| 1. |
- Carlbring, Per, et al.
(författare)
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ITSY : A Gamified One-Session Virtual Reality App With 12-Month Follow-Up Data
- 2017
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Ingår i: Program Book. ; , s. 396-396
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Konferensbidrag (refereegranskat)abstract
- Introduction: This is the first large randomized-controlled trial to evaluate whether commercially available VR hardware and software can be used for exposure therapy. The aim of this study was to compare gold-standard One Session Therapy (OST) for reduction of spider phobia symptoms and avoidance behavior using in vivo spiders and a human therapist, to a newly developed single-session gamified Virtual Reality Exposure Therapy (VRET) application with modern, consumer-available VR hardware, virtual spiders, and a virtual therapist.Method: Subjects (N=100) with spider phobia, diagnosed, and meeting inclusion criteria were recruited from the general population and randomized to 2 treatment arms. In 1-week intervals, pre-measurement, 3-hr treatment and post-measurement were completed with an in-vivo behavioral approach test (BAT) serving as the primary outcome measure for both groups. This study was powered to detect a non-inferiority margin of a 2-point between-group difference on the BAT, with a standard deviation of 4 (at 80% power).Results: 98 patients commenced treatment and 97 patients completed post-measurement. Per protocol analysis indicated VR was not non-inferior to OST. Repeated-measures ANOVA identified a significant main effect of time (p < .001) and time x group effect (p < .05). Both OST and VR participants experienced large BAT within-group effect sizes (d=2.28 and d=1.45, respectively). By the time of the conference there will be 12-month follow-up data including prediction analysis and the effect of treatment credibility and working alliance (with the virtual therapist).Conclusion: OST is the superior treatment option for spider phobia. VRET is an effective alternative if OST cannot be provided, as pure self-help, as the initial intervention in a stepped-care model, or as a possible post-OST booster.
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| 2. |
- Herlitz, Agneta, et al.
(författare)
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Cognitive Sex Differences Are Not Magnified as a Function of Age, Sex Hormones, or Puberty Development During Early Adolescence
- 2013
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Ingår i: Developmental Neuropsychology. - : Informa UK Limited. - 8756-5641 .- 1532-6942. ; 38:3, s. 167-179
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Tidskriftsartikel (refereegranskat)abstract
- Are cognitive sex differences magnified by individual differences in age, sex hormones, or puberty development? Cross-sectional samples of 12- to 14-year-old boys (n = 85) and girls (n = 102) completed tasks assessing episodic memory, face recognition, verbal fluency, and mental rotations. Blood estradiol, free testosterone, and self-rated puberty scores were obtained. Sex differences were found on all cognitive measures. However, the magnitude was not larger for older children, hormones and cognitive performance were not associated, and early maturers did not perform better than late maturers. Thus, cognitive sex differences were not associated with age, levels of sex hormones, or puberty development.
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| 3. |
- Johansson, Inga-Lena, 1967-
(författare)
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Parkinson’s Disease and Communication : Intelligibility, Interaction and Participation
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Parkinson’s disease is a neurodegenerative disorder affecting dopamine production in the basal ganglia. It is a common cause of disability among elderly people. The main symptoms are tremor, rigidity, and bradykinesia, but there is a substantial individual variation of how the disease manifests itself. Communicative changes occur frequently and motor speech impairment in the form of dysarthria is common. Other communicative abilities, such as language functions and the use of body gestures, may also be affected. Traditionally, the focus for research and clinical assessments and interventions in the context of communicative changes in Parkinson’s disease has mainly been on speech and voice impairment. However, the impact on communication is multi-faceted, and different factors may affect the ability to make oneself understood and participate in conversations. Conversation is also a collaborative activity, where all participants’ contributions would need to be considered. Although there is a growing body of research on communicative impact in Parkinson’s disease, these aspects have, so far, been less studied. In the present thesis, communicative changes in Parkinson’s disease were explored with a focus on speech intelligibility, interaction in conversations, and communicative participation.In study I, qualitative interviews with dyads consisting of a person with Parkinson’s disease and a close communication partner revealed individual variation in experiences of communicative changes. The results indicated multi-factorial disease-related impact on everyday communication and communicative participation. A change noted in almost all dyads was that the partner with Parkinson’s disease participated less in conversations. In study II, listener ratings of connected speech intelligibility showed both inter- and intra-speaker variability between different types of assessment tasks, indicating that di-verse factors may influence intelligibility for individual speakers. Listener knowledge of context significantly increased intelligibility scores. Acoustic analyses of consonant articulation in study III indicated that some measures may be more sensitive for detecting impact on speech and intelligibility for speakers with Parkinson’s disease, while other aspects of articulation may be demanding in terms of acoustic realisation also for healthy elderly speakers. Visual examination of spectrograms may provide qualitative information about speech production in relation to intelligibility. Paper IV reports a pilot trial of dyadic intervention from a self-management perspective. Qualitative exploratory interviews and video recordings of the dyads’ joint conversations formed the basis for the intervention. At follow-up, the participating dyads reported increased communicative awareness and changes in mind-set but minor changes of communicative behaviours. The results from the included studies contribute to the understanding of the complexity and individual variability of possible communicative impact in Parkinson’s disease and support a holistic perspective on communication. The thesis demonstrates that it is necessary to apply multiple methods in assessment for achieving in-depth knowledge of how Parkinson’s disease impacts on speech intelligibility and everyday communication, to optimally tailor communication interventions to the individuals’ needs. This should also include insights in the communicative habits and experiences of persons with Parkinson’s disease and their close communication partners.
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| 4. |
- Lindner, Philip, et al.
(författare)
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Attitudes Toward and Familiarity With Virtual Reality Therapy Among Practicing Cognitive Behavior Therapists : A Cross-Sectional Survey Study in the Era of Consumer VR Platforms
- 2019
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Ingår i: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Virtual reality exposure therapy (VRET) is an efficacious treatment for fear and anxiety and has the potential to solve both logistic issues for therapists and be used for scalable self-help interventions. However, VRET has yet to see large-scale implementation in clinical settings or as a consumer product, and past research suggests that while therapists may acknowledge the many advantages of VRET, they view the technology as technically inaccessible and expensive. We reasoned that after the 2016 release of several consumer virtual reality (VR) platforms and associated public acquaintance with VR, therapists' concerns about VRET may have evolved. The present study surveyed attitudes toward and familiarity with VR and VRET among practicing cognitive behavior therapists (n = 185) attending a conference. Results showed that therapists had an overall positive attitude toward VRET (pros rated higher than cons) and viewed VR as applicable to conditions other than anxiety. Unlike in earlier research, high financial costs and technical difficulties were no longer top-rated negative aspects. Average negative attitude was a larger negative predictor of self-rated likelihood of future use than positive attitude was a positive predictor and partially mediated the positive association between VRET knowledge and likelihood of future use, suggesting that promotional efforts should focus on addressing concerns. We conclude that therapist's attitudes toward VRET appear to have evolved in recent years, and no longer appear to constitute a major barrier to implementing the next generation of VR technology in regular clinical practice.
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| 5. |
- Lindner, Philip, et al.
(författare)
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Attitudes towards and familiarity with Virtual Reality therapy among practicing cognitive behavior therapists : A first survey study in the era of consumer VR platforms
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: To survey attitudes towards, knowledge of and familiarity with Virtual Reality (VR) technology and VR exposure therapy among practicing cognitive behavior therapists, after the recent release of consumer VR platforms, with the aim of identifying potential human barriers to implementing this technology and therapeutic method in regular care. Participants: 185 practicing cognitive behavior therapists attending a conference.Measures: Self-rated likelihood of future use of VR in a clinical setting, applicability of VR to treating specific mental disorders, as well as ratings of different positive and negative aspects of VR exposure therapy – all assessed using a standardized survey.Results: Very few respondents reported having used VR clinically. Therapists had an overall positive attitude toward VRET (pros rated higher than cons) and viewed VR as applicable to conditions other than anxiety. Unlike in earlier research, a high financial cost was no longer a top-rated negative aspects. Average negative attitude was a larger negative predictor of self-rated likelihood of future use than positive attitude was a positive predictor.Conclusions: We conclude that therapist’s attitudes towards VRET appear to have evolved in recent years, coinciding with the release of consumer VR platforms, and no longer appear to constitute a major barrier to implementing the next generation of VR technology in regular clinical practice.
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| 6. |
- Lindner, Philip, et al.
(författare)
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Creating state of the art, next-generation Virtual Reality exposure therapies for anxiety disorders using consumer hardware platforms : Design considerations and future directions
- 2017
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 46:5, s. 404-420
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Forskningsöversikt (refereegranskat)abstract
- Decades of research and more than 20 randomized controlled trials show that Virtual Reality exposure therapy (VRET) is effective in reducing fear and anxiety. Unfortunately, few providers or patients have had access to the costly and technical equipment previously required. Recent technological advances in the form of consumer Virtual Reality (VR) systems (e.g. Oculus Rift and Samsung Gear), however, now make widespread use of VRET in clinical settings and as self-help applications possible. In this literature review, we detail the current state of VR technology and discuss important therapeutic considerations in designing self-help and clinician-led VRETs, such as platform choice, exposure progression design, inhibitory learning strategies, stimuli tailoring, gamification, virtual social learning and more. We illustrate how these therapeutic components can be incorporated and utilized in VRET applications, taking full advantage of the unique capabilities of virtual environments, and showcase some of these features by describing the development of a consumer-ready, gamified self-help VRET application for low-cost commercially available VR hardware. We also raise and discuss challenges in the planning, development, evaluation, and dissemination of VRET applications, including the need for more high-quality research. We conclude by discussing how new technology (e.g. eye-tracking) can be incorporated into future VRETs and how widespread use of VRET self-help applications will enable collection of naturalistic “Big Data” that promises to inform learning theory and behavioral therapy in general.
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| 7. |
- Lindner, Philip, et al.
(författare)
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Experiences of Gamified and Automated Virtual Reality Exposure Therapy for Spider Phobia : Qualitative Study
- 2020
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Ingår i: JMIR Serious Games. - Toronto, ON, Canada : JMIR Publications Inc.. - 2291-9279. ; 8:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Virtual reality exposure therapy is an efficacious treatment of anxiety disorders, and recent research suggests that such treatments can be automated, relying on gamification elements instead of a real-life therapist directing treatment. Such automated, gamified treatments could be disseminated without restrictions, helping to close the treatment gap for anxiety disorders. Despite initial findings suggesting high efficacy, very is little is known about how users experience this type of intervention.Objective: The aim of this study was to examine user experiences of automated, gamified virtual reality exposure therapy using in-depth qualitative methods.Methods: Seven participants were recruited from a parallel clinical trial comparing automated, gamified virtual reality exposure therapy for spider phobia against an in vivo exposure equivalent. Participants received the same virtual reality treatment as in the trial and completed a semistructured interview afterward. The transcribed material was analyzed using thematic analysis.Results: Many of the uncovered themes pertained directly or indirectly to a sense of presence in the virtual environment, both positive and negative. The automated format was perceived as natural and the gamification elements appear to have been successful in framing the experience not as psychotherapy devoid of a therapist but rather as a serious game with a psychotherapeutic goal.Conclusions: Automated, gamified virtual reality exposure therapy appears to be an appealing treatment modality and to work by the intended mechanisms. Findings from the current study may guide the next generation of interventions and inform dissemination efforts and future qualitative research into user experiences.
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| 8. |
- Lindner, Philip, et al.
(författare)
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Is Continued Improvement After Automated Virtual Reality Exposure Therapy for Spider Phobia Explained by Subsequent in-vivo Exposure? : A First Test of the Lowered Threshold Hypothesis
- 2021
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Consumer Virtual Reality (VR) technology offers a powerful, immersive medium for scalable dissemination of mental health interventions. Decades of research has shown VR exposure therapy to be efficacious in the treatment of anxiety disorders and that the fear reduction generalizes to real-world stimuli. Many studies also report continued improvement over time, after discontinuing VR use. The lowered threshold hypothesis states that this continued improvement is moderated by lowering the threshold to conduct subsequent in-vivo exposure. The current study is the first to formally test this hypothesis, using data from a recent trial on automated VR exposure therapy for spider phobia, in which participants (n = 49) were followed for 1 year, completing assessments 1 week, 3 and 12 months post-treatment. The assessment included validated self-report of phobia symptoms, a standardized behavioral approach test featuring a real spider, and a questionnaire for self-reporting frequency of in-vivo exposures since last assessment. Number of in-vivo exposures was found to be independently associated with greater symptom decrease in longitudinal outcome models. In sequential structural equation models, immediate post-treatment symptom reduction was associated with subsequent in-vivo exposures, which in turn was associated with continued symptom reduction. However, this applied only to self-reported phobia symptoms (not behavioral avoidance) and no associations were found past 3 months. Our findings offer preliminary, partial support for the lowered threshold hypothesis, suggesting that VR exposure interventions may benefit from including explicit in-virtuo to in-vivotransitioning components.
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| 9. |
- Lindner, Philip, et al.
(författare)
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Predicting treatment outcomes after Virtual Reality exposure therapy using gaze proxy data collected during exposure : Preliminary findings
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND: Virtual Reality exposure therapy (VRET) is an efficacious treatment of phobias and allows for automatic data collection during standardized yet naturalistic exposure paradigms, yet next to no research has explored the clinical potential of such data. GOALS: To explore the predictive potential of using gaze proxy data collected during VRET to predict treatment outcomes. METHODS: Gaze focus proxy data from n=29 participants undergoing gamified, self-help VRET for spider phobia were extracted, compiled, and modeled. The VRET session featured eight levels with increasingly frightening spiders, each with an approach task requiring participants to keep looking at the phobic object for a specified time. Relative spider gaze focus was defined as time spent looking at each spider at each level (derived from head movement and overlap) divided by total time in level. High- versus low-improvement was defined using median-split on subsequent improvements on an in-vivo behavioral approach task. RESULTS: During the final three levels of the exposure session, relative spider focus time was initially lower among high-improvers (p=.039) and the decrease was lower over levels than among the low-improvers (p=.029). This suggests that non-improvers experienced a fear level mismatch during the final exposure phase. There were no differences in gaze patterns during other phases of the session. CONCLUSIONS: These preliminary results suggest that gaze proxy data automatically collected during VRET, even when rudimentary, can be used to predict treatment outcomes, and may thus be used to automatically personalize the exposure design of VRET self-help applications during actual use, to increase efficacy.
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| 10. |
- Lindner, Philip, et al.
(författare)
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What is so frightening about spiders? Self‐rated and self‐disclosed impact of different characteristics and associations with phobia symptoms
- 2019
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Ingår i: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 60:1, s. 1-6
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Tidskriftsartikel (refereegranskat)abstract
- Spider phobia is a common and impairing mental disorder, yet little is known about what characteristics of spiders that spider phobic individuals find frightening. Using screening data from a clinical trial, we explored which characteristics that spider‐fearful individuals (n = 194) rated as having the greatest impact on fear, used factor analysis to group specific characteristics, and explored linear associations with self‐reported phobia symptoms. Second, a guided text‐mining approach was used to extract the most common words in free‐text responses to the question: “What is it about spiders that you find frightening?” Both analysis types suggested that movement‐related characteristics of spiders were the most important, followed by appearance characteristics. There were, however, no linear associations with degree of phobia symptoms. Our findings reveal the importance of targeting movement‐related fears in in‐vivo exposure therapy for spider phobia and using realistically animated spider stimuli in computer‐based experimental paradigms and clinical interventions such as Virtual Reality exposure therapy.
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