevant exposure. Journal
of Anxiety Disorders 11 (1997), 489-497.
––––––––––––––––––––––––––––––––––––––––––––––
The impact of Visual displays in realistic Virtual
environment for Job interview fear
Remi. J. Kwona,1 and Benjamin H. Detenbera
a
Wee Kim Wee School of Communication and
Information, University of Nanyang, Singapore
1
Corresponding author:
Remi. J. Kwon
Wee Kim Wee School of Communication
and Information
Nanyang Technological University
31 Nanyang Link
Singapore 637718
E-mail: remi.kwon@pmail.ntu.edu.sg
abstract
Virtual reality exposure therapy (VRET) offers the pos-
sibility of tackling social anxiety in an efficient, safe and
controlled manner. A key question, however, is how ef-
fective are immersive VR environments in helping peo-
ple to deal with their anxiety in specific contexts. One
concern which affects many people from all walks of life
is the fear of a job interview. The objective of this study
was to compare a potential user’s anxiety responses in a
variety of VR environments simulating an interview sit-
uation using different immersive levels of visual display:
a high-resolution of head mounted display with motion
trackers, a large screen size of LCD screen, a laptop, and
an audio only. The results indicate that there is a correla-
tion between anxiety and the level of immersion, which
can inform the development of virtual reality exposure
Abstracts from CT15
therapy for job interview related anxiety. The results are
discussed in terms of how best to offer a flexible thera-
peutic environment to manage anxiety stimulus parame-
ters in a gradual manner.
Keywords: Virtual Reality Exposure Therapy,
Job Interview Fear, Immersive VR Displays
introduction
A very common fear that many people experience is anx-
iety related to job interviews (McCarthy & Goffin, 2004).
This is particularly true in student populations who are
close to finishing their degrees and are faced with the
prospect of their first ever job interview which could well
determine their future careers. A virtual reality environ-
ment can be used as a tool for treatment of the fear of in-
terviewing, while at the same time enabling students to
gain valuable experience at a time convenient to them.
A number of past studies in the field of VR therapy have
demonstrated the relationship between the level of im-
mersive displays and treatment outcomes in VRET (Krijn
et al., 2004; Bullinger & Riva, 2005). However, these
studies were limited to height phobia only, and compared
Cave Automatic Virtual Environment (CAVE) and Head
Mounted Display (HMD) conditions which were both
fully immersive environments. Due to the lack of evi-
dence about how human anxiety varies in accordance
with different immersive levels of VR environment, this
study investigated the relationship between the levels of
anxiety and various visual displays providing different
levels of immersive VR environment.
methods
The simulation of job interview used in this study is a
highly realistic multi-modal setting, including an office
and an interviewer (figure 1).
Figure 1. Virtual job-interview simulation.
Four different forms of VR environment were developed
to activate diverse levels of immersion:
Head Mounted Display (fully-immersive display): NVIS
nVisor SX was encompassed by a head motion tracker
JCR
Abstracts from CT15
(Polhe-mus 6DOF Motion Tracker). The HMD has a
maximum resolution of 1280x1240x60Hz, and run with
Intel Q6600 2.4GhZ core 2 Quad processor and Nvidia
Geforce 8800 GTX with 768 MB of RAM.
Large LCD (semi-immersive display): a 50-inch LCD TV
with Intel Q6600 2.4GhZ core 2 Quad processor and
Nvidia Geforce 8800 GTX with 768 MB of RAM.
Laptop (non-immersive display): a 14-inch laptop (Acer
Aspire 5920G) in a dark room setting. The simulation was
rendered by NVIDIA Geforce 8600M GT TurboCache
with 1024X800X60Hz resolution.
Audio-only: A typical stereo headset (SONY MDR-
NC60) was used with a blindfold.
Figure 2. Settings for virtual reality environments.
The target participants in this study were those who had
at least moderate symptoms of social phobia, thus only
individuals who scored more than 55 out of total 144 in
Leibowitz Social Anxiety Scale (LSAS) were invited
(Liebowitz, 1987). Twenty participants were selected
from the student population at the university and their
total average score of LSAS was 58.78 (SD=4.17). The
ethnic background was 14 female and 6 male, aged be-
tween 21 and 31 years old. In order to minimize the con-
founding variable of experiment expectancy, informed
consent was obtained after the introduction of the study.
After that, they were exposed to one of the four VR en-
vironments, and measured their physiological responses.
At the end of the course of virtual job interview, partici-
pants submitted Measure of Anxiety in Selection Inter-
views (MASI) to report their anxiety experience
(McCarthy & Goffin, 2004).
results
The level of increment of pulse rate from baseline (PR-
b) in the first minute was similar in all conditions, but the
mean distance between conditions widened later on. The
total average of PR-b in HMD, LCD, LAPTOP and
AUDIO conditions was 9.25, 6.80, 1.26 and 3.46, respec-
tively. The participants who were exposed to the virtual
job interview through HMD (fully immersive environ-
JCR
213
ment) had a higher increment in pulse rate than other
technical conditions, but no evidence was found for any
dissimilarity between the HMD and LCD conditions
(p=0.231) at 5% level. A similar result was found in the
MASI measures. The overall mean MASI response in
each condition of HMD, LCD, LAPTOP, and AUDIO
was 3.82, 3.71, 2.16 and 2.46, respectively. Across the
four conditions the difference in means for MASI was
significant at 5% levels (F(3; 34) = 281:98; P < 0:001).
From the multiple comparison procedure (Sidak) it was
noticed that in the HMD and LCD conditions the total
mean of MASI did not vary at 5% significant level (p =
0:485). This result indicated that, overall, the condition
of the large LCD screen provoked a similar level of anx-
iety to the HMD condition.
discussion
The initial hypothesis in this study was that the higher
immersive levels of visual display might provoke higher
levels of anxiety. The relation should be strongly corre-
lated. However, this experiment proved that this assump-
tion was not entirely valid. The study confirmed that
participants who have symptoms of social phobia felt
similar levels of anxiety in both fully (HMD) and semi
(large LCD) immersive levels of visual display, which
means they were concerned more about the context than
the quality of immersion. However, in order to activate
anxiety and maintain it over the course of the virtual sim-
ulation, at least some level of immersive display is re-
quired.
Conclusions
The study presented here has shown that VR exposure
can potentially be used as a therapeutic intervention for
job interview fears. A diversity of visual displays may be
a potential approach to treatment, providing anxiety-pro-
voking stimuli in a gradual order.
references
Bullinger, M. and Riva, G., Treating acrophobia in a vir-
tual environment, Proceeding in the cybertherapy confer-
ence 2005.
Krijn, M., Emmelkamp, P.M.G., Biemond, R., de Wilde,
L.C., Schuemie, M.J., et al, Treatment of acrophobia in
virtual reality: The role of immersion and presence, Be-
haviour Research and Therapy 42(2)(2004), 229-239.
Liebowitz, M.R., Social phobia, Modern Problems of
Pharmacopsychiatry 22 (1987), 141-173.
214
McCarthy, J.M., and Goffin, R.D., Measuring interview
anxiety: Beyond weak knees and sweaty palms, Person-
nel Psychology 57 (2004), 607-637.
––––––––––––––––––––––––––––––––––––––––––––––
neural mechanism of the interactive manner effect
to social Cognition on interacting with Virtual other
Hyeongrae Leea, Jeonghun Kua,1, Wonho Leea, Kang Jun
Yoonb, In Young Kima and Sun I. Kima
a
Department of Biomedical Engineering,
Hanyang University, Seoul, Korea
b
St. Peter’s Hospital, Seoul, Korea
1
Corresponding author:
Jeonghun Ku
Department of Biomedical Engineering,
Hanyang University
17 Haengdang-dong, Seongdong-gu
Seoul, 133-791
Korea
E-mail: kujh@bme.hanyang.ac.kr
abstract
In previous studies, interactive manner affects the user’s
feeling of presence. The different feelings of presence in-
fluence the user’s cognition, performance of tasks, im-
mersion level, memory and other factors. In this study,
we aimed to investigate how interactive manner affects
social cognition using a handshake paradigm by a con-
ventional interactive manner using a button so that the
subject’s hand motion synchronized with the avatar’s
hand motion. In results, the subjects felt more presence
and social presence in the real interactive manner condi-
tion. The main effect of the other avatar response was
shown in the right superior temporal sulcus (STS), right
inferior frontral gyrus (IFG) and left mid orbital gyrus. In
both interactive manners, The STS was significantly more
activated with the refused response, and the mid orbital
gyrus was more activated with the acceptive response.
However, the IFG was significantly more activated with
the acceptive response in the real interactive manner, but
was not differently activated in the conventional manner.
The subjects felt more presence and social presence in the
real interactive manner, and this different sense of pres-
ence affects a part of the mirror neuron system.
Keywords: Social Cognition,
Interactive Manner, Handshake
Abstracts from CT15
introduction
Social cognitive neuroscience benefits considerably by
using animated virtual agents. With the development of
an interactive technology, the user is able to experience
virtual environments consisting of more lifelike environ-
ments. In previous studies, interactive manner affected
the user’s feeling of presence. The different feelings of
presence affected the user’s cognition, performance of
tasks, immersion level, memory and other factors. How-
ever, it is unclear how the interactive manner affects so-
cial cognition on interacting with another. Therefore, in
this study, we aimed to explore how the effect of interac-
tive manner relates to social cognition using a handshake
paradigm by a conventional interactive manner and a real
interactive manner.
methods
subjects
Sixteen healthy participants were recruited for the fMRI
experiment.
experimental environments
We conducted an fMRI study using an interactive hand-
shake paradigm in which the user shook hands with a vir-
tual other. There are two kinds of interactive manners to
control my virtual avatar. In the conventional manner, the
subject presses the left button to raise my avatar’s hand
up, and presses the right button to lower my avatar’s
hand. In the real manner, my virtual avatar’s hand motion
is synchronized with the subject’s hand motion by calcu-
lating the position of marker on the subject's right hand.
The other avatar responds by accepting or refusing the
subject's offer. For the twelve pairs of avatars used in the
virtual environment (VE), each pair of avatars wears dif-
ferent clothes for the acceptance action and the refusal
action. After the fMRI experiment, subjects were asked
to complete the questionnaire about the their feelings to-
wards the virtual other’s response. The fMRI data were
analyzed with AFNI. We conducted ANOVA with facto-
rial model (interactive manner [real, button] by other
avatar response [acceptance, refusal]) for group level
analysis.
results
In questionnaire results the subjects felt more presence
and social presence with the real interactive manner. Dif-
ferent brain activations affected by the interactive manner
were in the left postcentral gyrus, left superior parietal
lobule, left middle cingulate cortex and left paracentral
lobule. The right superior temporal sulcus (STS), right in-
JCR
Abstracts from CT15
ferior frontral gyrus (IFG) and left mid orbital gyrus were
activated with the main effect of the avatar response. The
STS, which is associated with interpretation of the actions
and intentions of others, was significantly more activated
with a refused response in both interactive manners. The
mid orbital gyrus, which is implicated in the processing
of reward and social reinforcement, was significantly
more activated with an acceptive response in both inter-
active manners, but the IFG, which is related with imita-
tion of action and processing a symbolic gesture, was
significantly more activated with the acceptive response
in the real interactive manner, but was not differently ac-
tivated in the conventional manner.
Conclusion
In this study, we explored how interactive manner af-
fected social cognition with shaking hands using a con-
ventional interactive manner and a real interactive
manner. The subjects felt more presence and social pres-
ence in the real interactive manner, and this different pres-
ence affects a part of the mirror neuron system that is an
important factor of social cognition.
––––––––––––––––––––––––––––––––––––––––––––––
no sweat: Jogging in a Virtual World
using breath as avatar Control
Jacquelyn Ford Moriea,1, Eric Chancea, Kip Haynesa,
and Dinesh Purohita
a
University of Southern California Institute for Creative
Technologies, Marina del Rey, California, U.S.A.
1
Corresponding author:
Jacquelyn Ford Morie
University of Southern California Institute
for Creative Technologies
13274 Fiji Way
Marina del Rey, California, U.S.A.
E-mail: morie@ict.usc.edu
abstract
Recent research in the fields of Complementary and Al-
ternative Medicine (CAM) and virtual technologies sug-
gest some potentially new and beneficial therapies that
may help returning servicemen who present symptoms of
psychological stress. CAM therapies are now being val-
idated with evidence-based research. Data from the
emerging field of Self-Perception Theory shows that the
use of avatars in virtual worlds can affect a user’s psy-
JCR
215
chology and behavior. These findings and discussions
with psychologists who use Mindfulness-Based Stress
Reduction (a validated CAM therapy), and advice from
experts in military social work, has led us to develop a
virtual jogging system in the online virtual world of Sec-
ond Life. Our system is novel in that we use breathing to
control the movement of the avatar rather than keyboard
controls. There is no spirometer but breath detection is
instead done with a microphone by using the seldom-used
volume level detection technology available in Second
Life that is interpreted through a custom scripting solu-
tion.
Keywords: Virtual World, Therapy, Complementary &
Alternative Medicine, CAM, Stress Mitigation,
Breathing, Immersion
introduction
An extensive 2008 study by the Rand organization, titled
Invisible Wounds of War (Rand, 2008), reported that at
least 300,000 soldiers have symptoms of serious psycho-
logical stress, and also that gaps exist in the ongoing ef-
forts to provide veterans with proper health care for such
deployment-related psychological injuries.
The Coming Home project at the University of Southern
California's Institute for Creative Technologies (USC
ICT) is collaborating with experts in the fields of Com-
plementary and Alternative Medicine (CAM) and veteran
support to explore novel ways of extending available
health care possibilities for veterans. According to Dr.
Jose Coll, Clinical Associate Professor and Chair of Mil-
itary Social Work and Veteran Services at USC, disabled
veterans often express how much they miss jogging and
other physical training activities they are used to doing
every day.
Given recent research in the positive effects of virtual
world activity on real life, we believe that recreating such
an activity in a virtual world might have a positive benefit
on a person’s psychological and physical well-being. This
is a reasonable assumption based on research by Bailen-
son and colleagues at the Stanford Virtual Human Inter-
action Lab on what they term The Proteus Effect (Yee &
Bailenson 2007; Yee, Bailenson & Ducheneaut, 2009),
which indicates that users’ observations of their avatars’
behaviors can result in psychological effects and a change
in their real behavior. In one of the lab’s studies, users
who observed a virtual representation of themselves ex-
ercising reported significantly higher levels of exercise
in the real world after their session than those who
216
watched a representation of someone else exercising or
watching themselves not exercising (Fox & Bailenson
2009). Research by Lim and Reeves (2005) at Stanford
also shows that the simple act of allowing the user to
choose their avatar, and viewing that avatar in a third per-
son perspective, leads to greater physiological arousal and
an increased sense of presence in a virtual environment.
method/Tools/Challenges
Based on Dr. Coll’s suggestion and our preliminary re-
search, we set about creating a running path for veterans
in the virtual world Second Life. We felt it would be the
most beneficial if a real world activity or input could be
transferred to the virtual world as a control mechanism,
rather than the conventional method where a player sim-
ply hits a key to make an avatar run. Therefore, we made
the movement of the avatar dependent upon slow, regular
breathing. As long as the user maintains this breathing
rhythm, the avatar will run. This concept was based on
clinical research that has shown that slow, regular breath-
ing accompanied by biofeedback for as little as ten min-
utes a day can be effective in lowering blood pressure
(Grossman 2001), as well as by the technique of being at-
tentive to one’s breathing that is often employed in Mind-
fulness-Based Stress Reduction, a CAM therapy that is
used for stress reduction.
Several challenges were anticipated in the early develop-
ment cycle. These included virtual world limitations such
as seamless region crossing while jogging, lack of spe-
cific types of avatar movement and user control, and na-
tive data collection solutions. Anticipated challenges on
the user’s end, such as calibrating the microphone for
input, and training to use the system, were addressed via
an instructional video.
results
Initial usability testing was completed in early January
2010, with veterans who had considerable experience
using the Second Life platform, and who accessed the
jogging activity via a home-based microphone system. In
this testing, none of the participants were able to complete
the full length of the jogging path. We determined this
was due to several factors including variability in the mi-
crophones, the alibration instructions were unclear, and
the fact that the code could be improved to enable a
greater sensitivity for the breath input. We have com-
pleted these revisions and the second round of testing is
in progress through the month of January and early Feb-
ruary. Results are being analyzed to determine if a third
round of adjustments are necessary.
Abstracts from CT15
Conclusions
After the current development cycle is complete and
final revisions are implemented, a more extensive
round of user testing will be conducted to show the va-
lidity of our approach as part of a novel CAM therapy
to help reduce stress. We believe that real world con-
trols used within a virtual world setting hold a great
deal of promise for veterans and others with specific
health needs.
––––––––––––––––––––––––––––––––––––––––––––––
night Vision in open surgery preliminary
report on rabbits
V.J.L. Mossoa, O.R. Gonzaleza, R.G.Arrellína,
S.E. Rodrigueza, and L.D. Mossoa
Department of Surgery Panamericana University,
a
Mexico City, Mexico
1
Corresponding author:
Jose Luis Mosso
Calle Magdalena 218, interior 401
Colonia del Valle
Delegacion Benito Juarez,
Codigo postal 03100
Mexico City, Mexico
E-mail: quele01@yahoo.com
abstract
objective
Night vision technology permitted us to perform seven
open surgeries in the thorax and abdominal regions in rab-
bits with no complications.
Keywords: Night Vision, Open Surgery, Cybertherapy
method
In 2009, at the Department of Surgery at the Panameri-
cana University, Mexico City, we conducted a study using
a wireless microcamera with infrared light mounted on
the head of a surgeon, and night vision infrared stealth
goggles for the first assistant. The intraoperative, scrub
nurse and anesthesiologist didn´t used the systems, Re-
sults. It was possible to perform eight surgeries on rabbits
without surgical complications. Surgeries performed in-
cluded one laparotomy, one appendectomy, three
nephrectomies, one splenectomy, one left thoracotomy,
and one right thoracotomy, which were done under gen-
eral anesthesia.
JCR
Abstracts from CT15
Conclusions
Open surgeries performed on rabbits with the aid of night
vision technology showed promising results. In future
works, it is necessary to improve the resolution of micro-
cameras and all participants in the operating room must
use the same equipment. Future surgical procedures
which could be performed on humans using this tech-
nique include non-complicated hernia repairs, large lipo-
mas in soft tissues, subclavian catheter insertions and leg
amputations. This technology could be improved with
technology such as augmented reality and 3-D vision. Cy-
bertherapy could thus be used during surgical applications
to allow patients to be immersed in total darkness during
surgery, making VR immersion more realistic.
––––––––––––––––––––––––––––––––––––––––––––––
adolescents’ online activities and
Their friends in the real life
Vilmante Pakalniskienea
Vilnius University, Lithuania
a
Corresponding author:
1
Vilmante Pakalniskiene
Vilnius University
Universiteto 9/1, Room 202
Vilnius, Lithuania 01513
E-mail: vilmante.pakalniskiene@fsf.vu.lt
abstract
The purpose of this study is to evaluate adolescents
choice of best friend according to
Keywords: Internet Use, Friendship,
Similarity, Adolescents
introduction
Many adolescents spend time online chatting, playing
games, discussing various issues, or doing other activ-
ities. There are many studies examining adolescents’
activities and also their behaviors online and compar-
ing them to adolescents’ behaviors in real life. But
there is a lack of knowledge if adolescents’ behaviors
online could be somehow related to their best friends’
behaviors.
From peer network literature it is known that sole ado-
lescents choosing friends that are similar to themselves
or that friends become similar over time – in turn, they
JCR
217
influence each others behavior (Hamm, 2000; Hogue &
Steinberg, 1995; Jaccard, Blanton, & Dodge, 2005;
Kirke, 2004). There have been studies examining smok-
ing and drinking habits, among various problem behav-
iors. However, there is a question of whether or not
adolescents choose best friends in real life that are sim-
ilar to themselves or not according to their behaviors on-
line. Do adolescents choose people to become their
friends who are spending as much time as themselves
online and doing similar activities online?
method
participants
Three-hundred Lithuanian adolescents, aged from 12-
17 years, participated in a four-year longitudinal study.
Data used for the presentation are from the first wave
of the longitudinal study.
measures
Demographic information; information about the best
friend at school; evaluation of friendship quality; per-
sonality traits; self-esteem; activities online; time spend
online; having friends online; participation in certain
games, social networks, discussions online.
analysis
Social network analysis with SIENA software was used
for all analysis and Visone software for visualization.
SIENA software helps to analyze the choices of adoles-
cents and characteristics of the network. Visone soft-
ware helps to visualize the social network.
results
According to demographic characteristics younger ado-
lescents tend to play more games online compared to
older adolescents. Thus, activities affecting the best
friend choice are different according to age and gender.
Initial results of social network analysis suggest that
younger adolescents tend to choose friends similar to
them, according to their online activities and time spent
online. While for older adolescents it is the other way
around – they tend to choose friends who are not similar
according to what they do online or how much time they
spend online.
In an additional analysis, the model including several
youth characteristics, such as personality traits or prob-
lem behavior, would be included and tested to see if per-
sonality could have a stronger affect on adolescents
online activities and friendship per se, or not. Prelimi-
218
nary results of this model suggest that adolescents tend
to choose friends who are similar according to their ac-
tivities online, but not personality traits. Also, adoles-
cents who are doing certain activities online are more
popular among friends and tend to get more attention in
real life.
Conclusions
Certain online activities, such as participation in social
networks and playing certain games, could affect ado-
lescents’ friendship characteristics, such as reciprocity,
hierarchy, or similarity.
Certain youth characteristics, such as gender, age, or
self-esteem could moderate the role of online activities
and time spent online and how this relates to similarity
of friends.
Participating in online activities tends to make adoles-
cents more popular among friends.
discussion
This study looks at adolescents’ best friend choice while
examining certain youth activities online. Earlier studies
evaluating adolescents friendships did not include or
control for youth activities online or time spent online.
Considering that there are many activities online that
adolescents do, it is important to include this aspect in
adolescent research. We also lack knowledge on what it
is going on over time, if adolescents’ friends could affect
adolescents’ behaviors online or various activities on-
line. In this presentation first results from longitudinal
data would be presented as well to evaluate changes
over time and to evaluate if adolescents could model
their friends' behavior online.
references
Hamm, J.V., Do birds of a feather flock together? Indi-
vidual, contextual, and relationship bases for African
American, Asian American, and European American ado-
lescents' selection of similar friends, Developmental Psy-
chology 36 (2000), 209-219.
Hogue & Steinberg, L., Homophily of internalized dis-
tress in adolescent peer groups, Developmental Psychol-
ogy 31 (1995), 897–906.
Jaccard, J., Blanton, H., & Dodge, T., Peer influences on
risk behavior: An analysis of effects of a close friend, De-
velopmental Psychology 41 (2005), 135-147.
Abstracts from CT15
Kirke, M., Chain reactions in adolescents’ cigarette, al-
cohol and drug use: Similarity through peer influence or
the patterning of ties in peer networks? Social Networks
26 (2004), 3–28.
––––––––––––––––––––––––––––––––––––––––––––––
Visual fixations and eye-movement
in the Weapon focus effect during a
simulated eyewitness Crime scene
Kevin Kiwon Parka and Jang-Han Leea,1
a
Clinical Neuro-Psychology Lab, Department of
Psychology, Chung-Ang University, Seoul,
Republic of Korea
1
Corresponding author:
Jang-Han Lee
Clinical Neuro-pSychology Lab
Department of Pschology
Chung-Ang University
Seoul, Republic of Korea
Tel: +82 2 820 5751
E-mail: clipsy@cau.ac.kr
abstract
The weapon focus effect (WFE) states that eyewit-
nesses to crimes involving weapons focus more on
weapons than on details of the perpetrator or the crime
scene. We will investigate whether witnesses remain fo-
cused on a weapon preventing them from looking at
other details, or actually look at the whole scene but
simply do not remember what they saw. Using an eye-
tracker, we will measure eye movement and visual fix-
ations of participants while presenting a slide show of
a man taking a knife or money out of his pocket. We
will then test memory and target identification perform-
ance. Expected results are decreased memory and iden-
tification performance, with increased memory of the
weapon, in the weapon conditions, but not in the money
conditions. We expect the participants in the money
conditions will also notice an unusual probe in the
probe conditions, while the weapon conditions fail to
notice the probe. This will demonstrate that the pres-
ence of a weapon in fact causes witnesses to fixate on
the weapon, ultimately leading to a decrease in memory
for peripheral details.
Keywords: Weapon Focus Effect,
Visual Fixations, Eye Movement
JCR
Abstracts from CT15
introduction
The weapon focus effect (WFE) states that crimes involv-
ing weapons cause attention to be focused on central de-
tails – the weapon – leaving little attention to be spent
elsewhere. This causes memory impairment for periph-
eral details, such as the perpetrator’s external features or
the surrounding environment. The purpose of this study
is to determine whether eyewitnesses fixate on peripheral
details, but fail to remember what they saw, or whether
they spend all their attentional resources visually fixating
only on central details, such as a weapon.
method
The computer-based stimulus environment will be pre-
sented on a 22” wide LCD monitor, which will be con-
nected to a fully non-invasive eye-tracking system (SMI
iView X RED-IV) attached at the base of the monitor.
Therefore no equipment will be in physical contact with
the participant during the experiment. A digital slide show
of a simulated crime, or a typical encounter, depicting a
man (Target) entering a store, approaching the counter, and
interacting with the clerk (6 slides) is presented on a com-
puter monitor. The third slide shows the Target reaching
into his pocket, followed by the fourth slide (critical slide)
which shows the Target a) handing over a check (Control
condition), or b) pointing a knife (WFE condition). Also,
half of the participants in each condition will view the crit-
ical slide containing an unusual-peripheral detail (UPD) in
the top-left corner (Probe condition), and half without the
probe (No-probe condition). While viewing the slide show,
the eye movements and visual fixations will be measured
with the eye-tracking system. After viewing a slide show,
participants will complete a memory test regarding the cen-
tral detail (money or knife) as well as peripheral details
(e.g., Target appearance, environment), and a photo lineup.
A 2(WFE vs. Control) x 2(Probe vs. No-probe) ANOVA
will be used for data analysis.
expected results
We predict that the WFE conditions will spend more time
fixating on the central details, compared to the control
conditions, leading to increased memory for the central
details and decreased memory for peripheral details. In
contrast, the control conditions will spend less time fix-
ating on the central details, resulting in better retention
for peripheral details compared to the WFE conditions,
and will also show better retention for the Probe. We also
expect participants in the control conditions to perform
better on the photo lineup than participants in the WFE
conditions.
JCR
219
Conclusion
Until now, researchers have only been able to show that
the WFE causes memory impairment for peripheral de-
tails through research. The present study may be able to
demonstrate whether this is because witnesses fixate only
on central details, or actually see peripheral details but
simply do not remember them. This information could
help investigators interview eyewitnesses of crimes in-
volving weapons more effectively.
Acknowledgements
This work was supported by the National Research Foun-
dation of Korea (NRF) grant funded by the Korea gov-
ernment (MEST) (No. 2009-0084146).
references
Loftus, E. F., Loftus, G. R., & Messo, J. (1987). Some
Facts About “Weapon Focus.” Law and Human Behavior,
11(1), 55-62.
Pickel, K. L., Ross, S. J., & Truelove, R. S. (2006). Do
weapons automatically capture attention? Applied Cog-
nitive Psychology, 20(7), 871-893.
––––––––––––––––––––––––––––––––––––––––––––––
new Technologies and highly
specialized rehabilitation
Caterina Pistarinia, and Giorgio Maggionia
Neurorehabilitation Unit, IRCCS Salvatore Maugeri
a
Foundation, Scientific Institute of Pavia, Pavia, Italy
1
Corresponding author:
Caterina Pistarini
Salvatore Maugeri Foundation
via maugeri 10
27100 Pavia, Italy
E-mail: caterina.pistarini@fsm.it
abstract
The background against which SIRAS (the Italian So-
ciety of High Specialisation Rehabilitation) recently or-
ganized its IV Annual Meeting is on new technologies,
focusing on the clinical and rehabilitation implications,
consolidated applications and innovative developments
of these technologies. This event provided an opportu-
nity to swap experiences at different levels and was
structured around the following main topic areas – tel-
erehabilitation, nanotechnology, robotics, imaging, and
220
ethical considerations. The meeting fulfilled its aim,
which was to compare the various clinical and research
activities conducted in highly specialized areas of in-
terest to SIRAS, including cardiology, pneumology and
neurology, bringing together a large number of experts
interested in contributing to the rehabilitation of dis-
abilities associated with various diseases that can re-
duce an individual’s chances of leading an active life.
Here, description is presented of the actual Italian and
European situation in regards to this topic and our per-
sonal experience in neurorehabilitation
Keywords: Tele-health, Neurorehabilitation,
Kinematic Garment
introduction
The medical and healthcare fields have always kept a
very close eye on what technology can offer to improve
diagnosis and treatment. Concrete evidence of this
trend emerges in all aspects of rehabilitation. Recent
and ongoing advances in the fields of engineering, elec-
tronics and information technology have led to the
availability, at increasingly accessible costs, of compo-
nents, devices and systems offering solutions to im-
prove the health of patients, increase their level of
independence, and give them a better quality of life. It
is thus easy to see how technology touches on many as-
pects of the rehabilitation process. Furthermore, in re-
cent years the change of the concept of rehabilitation
has led to a strengthening of this tendency – rehabilita-
tion is now understood as the care of the person as a
whole. The advantages for rehabilitation offered by
technological developments include the possibility of
guaranteeing maximum homogeneity and measurability
of treatments and thus the possibility of conducting ex-
tensive and meaningful clinical investigations to pro-
vide evidence on biomechanical, functional and
cognitive aspects, as well as on individual perform-
ances. Some potentially complicating issues exist. One
is the difficulty of correlating real rehabilitation needs
and the outcome of technological research with the nec-
essary monitoring actions on the real effectiveness of
the innovations. Furthermore, patients may not accept
many devices.
On the contrary, another undeniable advantage is the
possibility of developing the use of telerehabilitation in
order to allow sustained and continuous treatments in
an economically sustainable framework. Telemedicine
and telerehabilitation rely on Information and Commu-
Abstracts from CT15
nications Technologies (ICT) for the actual delivery of
remote clinical care. Some issues include whether ICT
are accessible? Which kind of application can now be
supported? Where (from and to) can we remotely con-
nect? Accessibility is a general term used to describe
the degree to which a product is accessible by as many
people as possible or the "ability to access" the func-
tionality and its possible benefits. Increasingly, ICT
today is no longer a major constraint issue but an ac-
cessible, fast and reliable supporting tool for applica-
tions and devices for the actual development by Health
Organization of Telemedicine Integrated Solutions.
Concerning actual European policies, European mem-
ber States are urged to assess their needs and priorities
in telemedicine by the end of 2009, as stated in Brussels
on the 4th of November, 2008. These priorities should
be part of the national health strategies to be presented
and discussed at the upcoming 2010 eHealth Ministe-
rial Conference.
method and our experience
With the aim of fostering in-home rehabilitation, we
studied and used a kinesthetic garment (with piezo-re-
sistive sensors) able to detect upper limb posture and
movements. The garment, wirelessly connected to a
personal computer (PC), is the basis of a system that
will detect any movements, providing alerts to both pa-
tients and physicians. The core outcomes of our e-re-
habilitation program are the continuity of rehabilitation
at home for stroke patients with limb movement dis-
abilities after being hospitalized and fostering the pa-
tients’ discharge to return home more quickly and
recover in a familiar environment without losing the
feeling of being taken care of. The design of our study
is based on a tele-assistance, tele-consult, tele-monitor-
ing and tele-rehabilitation therapy framework. A central
server is at the core of the system to foster interaction
between the therapist or physician at the hospital and
patients at home. Patients are linked to their device at
home (or in a gym and in several different locations)
and they can interact in real time with their PC as well
as in real time, or at a later, delayed time, with the op-
erator. The operators may interact with patients and the
server. Proper study design is based on progressive
phases: a) T0-T1 (hospital): one month for recruitment
and clinical assessment; b) T1-T2 (home): patients’ per-
forming therapy; c) T2-T3 is the resting phase (one
month) and then there is a final clinical evaluation.
Every treatment session for motor therapy needs an ini-
JCR
Abstracts from CT15
tial phase of movement recognition and patients are
often helped by the operator first, then caregivers. Dur-
ing the treatment, we provided several movement algo-
rithms’ recognition since there is an important need for
a tolerance range for movement recognition, particu-
larly during initial sessions. The movement calibration
at the beginning of each session sometimes seems to be
difficult both for the patient and the caregiver. The de-
sign of the user’s interface (changed several times while
performing the observation), on the contrary, was re-
vealed to be well-accepted and widely understood. Pa-
tients' comments on the garment’s motor rehabilitation
highlighted the difficulties concerning wearability, but
problems were overlooked with the help of a caregiver,
and generated great overall interest. The initial calibra-
tion phase of the therapy is not considered to be easily
understood and there has been a need for at least three
or four trainee sessions with the therapist to learn to use
the PC.
Conclusion
Notwithstanding some difficulties, today's technologi-
cal innovations can make an important contribution to
rehabilitation, favoring correct, effective and safe – ap-
propriate – use of the different applications available.
Within the bounds of what is currently available, ap-
propriate technology can help to eliminate or reduce the
disabling effects of a disease and facilitate a patient’s
re-education, and reintegration into his/her family, so-
cial and working environment.
––––––––––––––––––––––––––––––––––––––––––––––
shoulder restriction influenced by
rotation Tasks in Virtual reality
Vaughan Powella,1, Brett Stevensa, Steve Handa,
and Maureen Simmondsb
a
School of Creative Technologies, University of
Portsmouth, U.K.
b
School of Physical & Occupational Therapy, McGill
University, Canada
1
Corresponding author:
Vaughan Powell
University of Portsmouth
Eldon Building
Winston Churchill Avenue
PO1 2DJ Portsmouth, U.K.
E-mail: vaughan.powell@port.ac.uk
JCR
221
abstract
Virtual Reality (VR) has been shown to increase en-
gagement and reduce pain in some patient groups, but
there is little work reporting the benefits for the chal-
lenging area of chronic shoulder pain and restriction.
This pilot study investigates the feasibility of an inter-
active VR task for shoulder range of motion (ROM) ex-
ercises. We recorded the upper limb motion of five
individuals with shoulder pain and dysfunction per-
forming a range of motion tasks with and without ex-
posure to VR. Results suggest that VR may increase the
ROM in some tasks, and reduces the perception of pain
during ROM exercise.
Keywords: Virtual Reality, Virtual Rehabilitation,
Shoulder, Pain
introduction
Restricted shoulder conditions are relatively common
(Buchbinder & Hetrick, 2003) with traumatic and atrau-
matic aetiology, and can lead to progressive loss of mo-
bility and associated pain, which compromises quality
of life and hinders rehabilitation efforts. Therapeutic
exercises to promote the range of motion in the affected
joint have been shown to improve physical function
(Buchbinder & Hetrick, 2003). However, adherence to
such a therapeutic program can be problematic due to
pain and low motivation.
Virtual Reality (VR) is showing great promise in reha-
bilitation, both by increasing engagement (Rizzo &
Kim, 2005) and providing distraction from pain (Hoff-
man et al., 2004). However, there has been little work
exploring the use of 3-dimensional tracking and VR to
improve internal and external rotation at the shoulder.
This paper reports the results of a pilot study investi-
gating the feasibility of an interactive VR task for
shoulder range of motion (ROM) exercises.
method
Five subjects, two male and three female aged between
34-45 years, participated in the study. All were suffer-
ing from pain and restriction in one shoulder. Motion
and position data was obtained using Ascension Tech-
nology “Flock of Birds” magnetic motion tracking,
with sensors placed on the acromion process, lateral
epicondyle of the humerus and radial styloid. Partici-
pants were immersed in a large-screen Virtual Environ-
ment (representing an orchard), and were encouraged
to grasp 10 virtual target objects (apples) using shoul-
222
der flexion and abduction and place them in virtual bas-
kets using internal and external rotation. The task was
repeated in three different conditions in a randomized
order – no VR, mono VR and stereo VR – for each
limb. The absolute position of the three sensors was
recorded at the point of maximum rotation, and the dis-
tance between the shoulder and wrist sensors was cal-
culated as a proxy measure of rotation (Magee, 1987).
Pain scores (QVAS) were recorded after the non-VR
and VR conditions.
Descriptive statistics of average internal and external
rotation were calculated and evaluated for trends in the
data. The sample size was too small for full statistical
analysis to be meaningful at this stage.
results
All participants reported enjoyment of the VR task, and
many of them demonstrated high levels of physical and
verbal engagement with the tasks in the VR conditions.
For the internal rotation tasks the ROM in the VR con-
ditions generally matched the ROM achieved in the
non-VR task, and in the external rotation tasks the VR
conditions were associated with a higher ROM than the
non-VR, and this was seen in both the affected and un-
affected shoulders. Interestingly, all participants re-
ported lower pain scores after the VR task than the
non-VR task, in spite of the increased ROM performed
during this part of the study.
Conclusion and discussion
This pilot study indicates that VR may be a useful tool
for shoulder rehabilitation, with the potential to reduce
perceived pain and even increase mobility. Range of
motion exercise for chronic shoulder pain and restric-
tion is an area of ongoing challenge for therapists, and
the potential of VR to increase engagement and adher-
ence to therapy, combined with the potential to increase
ROM and reduce pain, suggests that this may have sig-
nificant therapeutic potential, and a larger study is in
progress to further investigate these findings.
references
Green, S., Buchbinder, R., Hetrick, S.E. Physiotherapy
interventions for shoulder pain. Cochrane Database of
Systematic Reviews(2), 2003.
Hoffman, H., et al. Modulation of Thermal Pain-Re-
lated Brain Activity with Virtual Reality: Evidence
from fMRI, Neuroreport 15(8)(2004), 1245-1248.
Abstracts from CT15
Magee, D., Orthopedic Physical Assessment, Saunders,
Philadelphia, 1987.
Rizzo, A., and Kim, G., A SWOT analysis of the field
of virtual reality rehabilitation and therapy, Presence -
TeleOperators and Virtual Environments 14(2)(2005),
119-146.
––––––––––––––––––––––––––––––––––––––––––––––
a novel approach to Camera Tracking
in a Vr reaching Task for patients with
shoulder and neck pain
Vaughan Powella,1 and Wendy Powella,1
a
School of Creative Technologies, University of
Portsmouth, U.K.
1
Corresponding author:
Vaughan Powell
University of Portsmouth
Eldon Building
Winston Churchill Avenue
PO1 2DJ Portsmouth, U.K.
E-mail: wendy.powell@port.ac.uk
abstract
Immersive camera tracking in Virtual Reality (VR)
generally uses head-mounted markers or sensors to ori-
ent the camera position with respect to the user posi-
tion and orientation. However, patients with painful
restricted shoulder and neck movement have a limited
range of motion, and find it easier to use either a
greater degree of eye movement or full body reorien-
tation to allow the virtual camera to be oriented to-
wards the desired visual target. We present an
alternative solution which allows a more ecologically
valid camera movement by orienting the camera to-
wards the active hand as it reaches towards the visual
target. The development of the prototype software is
discussed, and informal user testing from a patient
group is presented.
Keywords: Virtual Reality, Virtual Rehabilitation,
Neck Pain, Camera Tracking
introduction
View display in immersive Virtual Reality (VR) appli-
cations is updated in real time to reflect the user's posi-
tion and orientation. Although the virtual camera
JCR
Abstracts from CT15 223

simulates the position of the users eye (both eyes for initial acceptability Testing
stereo display), it is impractical to mount tracking de- Twenty healthy volunteers and thirteen volunteers with
vices on the eyes themselves, and therefore the tracking neck and shoulder pain carried out a series of reaching
device is generally head-mounted, with an offset being tasks in the orchard VE using the new camera tracking
calculated to calibrate the virtual view to the eye posi- algorithm. After a short training period all the volun-
tion. For most applications, whether delivered via teers completed the tasks successfully. All were easily
Head Mounted Display (HMD) or Flat Screen Display able to manipulate and visually track the virtual hand
(FSD), this type of tracking is considered both accept- and acquire the target apples, and none of the volun-
able and efficient. Indeed, in healthy individuals there teers reported any negative experiences or side effects.
is generally only around 27o of eye movement without The volunteers generally did not realize that the camera
concomitant head movement (Stahl, 2001), so this was tracking their hand movements, and indeed a num-
could be argued to be the most ecologically valid solu- ber of them were convinced that it was their head or
tion to the problem of view updating. However, in in- eye movements that were controlling the camera view.
dividuals with restricted head movement, such as There was complete acceptance of the transfer of the
occurs with neck or shoulder dysfunction, there is an camera to straight-ahead gaze when the hand moved
increase of this eye-only movement to around 66o out of the natural visual boundary, and in fact very few
(Stahl, 2001), For these individuals head-tracking volunteers even noticed the transition of control to and
alone is clearly insufficient to simulate eye-gaze, and from the hand tracker.
this may lead to a lower sense of presence and de-
creased perceptual stability (Foxlin, 2002). discussion
We present a novel approach to view-updating in VR
It has been observed that during reaching tasks the eye which overcomes the limitations of conventional head
gaze typically is directed towards the reaching hand tracking for patients with restricted neck and shoulder
during active target acquisition (Crawford, Medendorp, movement. Initial testing suggests that this is both ac-
& Marotta, 2004) and regardless of whether this is ceptable and ecologically sound, and further evaluation
achieved by head, eye or whole body movement, it does and refinement is underway.
suggest an alternative approach to view updating. We
present a novel solution to simulate this natural gaze references
direction in VR shoulder rehabilitation. Crawford, J.D., Medendorp, W.P., Marotta, J.J., Spatial
Transformations for Eye-Hand Coordination, J. Neuro-
procedure physiol 92(1)(2004), 10-19.
The Virtual Environment (VE) used for the reaching
tasks is an orchard, with target apples for the user to Foxlin, E., Motion Tracking Requirements and Tech-
"pick." Magnetic tracking (Ascension Technologies nologies, in Handbook of Virtual Environments: De-
Flock of Birds) is used to monitor the position of the sign, Implementation and Applications, Lawrence
shoulder, hand and elbow during target acquisition. A Erlbaum, Mahwah, NJ, 2002.
tracker placed on the shoulder (acromiom) of the active
hand was linked to the virtual camera, with an offset Stahl, J., Adaptive Plasticity of head movement propen-
calculated to simulate eye position. The camera was sity. Experimental Brain Research, 139(2)(2001), 201-
then directed along a vector calculated from the eye to 208.
hand position, and this was updated in real-time to sim-
ulate the natural eye-hand gaze. A visual cue of a virtual ––––––––––––––––––––––––––––––––––––––––––––––
hand was linked to the hand tracker to facilitate senso- a neuroVr based Version of the multiple errands
rimotor recalibration in the VE. Observation of volun- Test for the assessment of executive functions in
teers testing the VE revealed that they broke patients with different etiologies
eye-contact with the active hand when it either moved
behind the plane of the body or when it dropped below Simona Raspellia, Noomi Katzd.e, Giovanni Albanif,
waist height, and therefore the algorithm was adjusted Riccardo Pignattif, Alessandro Maurof,
to revert to forward gaze while the active hand was out- Barbara Polettig, Barbara Corrag, Vincenzo Silanig,
side either of these boundaries. Francesca Morgantib, Laura Carellib and Giuseppe Rivaa.c

JCR
224
a
Applied Technology for Neuro-Psychology Lab, Isti-
tuto Auxologico Italiano, Milan, Italy
b
Department of Human Sciences, University of Berg-
amo, Bergamo, Italy
c
Department of Psychology, Catholic University of
Milan , Milan, Italy
d
Department of Occupational Therapy, University of
Haifa, Haifa, Israel
e
Research Institute for the Health & Medical Profes-
sions, Ono Academic College, Kiryat Ono, Israel
f
Department of Neurosciences and Neurorehabilitation,
Istituto Auxologico Italiano, IRCCS,
Piancavallo-Verbania, Italy
g
Department of Neurology and Laboratory of Neuro-
science, “Dino Ferrari” Center, University of Milan,
IRCCS Istituto Auxologico Italiano, Milan, Italy
1
Corresponding author:
Simona Raspelli
Applied Technology for Neuropsychology Laboratory
Istituto Auxologico Italiano
Via Pelizza da Volpedo 41
20100 Milan, Italy
E-mail: s.raspelli@gmail.com
abstract
The goal of the present study was to develop a tool for
the assessment of executive functions by customizing
a Virtual Reality (VR) version of the Multiple Errands
Test (MET) (Shallice & Burgess, 1991; Fortin, God-
bout, & Braun, 2003). This is an assessment of execu-
tive functions in daily life which consists of tasks that
abide by certain rules and which is performed in an ac-
tual shopping mall-like setting where there are items
to be bought and information to be obtained. The spe-
cific goal of this study was to conduct a pilot study
using the virtual version of MET (VMET) with two
clinical samples – patients suffering from Parkinson’s
disease (PD) and patients with cognitive impairment
derived from stroke.
Keywords: Virtual Reality, Executive Functions,
Multiple Errands Test (MET)
introduction and methods
The goal of the present study was to develop a tool for
the assessment of executive functions, by customizing
a Virtual Reality (VR) version of the Multiple Errands
Test (VMET) (Shallice & Burgess, 1991; Fortin, God-
bout, & Braun, 2003). This consists of tasks that abide
Abstracts from CT15
by certain rules and is performed in a mall-like setting
or shopping center. The tasks vary in terms of com-
plexity and there are a number of “hidden” problems
in the tasks that have to be acknowledged and the pos-
sible course of action has to be revaluated. After the
tasks and rules have been explained, patients are able
to plan and choose the sequence of actions to complete
the tasks. In this way the executive functions stimu-
lated are numerous, from the ability to plan a sequence
of actions, to problem solving and cognitive and be-
havioral flexibility.
The present work the MET procedure, previously mod-
ified according to the requirements of the NeuroVR soft-
ware system, was presented within a virtual supermarket.
Subjects were requested to select and buy various prod-
ucts presented on shelves with the aid of a joy-pad.
results and conclusions
Twelve patients suffering from Parkinson’s disease
(PD) (mean age=65.4 years, std.dev=11.2; mean num-
ber of school years=7.1 years, std.dev.=3.4;
MMSE=26.5, std.dev.=2.7) and six patients with cog-
nitive impairment derived from stroke (mean age=63
years, std.dev=8.05; mean number of school
years=15.33 years, std.dev.=2.58; MMSE=28.13,
std.dev.=1.38) were selected according to the severity
of the impairment, in line with neuropsychological and
physiatrist assessment.
The mean rank for PD patients was significantly higher
for errors in executing the task than for stroke patients
(Asym. Sig. = 0.02; M = 25.08 vs. 18.17; SD = 4.75
vs. 2.71) and the same result was also found for most
of the partial errors of the seven tasks. Moreover, PD
patients have a significantly higher mean of partial er-
rors of specific tasks than the other group and in par-
ticular for the task of buying a chocolate bar (Asym.
Sig. = 0.04; M = 13.25 vs. 9; SD = 3.88 vs. 1.67); buy-
ing a sponge (Asym. Sig. = 0.02; M = 13.33 vs. 8.33;
SD = 3.94 vs. 0.82); buying a product that is on sale
(Asym. Sig. = 0.03; M = 13.58 vs. 9.67; SD = 3.65 vs.
2.34); buying two products from the refrigerated prod-
ucts aisle (Asym. Sig. = 0.04; M = 12.83 vs. 9.17; SD
= 3.33 vs. 1.33); going to the beverage aisle and asking
about what to buy (Asym. Sig. = 0.00; M = 15.17 vs.
10.33; SD = 1.99 vs. 1.21). Finally, the mean rank for
rule breaks was higher for stroke patients than for PD
patients (Asym. Sig. = 0.03; M = 28.83 vs. 24.92; SD
= 1.72 vs. 3.42) while strategies were inferior as re-
JCR
Abstracts from CT15
lated to PD patients strategies (Asym. Sig. = 0.00; M
= 40 vs. 47.33; SD = 4.29 vs. 3.34). This means, on
the basis of the scoring key employed, that stroke pa-
tients break fewer rules and use more strategies than
PD patients.
These comparison results show more consistent im-
paired performance at the VMET test in PD patients,
with respect to stroke patients. This can be partly ex-
plained by our stroke patients’ characteristics. In fact,
lesion site was not a relevant criterion for the inclusion
in this clinical sample, since patients with conditions
other than frontal stroke localizations were also re-
cruited. For these reasons, comparison results reflected
the planning and set shifting deficits typically associ-
ated with PD.
As a whole, these results provide support for the fea-
sibility of using the VMET as an assessment tool of
executive functions in these two clinical samples. Em-
ploying larger groups of both healthy adults and also
stroke patients with frontal stroke localizations will
provide additional support for the use of the VMET in
assessment and rehabilitation intervention.
Acknowledgments
The work in preparing this paper was supported by the
funded project "Immersive Virtual Telepresence (IVT)
for Experiential Assessment and Rehabilitation,”
IVT2010, RBIN04BC5C.
references
Fortin, S., Godbout, L., & Braun, C.M.J., Cognitive
structure of executive deficits in frontal lesioned head
trauma patients performing activities of daily living,
Cortex 39 (2003), 273-291.
Shallice, T. & Burgess, P.W., Deficits in strategy ap-
plication following frontal lobe damage in man, Brain
114 (1991), 727-741.
––––––––––––––––––––––––––––––––––––––––––––––
The use of advanced Technologies in the Treatment
of generalized anxiety disorders
Giuseppe Rivaa,b,1, Davide Algeria, Federica Pallavicinia,c,
Claudia Repettoa,b, Alessandra Gorinia,d,
and Andrea Gaggiolia,b
a
Applied Technology for Neuro-Psychology Lab.,
JCR
225
Istituto Auxologico Italiano, Italy
b
ICE-NET Lab., Università Cattolica del
Sacro Cuore, Italy
c
Centre for Studies in Communication Sciences, Univer-
sity of Milan-Bicocca, Italy
d
Research Institute Brain and Behaviour, Maastricht
University, The Netherlands
1
Corresponding author:
Giuseppe Riva
Istituto Auxologico Italiano
Via Pelizza da Volpedo 41
20100 Milan, Italy
E-mail: giuseppe.riva@unicatt.it
abstract
Generalized Anxiety Disorder (GAD) is a common
anxiety disorder characterized by more than six
months of "excessive anxiety and worry" about a vari-
ety of events and situations. Anxiety and worry are
often accompanied by additional symptoms like rest-
lessness, being easily fatigued, difficulty concentrat-
ing, irritability, muscle tension and disturbed sleep.
GAD is usually treated with medications and/or psy-
chotherapy. In particular, the two most promising treat-
ments seem to be cognitive therapy and applied
relaxation. In this study we integrated these approaches
through the use of a biofeedback enhanced Virtual Re-
ality (VR) system used both for relaxation and con-
trolled exposure. Moreover, this experience is
strengthened by the use of a mobile phone that allows
patients to perform the virtual experience even in an
outpatient setting. The presentation will outline the re-
sults of a controlled trial involving 21 GAD patients
randomly assigned to the following groups – the VR
and Mobile group (VRMB) including biofeedback, the
VR and Mobile group (VRM) without biofeedback,
and the waiting list (WL) group.
Keywords: Generalized Anxiety Disorder, Virtual Re-
ality, Biofeedback, Relaxation, Portable Devices,
New Technologies
introduction
Generalized Anxiety Disorder (GAD) is a psychiatric
disease characterized by long-lasting anxiety that is not
focused on a specific object or situation.
Within the treatment of GAD, physical (relaxation and
controlled breathing), behavioral (visualization and
226
controlled exposure) and cognitive control strategies
(challenging negative thoughts) represent a key part of
the treatment, even if they are often difficult to learn.
To overcome this limitation this EU-funded IN-
TREPID research project aims to improve the treat-
ment of GAD using some advanced technologies
including Virtual Reality (VR), biofeedback and mo-
bile phones.
The approach of the inTrepid project:
a controlled study
Specifically, the INTREPID research project aims to
improve the treatment of GAD through the use of a
biofeedback enhanced VR system used both for relax-
ation and controlled exposure. Moreover, this experi-
ence is strengthened by the use of a mobile phone that
allows patients to perform the virtual experience even
in an outpatient setting. To study the efficacy of the
proposed approach, a between subjects design was
used with three experimental conditions and repeated
measurements (pre and post-treatment). Specifically,
the study compared the following conditions using a
sample of 21 GAD patients:
1.VR + Mobile Phone without Biofeedback Condition
(VRM). In this experimental condition patients re-
ceived an eight-session VR-based treatment including
both relaxation and exposure, and techniques sup-
ported by HR biofeedback. In sessions one through six,
the patient explored a beautiful tropical island experi-
enced with a head-mounted display and head-tracking,
following a predefined path leading to different relax-
ing areas – Campfire, Beach and Waterfall. In these
areas the patients started to relax by observing the
flickering campfire, watching waves lapping gently on
a shore, or looking to the waterfall and fish pond. Each
experience was supported by an audio narrative based
on progressive muscle relaxation and/or autogenic
techniques. To improve the efficacy of the training and
to increase the effects of relaxation, patients experi-
enced a non-navigable version of the same VR envi-
ronment experienced during the therapy at home, using
a mobile phone. The patient was asked to train relax-
ation abilities at least once a day for the entire duration
of the treatment following the treatment plan provided
by the therapist. In sessions seven and eight the pa-
tients explored the same island, this time reaching a
Gazebo in which they are exposed to pre-selected
words or images related to their personal stressful
Abstracts from CT15
events. The patients were then asked to use the learned
relaxation techniques to cope with them.
2.VR + Mobile Phone with Biofeedback Condition
(VRMB). The patients experienced the same protocol
described above, but with the biofeedback support.
Specifically, in the sessions with the therapist, heart
rate (HR) variations were used to modify specific fea-
tures of the virtual environment:
a. Campfire (sessions 1-2). HR controls the fire inten-
sity: a reduction of the patient's physiological activa-
tion reduces fire intensity until it disappears;
b. Beach (sessions 3-4). HR controls the movement of
the waves: a reduction of the patient's physiological
activation reduces the movement of the waves until the
ocean becomes completely calm;
c.Waterfall (sessions 5-6): HR controls the movement
of the water: a reduction of the patient's physiological
activation reduces the movement of the water until the
water flow becomes completely still;
d.Gazebo (sessions 7-8): HR controls the size of a
stressful image or video: a reduction of the patient's
physiological activation reduces the size of the stimu-
lus until it disappears;
3.Waiting List Condition (WL). This was a control con-
dition, in which patients were included in a waiting list
and did not receive any kind of relaxation training.
The final data provided initial evidence for improved
efficacy of the treatment for the VRMB group, even if
the VRM group, too, reported some significant im-
provements at the end of therapy.
––––––––––––––––––––––––––––––––––––––––––––––
analysis of heart rate Variability in Virtual envi-
ronments for emotional induction (4senses project)
Alejandro Rodrigueza,b,1, Beatriz Reya,b, Jaime
Guixeresa,b, Mariano Alañiza,b, B. Serranob,c, Rosa Maria
Bañosb,d, Cristina Botellab,c
a
Instituto en Bioingeniería y Tecnología Orientada al
Ser Humano, Universidad Politécnica de Valencia,
Valencia, Spain
b
Ciber Fisiopatología Obesidad y Nutrición,
JCR
Abstracts from CT15
Instituto Salud Carlos III
Departamento de Psicología Básica, Clínica y Psicobi-
c
ología, Universidad Jaume I, Castellón de la Plana, Spain
d
Departamento de Personalidad, Evaluación y
Tratamientos Psicológicos, Universidad de Valencia,
Valencia, Spain
1
Corresponding author:
Alejandro Rodriguez
Instituto en Bioingeniería y Tecnología Orientada al Ser
Humano, Universidad Politécnica de Valencia
Camino de Vera s/n,
46022 Valencia, Spain
E-mail: arodriguez@labhuman.i3bh.es
abstract
This paper aims to identify differences in heart rate
variability (HRV) before and after an inducted state of
relaxation. Several physiological variables (electrocar-
diogram -ECG-, respiration and Skin Conductance -
SC-) were recorded in 118 volunteers while they were
exposed to a virtual environment (VE) for emotional
induction. Different features were extracted from the
recorded ECG files, both in temporal and frequency
domain, in two specific baselines. The first baseline is
recorded when the individual is first introduced in the
mentioned virtual environment and does not have any
knowledge about his/her surroundings. The second one
is recorded when the individual has navigated in the
virtual environment and has changed its appearance
according to his/her preferences (participants can
change the texture of ceramic floor and walls). The RR
signal can be obtained from the ECG records, to sub-
sequently calculate its mean, typical deviation, maxi-
mum, minimum, etc., and also, applying the Welch
method, its Power Spectral Density (PSD) to analyze
the frequency components that compose that signal
(VLF,LF,HF). Preliminary analysis of the frequency
spectrum indicates that induction of relaxation seems
to be useful to avoid that the participant gets stressed
during the exposure to the VE.
Keywords: Emotional State, ECG,
Tompkins, HRV, Welch
introduction
Emotional detection is a field that has been investi-
gated for several years, but a solid conclusion about
the relationship between physiological variables and
mood has not been achieved (Stern, Ray, & Quigley,
JCR
227
2001). Nowadays, there are numerous researches
where different variables are analyzed to determinate
emotional states. One of the aspects that is analyzed is
HRV and that is the reason why our research has been
focused on the relation of HRV with the emotional
state of the individual under investigation.
method
Physiological signals were recorded on 118 volunteers.
Twenty-three of them were assigned to a neutral con-
dition (control group, without emotional induction)
and the others were grouped in 4 experimental condi-
tions and were placed in a VE with the aim of inducing
relaxation (a different version of the VE was used in
each group).
The first step to analyze HRV is to obtain the RR sig-
nal. The Tompkins’ Algorithm (Guger et al., 2004) was
applied (using Matlab) because its efficiency is better
on the detection of peaks than other algorithms, such
as Zelemberg’s.
Some of the measures that are calculated from the RR
signal, in both time and frequency domain, are (Kim
& André, 2008; Heart Rate Variability, 1996):
–MeanRR(ms): RR interval mean
–SDNN(ms): standard deviation of NN intervals.
–MeanHR(bpm):heart rate mean
–SDHR(bpm):standard deviation of the heart rate
–LF: power spectral density sum for frequencies be-
tween 0.04 and 0.15 Hz
–HF: power spectral density sum for frequencies be-
tween 0.15 and 0.4 Hz
These features were calculated in two specific base-
lines (before and after the emotional induction).
results
We present here preliminary results about the analysis
of the LF and HF components of the HRV. In the neu-
tral group, a tendency is observed to an increase in the
normalized LF and a decrease in the normalized HF
between the first and the second baseline. In the other
experimental groups, in which relaxation was induced,
the tendency of the normalized LF and normalized HF
is to remain stable.
Conclusions
Increases in LF component and decreases in HF com-
ponent, which are observed in the neutral group, indi-
228
cate mental stress (Guger et al., 2004). However, in the
conditions where relaxation is induced, this pattern is
not observed, so it seems that the induction of relax-
ation is useful to avoid that the participant gets stressed
during the exposure to the VE.
references
Guger, C., Edlinger, G., Leeb, R., Pfurtscheller, G.,
Antley, A., Garau, M., Brogni A., Friedman D., Slater,
M., Heart-Rate Variability and Event- Related ECG in
Virtual Environments; PRESENCE 2004,pp 140-145[5
page(s)(article)].
Heart Rate Variability: Standards of Measurement
Physiological Interpretation, and clinical Use; Circu-
lation 1996; 93: 1043-1065.
Kim, J., André, E., Emotion Recognition Based on
Physiological Changes in Music Listening; IEEE
Transactions on Pattern Analysis and Machine Intelli-
gence, Vol 30, Nº 12 December 2008: 2067-2083.
Stern, R.M., Ray, W.J., Quigley, K.S., Psychophysio-
logical Recording; Oxford University Press 2001; Sec-
ond Edition.
––––––––––––––––––––––––––––––––––––––––––––––
expectation for future achievement:
Key to online gamer loyalty
Ching-I Tengaa,1
a
Chang Gung University, Taiwan
1
Corresponding author:
Ching-I Teng
259 Wenhua 1st Rd.
Gueishan Shiang, Taoyuan, Taiwan
E-mail: chingit@mail.cgu.edu.tw.
abstract
Achievement has been known to be one important rea-
son for playing online games. However, no studies
have investigated expectation for future achievements
and its role in online game play. The goal-setting the-
ory (Locke, 1996) can be used to hypothesize that skill
and challenge may antecede expectation for future
achievements and then predict gamer loyalty to a cer-
tain game. This study thus investigated if the goal-set-
ting theory can actually predict the role of expectation
Abstracts from CT15
for future achievements. This study surveyed 307 on-
line gamers with scales used in previous studies. Con-
firmatory factor analyses demonstrated sufficient
reliability (four indices) and validity (convergent va-
lidity and discriminant validity) by comparing the sta-
tistics with the criteria proposed by previous studies.
Structural equation modeling was used for testing the
hypotheses. Analytical findings indicated that skill and
challenge anteceded expectation for future achieve-
ments (path coefficients = .19, .28, p < .05), and then
led to gamer loyalty (path coefficient = .57, p < .05).
This study is the first to propose the new construct of
expectation for future achievements, and to identify its
mediator role in the relationships among gamer skill,
challenge, and loyalty, encouraging future studies to
study this novel construct.
Keywords: Online Game, Expectation for Future
Achievements, Gamer Loyalty, Skill, Challenge
introduction
Previous studies have demonstrated that achievement
is one of the key motivators for playing online games
(Yee, 2006). No studies, however, have addressed ex-
pectation for future achievements and its role in online
game play, indicating a significant research gap. Fill-
ing this gap is important in academics. Academic re-
search on a novel construct (as expectation for future
achievements) and its impact can help understand in-
dividual psychology and behavior in cyberspace.
When predicting user psychology or behavior with re-
gard to achievement, the goal-setting theory (Locke,
1996) is useful for identifying relevant constructs. The
goal-setting theory (Locke, 1996) posits that confi-
dence in achieving goals and payoff of the goals posi-
tively contributes to individual motivation to pursue
these goals. Skill indicates individual capability and
thus may increase individual confidence at achieving
goals. Challenge indicates the difficulty of a goal and
thus individuals may perceive a high payoff when
achieving a challenging goal. Thus skill and challenge
are possible antecedents for expectation for future
achievements. Moreover, motivation for pursuing an
online gaming goal requires an individual to play
games repetitively, revealing that gamer loyalty is a
key consequence for expectation for future achieve-
ments. This study thus investigates if gamer skill and
challenge influence expectation for future achieve-
ments, and if it influences gamer loyalty as well.
JCR
Abstracts from CT15
method
This study solicited online gamers to complete an on-
line questionnaire, obtaining 307 usable responses.
Among them, 65.5% were male and 59.5% were under
25 years old. Items came from the studies on skill and
challenge done by Novak, Hoffman, & Yung (2000)
and loyalty (Zeithaml, Berry, & Parasuraman, 1996).
Items measuring expectation for future achievement
were adapted from the scale of Yee (2006). Cronbach’s
alpha for items measuring each construct exceeded .85.
Lower bounds of confidence intervals for alpha values
exceeded 80. Composite reliabilities exceeded .88. Av-
erage variance extracted (AVE) exceeded .66, indicat-
ing good reliability. Indicator loadings exceeded .75,
indicating satisfactory convergent validity. Maximum
squared correlations were below the minimum of AVE,
indicating sufficient discriminant validity. Fit indices
performed acceptable (CFI = .96, IFI = .96, and NNFI
= .95).
results
Analytical findings indicated that skill and challenge
anteceded expectation for future achievements (path
coefficients = .19, .28, p < .05), and then it leads to
gamer loyalty (path coefficient = .57, p < .05).
Conclusion
Expectation for future achievements is key to online
gamer loyalty.
novelty
This study is the first in proposing the new construct
of expectation for future achievements and identifying
its mediator role in the relationships among gamer
skill, challenge, and loyalty, encouraging future studies
to study this novel construct.
Acknowledgements
The author thanks National Science Council, Taiwan,
for financial support (NSC96-2416-H-182-002-MY3).
references
Locke, E.A., Motivation through conscious goal-set-
ting. Applied and Preventive Psychology 5 (1996),
117-124.
Novak, T.P., Hoffman, D.L., Yung. Y.F., Measuring the
customer experience in online environments: A struc-
tural modeling approach. Marketing Science 19
(2000), 22-42.
JCR
229
Yee, N., Motivations for play in online games. Cy-
berPsychology & Behavior 9 (2006), 772-775.
Zeithaml, V.A., Berry, L.L., Parasuraman. A., The be-
havioral consequences of service quality. Journal of
Marketing 60 (1996), 31-46.
––––––––––––––––––––––––––––––––––––––––––––––
social anxiety and preference for solitude
of heavy internet users
Yann-Jy Yanga, and Chih-Chien Wangb,1
a
National ChengChi University, Taiwan
b
National Taipei University, Taiwan
1
Corresponding author:
Chih-Chien Wang
PO. Box 4-1, Sansia Township
Taipei County 23799, Taiwan.
E-mail: wangson@mail.ntpu.edu.tw
abstract
The study conducted an online questionnaire survey to
explore the relationship among preference for solitude,
social anxiety, and Internet usage. The study recruited
heavy Internet users as respondents. Data analysis re-
sults indicated that the time spent in using instant mes-
saging and participating in online communities was
relative to the preference for solitude and level of so-
cial anxiety, while e-mail and online dating activities
were not significantly relative to these factors. This
study proposed an argument that people who prefer
solitude and also exhibit social anxiety behavior may
also prefer to participate in online community activi-
ties and use instant messaging to communicate with
others.
Keywords: Preference for Solitude, Social Anxiety,
Internet Usage
introduction
The Internet is an integral part of daily life for many
Internet users. Some heavy Internet users spend signif-
icant amounts of time on the Internet. Previous studies
have linked heavy Internet usage to the negative con-
sequences of the Internet. However, some personality
traits, including preference for solitude and social anx-
iety, cause heavy Internet users to spend their time on
the Internet.
230
This study focuses on the influence of Internet usage
and preference for solitude, and social anxiety. This
study advocates that heavy usage of the Internet is rel-
ative to the individuals' personality traits. Individuals
with personality traits of preference for solitude and
tendencies towards social anxiety do not like commu-
nicating face-to-face with others. Computer-mediated
communication is now one alternative to communicate
with others, due to the advance of Internet technology.
They may use the Internet to communicate with others
to cover up their preference for solitude and tendency
towards social anxiety.
method
The current survey collected data in an online commu-
nity which is the most widely known online commu-
nity Web site in Taiwan. The original sample was
comprised of 772 participants. To focus on heavy In-
ternet users, only 368 respondents who spent at least
20 hours per week on Internet activities were included
in the study. Of them, 30.97% were male and 69.03%
were female, with an average age of 23.53 years old
and standard deviation of 3.02 years old. Respondents
reported that they spent an average of 6.45 (SD=1.44)
days per week and 5.64 (SD=3.11) hours per day on
the Internet.
This study employed a three-session online question-
naire survey to examine the relationship among pref-
erence for solitude, social anxiety, and Internet usage.
The first section consisted of four items to measure in-
dividuals’ preference for solitude. The four items were
adapted from the 12-item relational privacy preference
scale developed by Craddock (1997). To shorten the
online questionnaire, we used only four items in the
current survey. The second section was composed of
the Social Anxiety Scale for Adolescents developed by
Myers et al. (2002). There are three dimensions for the
Social Anxiety Scale for Adolescents – Fear of Nega-
tive Evaluation (FNER), Novel Social Situation Fears
(NSSF), and General Social Situation Fears (GSSF).
The last section consisted of demographic data and
items relating to usage of Internet activities.
data analysis
The current study used correlation analysis to test the
relationship among preference for solitude, social
anxiety, and Internet usage. The correlation analysis
results revealed that time spent using instant messag-
ing services and participating in online community
Abstracts from CT15
activities is positively related to preference for soli-
tude and social anxiety. Time spent on online auction
sites was significantly negatively related to prefer-
ence for solitude, while the relationship with social
anxiety was not significant. Time spent on online
game was significantly relative with NSSF, while the
relationships with other social anxiety dimensions
and preference for solitude was not significant. Time
spent in e-mail, blog and online dating were not sig-
nificantly relative.
discussion
Based on the empirical survey results, this study re-
vealed that heavy Internet users who prefer solitude
and have tendency towards social anxiety prefer to use
instant messaging services to communicate with oth-
ers. They also spent a large amount of time in online
community activities than others. Internet messaging
services may be regarded as a tool to overcome social
anxiety when they need to communicate with others.
Online community activities may be a substitute for
physical social activities for individuals with a prefer-
ence for solitude and social anxiety.
Another finding of the study was the negative relation-
ship between time spent on online auction sites and
preference for solitude. The possible reason is that in-
dividuals with a preference for solitude and social anx-
iety do not like communicating with strangers, while
it is necessary for online auction buyers to communi-
cate with sellers.
references
Craddock, A.E., The measurement of privacy prefer-
ences within marital relationships: The relationship
privacy preference scale, American Journal of Family
Therapy 25(1997), 48-54.
Mayers, M.G., Stein, M.B., and Aarons, G.A., Cross
validation of the social anxiety scale for adolescents in
a high school sample, Journal of Anxiety Disorders 16
(2002), 221-232.
––––––––––––––––––––––––––––––––––––––––––––––
learning natural science and ecology issues of the
mediterranean sea in the Virtual aquatic World:
a pilot study
Maja Wrzesiena,1, David Pérez Lópeza,
and Mariano Alcañiz Rayaa
JCR
Abstracts from CT15
a
Instituto Interuniversitario de Investigación en
Bioingeniería y Tecnología Orientada al Ser Humano,
Universidad Politécnica de Valencia, Valencia, Spain
1
Corresponding author:
Maja Wrzesien
Instituto Interuniversitario de Investigación en
Bioingeniería y Tecnología Orientada al Ser Humano
Universidad Politécnica de Valencia, Camino de Vera s/n
46022 Valencia, Spain
E-mail: mwrzesien@labhuman.i3bh.es
abstract
The aim of this study is to present a pilot evaluation of
the E-Junior application. E-Junior is a Serious Virtual
World (SVW) for teaching children about natural sci-
ence and ecology issues of the Mediterranean Sea
while playing. A pilot evaluation on a sample of 24
children showed that students thoroughly enjoyed the
virtual learning session, and were engaged with and
had fun interacting with the system. Moreover, some
suggestions for improvement were given by the partic-
ipants. The results and their implications are discussed.
Keywords: Interactive Learning Environments,
Virtual Reality, Ecology
introduction
Serious Virtual Worlds (SVWs) have proven to be po-
tentially effective educational tools in numerous appli-
cation domains as shown by De Freitas (2006), for
example, and games used for educational purposes rep-
resent an effective learning environment for a number
of reasons (Kebritchi & Hirumi, 2008). Therefore,
from a research point of view, it is relevant to study
the ways in which SVWs could be an effective tool to
engage and satisfy students. This study presents a pilot
evaluation of the E-Junior system, which aims at pro-
moting interest among children to learn about the
Mediterranean Sea and ways to protect it.
E-Junior is a SVW based on pedagogical theories and
the curricular objectives of Spanish primary schools.
The goal of E-Junior is to introduce children to the
basic notions of natural science and ecology, and to en-
courage active learning within a highly immersive,
fun, and interactive environment. Each part of the
game is constructed with a theoretical introduction to
the scientific concept that is presented by the virtual
tutor, a fish from the Brown Grouper species, and an
JCR
231
interactive-gaming part. Students then participate in
learning about photosynthesis, distinguish between dif-
ferent types of animals, seagrass, seaweed and plants,
and judge the positive or negative actions that human
beings can have on the ecosystem.
method
Twenty-four children participated in the virtual learn-
ing session (E-Junior). The following qualitative meas-
ures were used in this pilot evaluation – a post-test
feedback questionnaire with open-ended questions and
informal observations of the children.
results
The results from the post-test feedback questionnaire
showed that the children enjoyed the game – “[I really
enjoyed] following and catching the oxygen.” The 3-
D effect were also appreciated – “[ really enjoyed] that
it was real.” The frequently mentioned negative criti-
cism concerned the length of the speeches made by the
virtual tutor –“[I didn’t like] when the fish was talking
and talking to us all the time.”
According to the informal observation of the children,
the students seemed to be deeply absorbed, engaged,
and involved. However, their level of attention to what
the virtual tutor was explaining was not very high.
Children were running around trying to explore the vir-
tual aquatic environment. The majority of the students
collaborated collectively and helped each other to un-
derstand the game rules – “You are the photon, you
have to go to the right”).
discussion and Conclusions
This study presents and evaluates E-Junior. The pilot
evaluation showed that the children seemed to be sat-
isfied and engaged in the virtual learning session and
had a lot of fun while interacting with the system. Ac-
cording to Prensky (2003), this aspect is crucial during
the learning process, especially when the application
is directed at school-aged children, which is a very de-
manding demographic. This issue should be addressed
in the future evaluation of E-Junior.
Although this paper presents a pilot evaluation, the
data has already brought some interesting information
to light. The most frequent negative comments about
the virtual learning session concerned the long concept
introduction given by the virtual tutor, thus, some ele-
ments of the lecture should be transformed into inter-
232
active game segments. We hope that the planned
changes will improve the system.
references
De Freitas, S., Learning in Immersive worlds. A review
of game-based learning. Rapport prepared for the JISC
e-Learning Program (2006).
Kebritchi, M., Hirumi, A., Examining the pedagogical
foundations of modern educational computer games.
Computers & Education 51 (2008), 1729-1743.
Prensky, M., Digital game-based learning. ACM Com-
puters in Entertainment 1, 1 (2003).
––––––––––––––––––––––––––––––––––––––––––––––
use of mobile devices for eating disorders
Irene Zaragozáa,b, Mariano Alcañiza, Rosa Maria Bañosc,
and Ausiàs Cebollaa,d
a
Instituto Interuniversitario de Investigación en
Bioingeniería y Tecnología Orientada al Ser Humano,
Universidad Politécnica de Valencia, Valencia, Spain
b
CIBER Fisiopatología de la Obesidad y Nutrición,
Valencia, Spain
c
Universitat de València- Valencia, Spain
d
Universidad Jaume I- Castellón, Spain
1
Corresponding author:
Irene Zaragozá
Instituto Interuniversitario de Investigación en
Bioingeniería y Tecnología Orientada al Ser Humano
Universidad Politécnica de Valencia
Camino de Vera s/n
46022 Valencia, Spain
E-mail: izaragoza@labhuman.i3bh.es
abstract
Self-monitoring techniques such as the use of dietary
and physical activity registers are considered to be cen-
tral to cognitive-behavioral weight control programs.
Traditionally, these conventional diaries have been cre-
ated using pen and paper. The objective of this paper
is to describe the advantages of using mobile devices
for recording food and physical activity for the treat-
ment of eating disorders
Keywords: Mobile Device, Eating Disorder,
Obesity, Electronic Diary
Abstracts from CT15
introduction
Self-register techniques are considered necessary for
both assessment and treatment phases in eating dis-
order therapies (Barker & Kirschenbaum, 1993). The
goal is to evaluate behaviors in a natural setting, such
as home or school. The patient is given a paper
which explains the behavior that needs to be
recorded and the conditions under which it must be
done (Burke et al., 2008). It is important that the be-
havior is recorded immediately in order to minimize
memory bias (Beasley, Riley, Davis, & Singh, 2008).
The information obtained allows the clinic to iden-
tify behavior cues and the thoughts and emotions as-
sociated with the behavior. A more accurate
evaluation can then be made, and the treatment ef-
fects and the patient’s progress can be properly as-
sessed.
New technologies are becoming more and more pres-
ent in our everyday lives. Moreover, almost everyone
has at least one mobile device, like a telephone or a
PDA, which they use daily. The idea of using mobile
devices to complete self-registers in therapies for
eating disorders has the following advantages.
Firstly, it reduces the work done by the therapist,
since data introduced by the user are automatically
corrected and stored in a database. Previously, the
therapist had to correct the registers done on paper
and manually input the results into the database. Sec-
ondly, it prevents loss of information. Until now it
was possible that paper registers would be lost or
questions remained unanswered, with with mobile
devices that does not happen because the whole data
collection process is automated. Lastly, the data col-
lection method is more attractive. The patient is more
satisified and comfortable completing self-registers
on a mobile device than on paper because the infor-
mation is presented with bright colors and images.
Additionally, the user can complete them at any time
– he/she only needs to carry the mobile device.
methods
Two applications have been previously developed to
introduce self-registers in eating disorder therapies
using mobile devices.
The first is an application for a diary for obese chil-
dren. This diary allows children to record informa-
tion about food intake and activity. The food diary
allows the child to record everything he has eaten,
JCR
Abstracts from CT15
specifying the order, amounts, and the applications
asks about when, where and with whom the child ate.
It also allows recording of the childs’ emotions be-
fore and after eating. In the exercise diary the child
records information about physical activity com-
pleted, and time and intensity of exercise.
The second application is related to adult eating dis-
orders (especially binge eating disorders). The appli-
cation presents a set of questions for the user to
realize if there has been a binge, how, when and if
there has been loss of control and possible compen-
satory behavior undertaken. It also asks about the
emotion of the user before and after eating.
To simplify the maximum the use of the mobile de-
vice, in both cases the application is started automat-
ically when starting the PDA. When it is turned on a
main screen appears. This screen consists of an
image with the name/logo of the application and a
button with the tag “self-registers.” In this way the
user interface is very easy to use and when the user
wants to complete a self-register they only have to
press the “self-register” button, and when the register
is complete the application returns to the main screen
described before. The application should be opened
all the time, so that if the PDA is set to “standby/save
of energy” mode, on returning to the active mode this
main screen appears again without the need of ma-
nipulating the device to start the application. As
mentioned before, all the data collected with these
JCR
233
applications is stored in a database and it is presented
in a report whenever the therapist wants.
results and Conclusions
Two applications using mobile devices to improve data
collection in therapies for eating disorders have been
developed. These applications are going to be tested to
demonstrate their efficiency and the advantages men-
tioned in the introduction.
We must exploit the advantages provided by new
technologies in order to facilitate the work done by
therapists in the data collection arena to make the
idea of complete self-registers more attractive to the
patient.
references
Barker R., Kirschenbaum D., Self-monitoring may be
necessary for successful weight control, Behavioral
Therapy 24 (1993), 377-394.
Beasley M., Riley W.T., Davis A. & Singh J., Evalua-
tion of a PDA-based dietary assessment and interven-
tion program: a randomized controlled trial, Journal of
the American College of Nutrition 27 (2008), 380-386.
Burke L.E., Sereika S.M., Music E., Warziski M., Styn
M.A., Stone A., Using instrumented Paper
Diaries to Document Self-Monitoring Patterns in
Weight-Loss, Contemporary Clinical Trials 29 (2008),
182-193.

CyberproJeCTs
IN THIS FEATURE, we will try to describe the char-
acteristics of current cyberpsychology and rehabilitation
research. In particular, CyberProjects aims at describing
the leading research groups and projects, actually run-
ning around the world, with a special focus on European
research.
The inTerneT of Cars
An "Internet of cars" promises a road system designed
around cooperative technology enabling each element
of the traffic system – cars, drivers, traffic lights, signs
– to cooperate proactively to create a safer, more effi-
cient driving experience. No road rage required.
Your cooperative dashboard flashes a warning: “Emer-
gency vehicle crossing at the next intersection!” You start
slowing down. On cue, the lights on your route turn red,
simultaneously turning green for a fire engine crossing
at the intersection. That fire engine will surf a "wave" of
green lights all the way to the blaze further downtown.
As the lights turn green, your display suggests a diver-
sion that will skirt the scene of the accident, avoiding
any risk of congestion. You take the suggested turn and
your car advises you of a new speed limit.
You slow down and gain some extra "green miles,"
bonus points awarded to careful drivers, redeemable
against a range of privileges, such as driving in the city
center without charge, or using bus lanes outside rush
hour.
The day started more or less as any other. Your mobile
phone woke you a little earlier than usual because heavy
rain meant traffic was less fluid than usual.The SafeR-
oute service you subscribe to estimated a 10-minute
delay in your normal commute and so sent your mobile
an earlier alarm.
Now you are glad for the early start – an unhurried drive
is a happy one.
As you make the final turn on the way to work, your co-
operative co-pilot reads a message from the car behind
JCR
235
you. It’s your colleague, asking if you have time for cof-
fee. Thanks to all the cooperative vehicle-infrastructure
systems (CVIS), you are early for work so you catch a
quick coffee with your friend.
CooperaTiVe driVing
This is a future without road rage, a future of cooperative
drivers using cooperative vehicle infrastructure systems.
It is the vision of the CVIS project, which is itself part
of a broader international trend with a focus on Intelli-
gent Transport Systems (ITS).
The U.S.A., Japan and Europe are all thinking of coop-
erative systems like this, according to Paul Kompfner,
Head of Sector, Cooperative Mobility at ERTICO – ITS
Europe and coordinator of the CVIS Project.
“On every continent, part of the spectrum has been re-
served for cooperative systems, 5.9 GHz in the States
and Europe, and 5.8 GHz in Japan, so this subset of ITS
is certainly coming. Right now, I’d say Europe has some-
thing of a lead in technology development and validation
across a wide range of test sites,” suggests Kompfner.
Europe also leads on vision, with the development by the
CVIS team of an open, state-of-the-art ITS platform
which can function on a variety of levels, from in-vehicle
and roadside systems to portable devices. It can also
evolve over time to take advantage of new technologies
and business models.
It is a large vision, and the project has the resources to
deliver.
The CVIS project is huge, literally and figuratively. The
budget is over €40 million with €20 million coming from
the EU, and there are 62 partners developing several core
technologies to create a totally integrated, open-source
"Internet of cars."
There have been many piecemeal attempts to create a
compelling mobile platform for infrastructure-to-car
communication, and other efforts for car-to-car commu-
nication, and still other initiatives for mobile ITS and
236
mapping, but except for GPS none have really broken
through.
The cooperative vehicle infrastructure system tackles all
these issues and many others, and incorporates highly
ambitious technical goals, compelling applications and
extensive demonstration, validation and exploitation
plans – the latter being a particular weakness in many
earlier efforts of this kind.
Complete infrastructure
First off, CVIS has developed a complete communica-
tions infrastructure, running from hardware, through pro-
tocols, standards, middleware application programming
interfaces (APIs) and cross-platform integration.
In communications hardware alone, the CVIS team has
developed a platform that can essentially use any known
communication infrastructure, including WiFi, WiMAX,
broadcast radio, satellite communication, dedicated
short-range communications (DSRC), radio frequency
identification (RFID), microwave, 3G and even infra-
red.
Bolted on to a scalable hardware chain is a massively
scalable, open (and partly open-source) software chain.
It handles all the different elements of the CVIS frame-
work – traffic management, vehicle-to-vehicle (V2V)
communications, floating vehicle data collection, appro-
priate integration of city traffic networks with public
communication networks, and so on.
But it also creates a series of APIs and an open applica-
tion development suite that will allow third-party soft-
ware developers and service providers to create
CyberProjects
applications which run across the CVIS platform – a kind
of "ITS app store."
large-sCale Trials
Finally, the project tested the combined technologies in
many large-scale trials in seven countries and the team
has developed a progressive and detailed exploitation
plan that should see these technologies adopted and de-
ployed in the short- to medium term.
The project coordinator is ERTICO, a European public-
private partnership representing all the stakeholders, in-
cluding car and traffic system manufacturers,
governments, road operators, telecom operators, users
and service providers. Every aspect of road use will be
impacted by the new Internet of cars, and it is set to be-
come the model for how other Intelligent Transport Sys-
tems will be developed in the future.
The CVIS project was demonstrating its main applica-
tions at the Cooperative Mobility Showcase 2010 in Am-
sterdam, held March 23-26, 2010. The general public
was welcomed and present to see some of the coopera-
tive technologies in action.
The CVIS project received funding from the ICT strand
of the EU’s Sixth Framework Programme for research.
For more information visit http://www.ta2-project.eu/.
Compiled by Giuseppe Riva, Ph.D.
Istituto Auxologico Italiano
Data provided by ICT Results
(http://cordis.europa.eu/ictresults).
JCR
 237

CyberfoCus

New technologies are developing at a rapid pace. To help you stay abreast of the latest trends in advanced technolo-
gies and healthcare, this feature showcases upcoming, 2009- 2010 events, which will provide you with the oppor-
tunity to connect with leading experts worldwide and remain on the cutting edge of the most recent developments.

The CyberFocus column welcomes your contributions. To supply relevant information for this feature, please send
an e-mail to: office@vrphobia.eu.

Cyberpsychology & CyberTherapy 16

June 20-22, 2011
Gatineau, Canada
www.interactivemediainstitute.com

The Journal of CyberTherapy & Rehabilitation is the official journal of the CyberTherapy Conference. The 16th An-
nual International CyberTherapy Conference (CT16) brings together researchers, clinicians, policy makers and funding
agencies to share and discuss advancements in the growing discipline of CyberTherapy & Rehabilitation, which in-
cludes training, education, prevention, rehabilitation, and therapy. The focus of next year’s conference is two-fold–first,
“Technologies as Enabling Tools” will explore the use of advanced technologies in diagnosis, assessment and pre-
vention of mental and physical disorders. In addition, attention will be drawn to the role of interactive media in training,
education, rehabilitation and therapeutic interventions. Secondly, CT16 will investigate the “Impact of New Tech-
nologies” and how they are influencing behavior and society through cyberadvertising, cyberfashion and cyberstalking,
among others. Technologies featured at the conference include VR simulations, video games, telehealth, the Internet,
robotics, brain-computer interfaces, and non-invasive physiological monitoring devices. Conference attendees have
the opportunity to play a role in designing the future of mental healthcare. CT16 features interactive exhibits at the
Cyberarium allowing participants to experience the technologies firsthand as well as the opportunity to display their
exhibits in a forum-type setting.

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2010 Conferences

WCbCT 2010-World Congress of behavioral and Cognitive Therapies

June 2 - 5
Boston, Massachusetts, USA
http://www.wcbct2010.org/

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Cyberpsychology & CyberTherapy 15

June 13 - 15
Seoul, Korea
www.e-therapy2010.org

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siggraph 2010
July 25 - 29
Los Angeles, California, USA
http://www.siggraph.org/s2010/

JCR
238

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3rd international symposium on intelligent interactive multimedia: systems and services

July 28 - 30
Baltimore, Maryland, USA
http://iimss-10.kesinternational.org/

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2010 american psychological association Conference

August 12 - 15
San Diego, California, USA
http://www.apa.org/convention/

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8th iCdVraT with artabilitation

August 31 - September 2
Valparaiso, Chile
http://www.icdvrat.rdg.ac.uk/

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The 5th international Conference on interactive mobile and Computer aided learning
September 16 - 17
Hasselt University, Belgium
http://www.imcl-conference.org/

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10th international Conference on intelligent Virtual agents (iVa 2010)

September 20 -22
Philadelphia, Pennsylvania, USA
http://iva2010.org/

-----------------------------------------------------------------------------------------------------------------------------------------

40th european association for behavioural and Cognitive Therapies annual Conference
October 7 - 10
Milan, Italy
http://www.eabct2010-milan.it/

-----------------------------------------------------------------------------------------------------------------------------------------

association for behavioral and Cognitive Therapies (abCT 2010)

November 18 - 21
San Francisco, California, USA
http://www.abct.org/dMembers/?m=mMembers&fa=Convention

JCR
 Join the iACToR
Ning Network
Join the iACToR online community by creating your profile and
joining the discussion between eminent experts in the field today.
Plus get access to the official journal and official voice of the
association, the Journal of CyberTherapy & Rehabilitation and
CyberTherapy & Rehabilitation Magazine!

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BECOME A PREMIUM MEMBER OF iACToR

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general informaTion
Journal of CyberTherapy & Rehabilitation
ISSN: 1784-9934
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Journal of CyberTherapy & Rehabilitation is published
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occupational therapy, physical therapy, cognitive reha-
bilitation, neurorehabilitation, oncology, obesity, eating
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