Journal of CyberTherapy and Rehabilitation, 3 (2), 2010 by Giuseppe Riva

Volume 3, Issue 2, Summer 2010

Abstracts from the 15th Annual CyberPsychology & CyberTherapy Conference June 13-15, 2010 – Seoul, Korea

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ediTor-in-Chief

assoCiaTe ediTors

Brenda K. Wiederhold, Ph.D., MBA, BCIA Virtual Reality Medical Institute Brussels, Belgium Virtual Reality Medical Center San Diego, California

Cristina Botella, Ph.D. Jaume I University Castelló de la Plana, Spain

Luciano Gamberini, Ph.D. University of Padova Padova, Italy

Stéphane Bouchard, Ph.D. Université du Québec en Outaouais Gatineau, Québec, Canada

Giuseppe Riva, Ph.D., M.S., M.A. Istituto Auxologico Italiano Verbania, Italy

Mariano Luis Alcañiz Raya, Ph.D. Universidad Politécnica de Valencia Valencia, Spain

Tom Furness, Ph.D. University of Washington Seattle, Washington

Paul Pauli, Ph.D. University of Würzburg Würzburg, Germany

Rosa M. Baños, Ph.D. University of Valencia Valencia, Spain

Charles Hughes, Ph.D. University of Central Florida Orlando, Florida

Heidi Sveistrup, Ph.D. University of Ottawa Ottawa, Ontario, Canada

A.L. Brooks Aalborg University Esbjerg, Denmark

Wijnand IJsselsteijn, Ph.D. Eindhoven University of Technology Eindhoven, Netherlands

Richard M. Satava, M.D., F.A.C.S. University of Washington Seattle, Washington

Julian Dooley, Ph.D. Edith Cowan University Mount Lawley, Australia

Linda A. Jackson, Ph.D. Michigan State University East Lansing, Michigan

Mark D. Wiederhold, M.D., Ph.D., FACP Virtual Reality Medical Center San Diego, California

Paul M.G. Emmelkamp, Ph.D. University of Amsterdam Amsterdam, Netherlands

Sun. I. Kim, Ph.D. Hanyang University Seoul, South Korea

Uri Feintuch, Ph.D. Hadassah-Hebrew University Medical Center Jerusalem, Israel

Dragica Kozaric-Kovacic, M.D., Ph.D. University Hospital Dubrava Zagreb, Croatia

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Emily Butcher Interactive Media Institute San Diego, California ediTorial board

Joshua Fogel, Ph.D. University of New York Brooklyn, New York

José Luis Mosso, M.D. Regional Hospital No. 25 of the IMSS Mexico City, Mexico

XiaoXiang Zheng, Ph.D. Zhejiang University Hangzhou, P.R. China

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editorial B. Wiederhold

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

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

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Cyberfocus D. Stevens

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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 CyberTherapy & Rehabilitation (JCR). As you know, JCR is one of the two official journals of the International Association 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 celebrate our Combined Communications Platform. The journals, conference, magazine, and association combine into one powerful platform to address previous information 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.

through their tireless energy and drive – the Co-Organizer 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, Professor Jang-Han Lee; Cyberarium Chair Professor Hunter Hoffman; and Technical Chairs Professors Mariano Alcañiz and Evangelos Bekiaris. Many thanks also to the Scientific Committee, made up of prominent researchers from around the world, and the Local Advisory Committee 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 Medical Institute for their time and contributions to all facets of the conference.

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 1315, 2010 in Seoul, Korea. This venue speaks to the continued 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 technologies such as virtual reality simulations, videogames, telehealth, video-conferencing, the internet, robotics, brain computer interfaces, wearable computing, non-invasive physiological monitoring devices, in diagnosis, assessment, 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 technologies. CT15 will investigate how new technologies are influencing behavior and society through cyberadvertising, cyberfashion, and cyberstalking, to name a few.

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 Institute.

I would like to take this opportunity to thank all those who are helping to make this year’s conference possible

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As integral parts of our Combined Communications Platform, the CT Conference series will continue to work together 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

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outstanding achievements by students, new researchers, as well as lifetime achievement to a senior researcher, we will also be hosting awards during the conference and announcing the 2010-2011 iACToR officers during the General Assembly. Pre-conference workshops will highlight psychotherapeutic applications, brain computer interface devices, rehabilitation for seasoned researchers, and an introduction to VR will be given for those newer in the field. As we approach CT15 with excitement, we begin too to look toward next yearâ&#x20AC;&#x2122;s conference, CyberPsychology &

CyberTherapy 16, to be held in Gatineau, Canada on June 20-22, 2011. Thank you again for your commitment to the evolution of healthcare!

Brenda K. Wiederhold, Ph.D., MBA, BCIA Editor-in-Chief, Journal of CyberTherapy & Rehabilitation Virtual Reality Medical Institute

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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 ÂŠ 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

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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 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 Professions, Ono Academic College, Kiryat Ono, Israel

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

movement disorder due to a dysfunction of the nigrostriatal dopaminergic system, in recent years, many scientific studies, supported by clinical evidence, have also revealed an alteration in executive functions. This includes difficulty 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 attenuated, 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 controls 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 London Test, Frontal Assessment Battery, Trail Making Test, Street Completion Test) and a virtual version of MET (VMET), which was presented within a virtual supermarket. This is an assessment of executive functions in daily life which consists of performing tasks according predefined rules, meaning there are items to be bought and information 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 executing 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

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Abstracts from CT15

Table 1 Group Statistics

Errors

Searched item in the correct area

Maintained task objective to completion

Maintained sequence of the task

Divided attention

Organized materials appropriately throughout task

Self corrected upon errors made during the task

No evidence of perseveration

Sustained attention throughout the sequence of the task

Buying a chocolate bar

Buying toilet paper

Buying a sponge

Buying two products from the refrigerated products aisle

Going to the beverage aisle and asking about what to buy

Rule breaks

Strategies

group

mean

std. deviation

Healthy subjects

17,64

3,895

Patients

25,08

4,757

Healthy subjects

8,86

1,512

Patients

11,92

2,314

Healthy subjects

8,86

1,351

Patients

11,83

2,368

Healthy subjects

8,93

1,328

Patients

12,08

2,234

Healthy subjects

9,29

1,437

Patients

12,25

2,379

Healthy subjects

9,50

1,990

Patients

12,25

2,454

Healthy subjects

9,86

1,834

Patients

12,50

1,931

Healthy subjects

8,50

1,160

Patients

11,92

2,429

Healthy subjects

9,43

1,342

Patients

12,17

2,082

Healthy subjects

9,29

2,555

Patients

13,25

3,888

Healthy subjects

9,07

2,165

Patients

13,33

3,939

Healthy subjects

9,07

2,556

Patients

13,33

3,939

Healthy subjects

9,64

2,590

Patients

12,83

3,326

Healthy subjects

10,50

2,312

Patients

15,17

1,992

Healthy subjects

28,50

2,378

Patients

24,92

3,423

Healthy subjects

37,36

8,608

Patients

47,33

3,339

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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 demands. Conclusions If we exclude clinical forms of atypical parkinsonism, such as Lewy Body disease, the course of mental dysfunction 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 behavioral symptoms included in an impulse control dis-

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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 assessment. 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 Bioingeniería y Tecnología Orientada al Ser Humano, Universidad Politécnica de Valencia,Camino de Vera s/n, 46022 Valencia, Spain 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-

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habilitation Therapy. To carry out this study, used a system for standing balance rehabilitation. We applied two different 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 tracking 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 Response, 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 injuries and illnesses, such as strokes, cerebral palsy, paralysis and Parkinsonâ&#x20AC;&#x2122;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 patientâ&#x20AC;&#x2122;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 validated 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: patient using the system.

visualization setup, and the tracking components. Additionally, 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 beginning 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 system 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 afterwards 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 eliminating 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.

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Abstracts from CT15 –––––––––––––––––––––––––––––––––––––––––––––– lean on Wii: physical rehabilitation With Virtual reality and Wii peripherals Fraser Andersona,1, Michelle Annetta, Walter F. Bischofa Department of Computing Science, University of Alberta

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 virtual character run). In recent years, the Wii has been integrated into rehabilitation programs (Deutsch et al., 2009; Dixon, 2008; Halton, 2008; Sugerman et al., 2009) and has gained the support of occupational therapists 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 rehabilitative 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 adequately 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 aspects of current Wiihabilitation practices. Virtual Wiihab Our Virtual Wiihab system integrates existing Wii peripherals (Wii Balance Board, Wii Remote, Wii Motion

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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 system 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 abilities. Our Virtual Wiihab system provides features and functionalities 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 customizations 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 perform 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 diagrams 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 additional players has the potential to motivate patients to continue an activity longer than if they were doing it on their own.

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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, University of Alberta

Corresponding author: Michelle Annett University of Alberta 6307 - 144 A Ave Edmonton, Alberta, Canada T5A1S3 E-mail: mkannett@cs.ualberta.ca

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 Wiihabilitation 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 flexibility of VR with the availability and enjoyment of Wiihabilitation. Our system includes four rehabilitationcentric 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.

introduction Over the last decade, interest and excitement surrounding interactive surfaces and multi-touch tabletops has dramatically increased. One of the most recent applications 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 neglected an important aspect of the rehabilitation process, namely group therapy. Group interaction in rehabilitation 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 additional 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 tables, supper tables, and meeting tables) improve social dynamics and encourage conversation and interaction. The fusion of interactive tabletops and group rehabilitation has the potential to greatly improve patient confidence and give patients the motivation to work harder and persevere through difficult activities. We have extended our suite of tabletop-based rehabilitation activities (AIR Touch; Annett, 2009) to support cooperation and

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Abstracts from CT15

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competition between patients and their therapists, family members, and peers. We also discuss a number of recommendations 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. Discussions with these experts produced a number of suggestions, 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 patients to put in more effort and spend more time performing an activity. –Communication during multi-user activities can promote 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 disabling conditions or impairments (Figure 1). These activities can be adjusted to easily meet the needs of individual patients and enable therapists to quantitatively measure patient behavior and performance. To encourage social dialogue and emotional immersion, most activities use patient photographs. Conclusion and future Work Previous tabletop rehabilitation technologies have focused on single-user interaction, neglecting the benefits of collaboration and group rehabilitation. We have addressed this issue by working with practicing therapists to create a number of multi-user activities. These activities 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 multiuser tabletop activities.

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Figure 1: A) Three patients assembling a Touch Tessellation 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, patients, and family members is currently underway to determine 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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De Weerdt, W., et. al. C. Group physiotherapy improves time use by patients with stroke in rehabilitation. Australian 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 c European Game Developer Federation

Corresponding author: Klaus M. Beier Charite - Universitätsmedizin Berlin Luisenstr. 57 Berlin, Germany, 10117 Email: klaus.beier@charite.de.

introduction Clinical experience in sexual medicine reveals the increasing 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 increasingly 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 enlargements. 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 attachment capabilities of the players. approach and methods The general idea is to set up a basic concept which can

be adapted to different fields and adjusted to reach different target groups (adolescents, the chronically ill, mentally 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 enhances 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 relationships –patients with mental and emotional retardation and sexual 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 centered reactions and other factors. A book of duties provides 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 patterns, 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.. Sexualmedizin. 2. Aufl. München, Elsevier (2005). Bowlby, J. (1969, 1973, 1980): Attachment and loss. Vol. 1, 2, 3. New York: Basic Books.

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Brezinka, V. , L. Hovestadt, L. , Serious games can support 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 Defence R&D Canada – Valcartier Université du Québec en Outaouais c Université d’Ottawa

a b

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 opinion of the author and do not necessarily represent the opinion 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 compared three immersive stereoscopic technologies–a 22inch 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 procedure. 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 variable. Repeated measures ANOVAs revealed statistically significant increase in heart rate and respiration rate while playing the 3-D games and during the TSST. No significant group or interactions effects were found. Increases in

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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 practice 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 benefit from stress management training. Although preliminary data from the few available programs are somewhat encouraging, they are confronted with significant adherence 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 requires 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 virtual environment without knowing if it will be significantly stressful, researcher can use off-the-shelf 3-D games. Several 3-D games companies are investing millions 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 commercial 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 technologies–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 images). The games were selected after considering 38 criteria, 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 stimulus because of superior graphics quality compared to “Killing Floor,” but only “Killing Floor” could be modified to be used in the CAVE. It was therefore decided to use both games, as it would allow comparing two levels of graphics quality.

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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 Université du Québec en Outaouais

Figure 1. Screenshot from Figure 2. Screenshot from “Left 4 Dead.” “Killing Floor.” An initial sample of 56 solder participated in the study. Subjective data were collected on all participants using the State anxiety scale of the State Trait Anxiety Inventory but extremely slow scores (e.g., baseline mean score of 29.7, sd = 7.1) cast very serious doubt on the validity of the results on this variable. Therefore, only psychophysiological parameters will be reported. Due to technical problems, only 36 participants could be used for the analysis of heart rate data and 42 for the breathing data. Participants were randomly assigned to one of five conditions in which they played either the 3-D game “Killing Floor” or “Left 4 Dead” using the small monitor (22-inch), the large monitor (73-inch) or the room-size CAVE (only used with Killing Floor). To have a control and reference comparison of induced stress, participants were exposed to the well-validated Trier Social Stress Test (TSST; Kirschbaum, Pirke & Hellhammer, 1993) after the collection of baseline physiological data and before the experimental manipulation with 3D games. Participants’ heart rate and respiration rate were measured continuously using the Bioharness from Biopack. results Repeated measures ANOVAs (3 Times X 5 Conditions) revealed significant increases in heart rate (HR) and respiration rate (RESP) while playing the 3D games (HR: F = 5.21, p < .05; RESP: F = 33.51, p < .05) as well as during the TSST (HR: F = 15.94, p < .05; RESP: F = 15.76, p < .05). However, no significant interactions between conditions were found (see Figure below). Repeated-measures contrasts confirmed that increases in heart rate and respiration rate were significant when comparing the baseline to the 3-D games and to the TSST, but not when comparing the TSST to the 3-D games. The discussion will address implications of these findings for the development of reliable stressors allowing practicing stress management skills with solders. ––––––––––––––––––––––––––––––––––––––––––––––

Corresponding author: Stéphane Bouchard Université du Québec en Outaouais Dept. de Psychoéducation et de psychologie CP 1250, Succ Hull, Gatineau, Qc. J8X 3X7 Canada E-mail: Stephane.bouchard@uqo.ca

This presentation is based on a reanalysis of data presented at the 2009 Presence Conference in Los Angeles. introduction Being immersed in virtual reality (VR) can create the subjective impression of being “there” in the virtual environment (VE) (Sadowski & Stanney, 2002; van der Straaten & Schuemie, 2000). The illusion of presence requires processing multimodal input (visual, auditory, tactile, kinaesthetic or olfactory) from the VE be combined to form coherent perceptions so the VE be recognized as “real”, and integration of these multimodal stimuli into some egocentric reference frame so the user feels that he or she is within the environment. A previous study (Bouchard, Dumoulin, Labonté-Chartrand, Robillard, & Renaud, 2006) showed that it is possible to increase presence simply by manipulating the narrative context of an immersion in VR (i.e., without changing any objective properties of the VE). It opened the possibility of studying neural correlates of presence without creating artifacts induced by the modifications of the stimuli (i.e., comparing immersions with / without sound, or in mono / stereoscopy would predictably stimulate different brain areas). After a brief overview of studies suggesting that presence is simply a (rather good) perceptual illusion, we will report on a study investigating neural correlates associated with the illusion of presence in VR. method Five adults (all right-handed, three females, two males, mean age of 33) provided their informed consent and 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 suffering from a mental disorder, based on the Structured Clinical Interview for DSM-IV-Non-Patient Edition (First, Spitzer, Gibson, & Williams, 2002)). During the experimental task, participants first visited a staff room adjacent 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-dimensional 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 modified International Consortium for Brain Mapping T1 Protocol. The virtual environment was displayed using a stereoscopic fMRI-friendly HMD (Silent Vision SV7021) 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, participants were informed via instruction provided in the HMD that the image were coming directly from the adjacent 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 observed 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 virtual reality by using a high tech device that will take images of your brain in action. For the very first time, we

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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 reality 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 environment and looking around. We also built a copy of this staff room. After having the unique chance of being immersed 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 abnormalities. For the experimental scan, the instructions were projected in the HMD once more “In this unique experience, you will visit the real staff room, then a copy. This will be repeated twice. Let go, observe these virtual environments 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 significantly activated by the experimental manipulation. Significant cluster of voxels in the right parahippocampal gyrus (MNI 28 -4 -36) cluster size KE= 5 cluster was activated, as well as a significant cluster in the left parahippocampal gyrus (MNI -28 - 16 -24) cluster size KE = 5 cluster. Conclusion The design of this preliminary study was based in previous findings (Bouchard, Dumoulin, Labonté-Chartrand, Robillard, & Renaud, 2006) where manipulating the context or narrative associated with the immersion statisti-

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122 cally influenced presence. Any other manipulation involving the properties of the stimuli would have blurred the results by recruiting other areas of the brain.

–––––––––––––––––––––––––––––––––––––––––––––– multi-modal memory restructuring for patients suffering from Combat-related pTsd: a pilot study

Despite the small sample size, clear and significant results were obtained in one specific region, the parahippocampal cortex. This area of the brain mediates the representation and processing of contextual associations (Aminoff & Schacter, 2008). The parahippocampus provides contextual meaning of scenes and places. Our results 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 perceptual illusion that triggers three events: (a) basic reflex reactions, (b) integration of sensory information, and (c) self-reflexive conscious-cognitive dissonance. We propose that conscious-cognitive dissonance involves the parahippocampal gyrus and constitutes what is usually referred to as Presence.

Matthew van den Steena, Willem-Paul Brinkmana, Eric Vermettenb,c and Mark Neerincxa, d

references Bar, A., Aminoff, E., Schacter, D.L. Scenes unseen: The parahippocampal cortex intrinsically subserves contextual associations, not scenes or places per se. Journal of Neuroscience, 28, 8539-8544, 2008. Bouchard, S. Dumoulin, S., Labonté-Chartrand, G., Robillard, G., Renaud, P. Perceived Realism has a Significant Impact on the Feeling of Presence. 11th Annual CyberTherapy Conference, Gatineau (Québec), June 1215. 2006. First, C.D., Spitzer, R.L., Gibson, M., Williams, J.B.W. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition (SCIDI/NP). Biometrics Research, New York State Psychiatric Institute, New York. 2002. Sadowski, W., Stanney, K.M. Presence in virtual environments. In K.M. Stanney (Eds.). Handbook of virtual environments: Design, implementation and applications (pp. 791-806), Mahwah : IEA. 2002. Van der Straaten, P., Schuemie, M.J. Interaction affecting the sense of presence in virtual reality [Online]: http://graphics.tudelft.nl/vrphobia/intpres.pdf. 2000.

a Delft University of Technology, The Netherlands Military Mental Health Research Center, Central Military Hospital, Utrecht, The Netherlands c Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands d TNO, Soesterberg, The Netherlands

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 multimedia software application which can be used in the treatment of combat-related Posttraumatic Stress Disorder (PTSD). The application allows patients and therapists to visualize the patients' past experiences using maps, personal photos, stories and self-created 3D virtual worlds. The tool aims to allow patients to restructure and relearn about their past experiences involving problematic stressors. 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 return 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 treatment of PTSD. VRET focuses on exposure with pre-defined scenarios. Instead of using prolonged exposure therapy, this paper explores the possibility of using computer assisted technology to support trauma-focused psychotherapy, to be used both in a group therapy setting as

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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 content, 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 familiar 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 compromised and due to memory distortions or amnesia concerning 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 involving problematic stressors. Patients are invited along a set timeline to sequentially add media and self-created virtual 3D worlds. In this way, patients are able to express and think again about their experiences during their time of deployment. The MMMR system provides contextual information 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 objects patients brought with them. The system support consists 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 specific 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 geographical maps. In addition, the patient can also use an

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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 chronological timeline. (4) This can be worked through and commented on back and forth. (5) The session ends again by visually moving back from the event in the past to the present 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 engineering approach. This started with establishing an inventory 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 (timeline, 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 members), 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 interviews, 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 implemented and used in a usability evaluation with 18 participants, and in a small case study with a single patient. Initial results suggest that the system can facilitate patients' sharing and reappraising past experiences and in managing various autobiographic memory elements. –––––––––––––––––––––––––––––––––––––––––––––– optimizing non-immersive devices Susan Brucka,1 and Paul A.Watters b Macquarie University, Sydney, Australia University of Ballarat, Victoria, Australia

a b

Corresponding author: Susan Bruck Macquarie University Department of Computing North Ryde, Australia 2109 E-mail: sbruck@science.mq.edu.au

124 abstract Simulated immersive environments displayed on large screens are a valuable therapeutic asset in the treatment of a range of psychological disorders. Permanent environments are expensive to build and maintain, require specialized clinician training and technical support and often have limited accessibility for clients. Ideally, Virtual Reality Exposure Therapy (VRET) could be accessible to the broader community if we could use inexpensive hardware with specifically designed software. This study tested whether watching a handheld non-immersive gaming device causes nausea and other cybersickness responses. Using a repeated measure design we found that nausea, general discomfort, eyestrain, blurred vision and an increase in salivation significantly increased in response to handheld non-immersive gaming device exposure. Keywords: Non-immersive gaming, cybersickness, virtual reality exposure therapy introduction Virtual Reality Exposure Therapy (VRET) (Powers & Emmelkamp, 2008) has immense potential, however, it inherently has the drawback that it can be expensive to establish and requires specially trained counselors and technicians to efficiently run a clinic and is not always accessible for all clients due to distance or work/study or family commitments. Cybersickness is a collection of symptoms that are reported in response to simulated immersive environments (Kim, Kim, Kim, Ko, & Kim, 2005). The Simulator Sickness Questionnaire (SSQ) (Kennedy, Lane, Berbaum & Lilienthal, 1993) is a standardized sixteen symptom questionnaire that is used to identify the severity of responses specific to exposure to computer-generated environments. This study proposes that the use of a small, inexpensive apparatus such as a handheld non-immersive gaming device may be an alternative to using exclusive well equipped clinics for VRET. It is hypothesized that there will be no reports of cybersickness in response to simulated movement on a handheld non-immersive gaming device. method Twenty-nine (13 male, 16 female) healthy Macquarie University students (aged between 18 and 35 years) voluntarily participated in the Macquarie University Human Ethics Committee approved experiment. A within-subject design was used to compare self-reported measures of cybersickness using the SSQ. Participants completed

Abstracts from CT15 the SSQ before and after watching a six-minute roller coaster video (Bruck & Watters, 2009) on the handheld non-immersive device. results The hypothesis was tested using a Wilcoxon Matched Pairs Signed Rank Test. The prediction that there would be no significant difference between the Pre-Test SSQ and the Post-Test SSQ scores was not supported on five SSQ symptoms (Table 1). In contrast, there was no significant difference between the Pre-Test and the PostTest for 11 symptoms. The results indicate that exposure to a handheld non-immersive device can cause significant discomfort for individuals exposed to simulated movement. Table 1 Wilcoxon Matched Pairs Signed Rank Test Significant Difference Pre and Post- Test ssQ symptoms

Wilcoxon matched pairs signed rank Test

General Discomfort

z = -2.000, p = 0.046

Eyestrain

z = -3.000, p = 0.003

Salivation

z = -2.449, p = 0.046

Nausea

z = -2.121, p = 0.034

Blurred Vision

z = -2.121, p = 0.034

discussion The results indicate that a handheld non-immersive gaming device can cause cybersickness symptoms when the client is exposed to significant simulated motion. Further work is required to determine whether exposure to less capricious simulated movement would provide a more comfortable experience, and to test whether these results are applicable to a clinical population. Acknowledgment The authors are extremely grateful to the Apple University Consortium for providing the Apple iPod Touch速 for this experiment. references Bruck, S. and Watters, P.A. Estimating cybersickness of

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Abstracts from CT15 simulated motion using Simulator Sickness Questionnaire (SSQ): A controlled study, Proceedings of the 2009 Sixth International Conference. Computer Graphics, Imaging & Visualization, IEEE Computer Society, California, 2009. Kennedy, R.S., Lane, N.E., Berbaum, K.S., and Lilienthal, M. G, Simulator Sickness Questionnaire: An enhanced 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 components of cybersickness, Psychophysiology 42 (2005), 616-625. Powers, M. and P. Emmelkamp, P., Virtual reality exposure therapy for anxiety disorders: A meta-analysis, Journal 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 (CIBEROBN) b Universidad Jaume I c Universidad de Valencia d I3BH Innovation & Research Institute on Bioengineering for Humans- Universidad Politécnica de Valencia e PREVI Clinical Center a

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 registers, are considered to be central to cognitive-behavioral treatment of Eating Disorders (ED). This information allows the clinician to identify the triggers of the behaviors associated to ED as purges and/or binges, and the associ-

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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 acceptability and satisfaction with a PDAs self-register system specifically designed for assessment and treatment of ED. A sample of 30 patients diagnosed with ED are receiving a PDA with software specifically designed for recording 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 questionnaire. This work is in progress at this moment. It is expected 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 diagnosis, functional analysis and evaluation of treatment in Eating Disorders (ED). The self-register is a semi-structured assessment technique that measures behavior in natural settings such as home, work, school,and others. It is also useful to know the monitoring of therapeutic guidelines and assess the effects of treatment and patient outcomes. 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 associated thoughts and emotions, helping to carry out a more accurate assessment. But the traditional self-register system has several problems, such as situational constraints, missing 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 adherence 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 personal digital assistants (PDAs) and mobile phones have be

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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 satisfaction with a PDAs self-register system specifically designed for assessment and treatment of ED.

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 portability and novelty of the system, the adherence will improve rather than allowing users' motivation to deteriorate over time. These improvements will act together to facilitate acceptance of the system in ED patients. These advantages 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 developed (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.

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). Exclusion 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 surrounding their eating behavior [Fig. 2], frequency of binge eating, 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.

Helsel, D.L., Jakcic J.M. & Otto A.D. (2007.) Comparison of Techniques for Self-Monitoring Eating and Exercise Behaviours on Weight Loss in a Correspondence- Based Intervention. Journal of American Diet Association 107, 1807-1810.

results Work in progress. It is expected that the PDA system will show high levels of acceptance and satisfaction.

Mu-Li Yanga and Wen-Bin Chioub,1

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

Chang Jung Christian University National Sun Yat-Sen University

Conclusion The use of electronic PDA diaries offers important advantages and may enhance weight loss treatments and assessment of ED. It is expected that in this study the PDA system will show high levels of acceptance and satisfaction

Corresponding author: Wen-Bin Chiou National Sun Yat-Sen University 70 Lien-Hai Rd.

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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 effect refers to the fact that more searching leads to worse choices by reducing users’ cognitive resources, distracting them with irrelevant information, and reducing their ability to screen out inferior options. A two by two experimental 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 undergraduates with experiences of online romantic relationships participated in the experiment. After participants were administrated 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 indicated 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 excessive searching, and then reduce decision quality, i.e., the more-means-worse effect. Need for cognition (NFC) is a promising cognitive personality characteristic (Cacioppo, Petty, Feinatein, &Jarvis, 1996). An individual’s need for cognition has

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127 been identified as one of the precedent variables contributing 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 processing 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 conducted to examine whether individual differences in NFC would moderate the effects of available options on excessive searching and decision quality in the context of finding 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 options–small or large number of options) by two (need for cognition–low or high) between-subjects design. Assignment of participants to levels of the second factor, i.e., need for cognition (high or low), was based on their responses 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 introducing 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 recommended 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 condition (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,

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p < .001, η2 = .15. Further analyses indicated that the more-means-worse effect was robust for high-NFC participants (Mlarge = 8.57; Msmall = 4.57), F(1, 58) = 89.38, p < .001, η2 = .61. However, this effect was small for lowNFC participants (Mlarge = 4.60; Msmall = 3.23), F(1, 58) = 12.45, p < .001, η2 = .18. The selectivity data indicated 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; Msmall = 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-saving benefit of search tools. Moreover, need for cognition was demonstrated as a moderator of the more-meansworse 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 construct 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 online 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 relationships online: An experimental study, CyberPsychology & Behavior 12 (2009), 315–318. Yang, M., Chiou, W., Looking online for the “best” romantic partner reduces decision quality: The moderating role of choice-making strategie, CyberPsychology & Behavior 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 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 Psicobiología, Universidad Jaume I, Valencia, Spain d Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad de Valencia, Valencia, Spain e Dept. Psicología Bàsica, Clínica i Psicobiología, Universitat Jaume I, Castelló, Spain a

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 phobias, specifically a phobia to insects (spiders and cockroaches), using virtual reality (VR) as stimulus. To study brain activation, subjects will be introduced to a functional magnetic resonance imaging (fMRI) machine. Two different sessions using fMRI will be performed, before and after an intensive treatment specific for the phobia. Participants will wear specific glasses to visualize the VR environments 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 sensation 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 present. The first experiments will take place during January and February of 2010.

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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, analyzation has been done of the activation of brain areas related to phobias (Canli et al., 2001), and, more precisely, to a phobia of spiders (Paquette et al., 2003). Other research has been done combining VR with fMRI, for example, 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 unexplored 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 Castellon. 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 experienced psychologists. Our study uses virtual environments as stimuli where subjects can navigate freely during shorts periods of time (avoiding the possible habituation effect). Different experimental conditions will be applied in a repetitive and counterbalanced 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 treatment 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

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months of January and February 2010. Results will be available at this time. We expect brain activation to be similar to the studies that used images of real spiders as stimuli. 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 patterns 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 influences 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 cognitivebehavioral therapy on the neural correlates of spider phobia. 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 reality-induced cortical reorganization and associated locomotor 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 Faculty of Electrical Engineering and Computing, University of Zagreb, Croatia b Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Croatia

Corresponding author: Davor Kukolja

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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 operations underscores the importance of effective methods for strengthening the stress resilience of military personnel. Virtual reality (VR) adaptive stimulation techniques presented in the paper, based on an estimation of the participant’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 building. 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, cognitive, and memory) participate with lesser known parameters 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, Response of Limbic Structures, Mental Readiness Training, Stress Resilience, Physiological Measurements, Emotional State Estimation introduction A significant proportion of severe psychological problems related to combat stress in recent large peacekeeping operations (Tanielian & Jaycox, 2008) highlights the significance 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 resilience 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 correlates of treatment outcomes in psychotherapy, such as

Abstracts from CT15

demonstrated byNardo, Högberg et al.'s work (2009), suggest 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 physiology-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 stimuli (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 psychophysiological correlates of stress resilience, using the stimuli of desired semantics and emotional properties. neurobiological Considerations of stress resilience Physiological fluctuations during physiology-driven adaptive VR stimulation for MRT reflect changes in brain-body interaction influenced by the presented stimuli, and also baseline brain activity and other potential stimuli-unrelated processes. Thalamo-amygdala and thalamo-corticoamygdala 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 (Marrelec, Bellec et al., 2006). The so-called “paralimbic” and “limbic” structures are known to be affected in stress-related disorders (Nardo, Högberg et al., 2009). An interdisciplinary 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 military 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

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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 resting-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 consequences, and services to assist recovery. RAND Corporation, 2008. Wiederhold, B.K., Wiederhold, M.D., Virtual reality for posttraumatic stress disorder and stress inoculation training, 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

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-

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131 amining if mood produced by virtual reality (VR) exposure influenced body image disturbances. As expected, dysphoric mood increases body image disturbances in patients with eating disorders. Keywords: Body Image, Eating Disorders, Virtual Reality, Mood introduction Previous research has provided evidence about the capability of virtual reality (VR) exposure to produce emotional 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-García, 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 depressed 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 environments randomly displayed – the kitchen with lowcalorie 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 between 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 dissatisfaction. As Table 2 shows, depressed mood was the best predictor of body image dissatisfaction in ED patients. Neither anxiety nor depression significantly influenced control participants' body image disturbances.

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Table 1 Correlations between mood and body image disturbances body image distortion

Anxiety Control ED Depressed mood Control ED

body image dissatisfaction

VE1

VE2

VE3

VE4

Mean

VE1

VE2

VE3

VE4

Mean

.083 .430** .113 .405**

.189* .468** .176* .467**

.265** .464** .267** .496**

.226** .517** .139† .516**

.224** .511** .175* .511**

-.099 -.593** -.179* -.575**

-.344** -.583** -.297** -.606**

-.294** -.549** -.338** -.582**

-.205* -.638** -.200* -.653**

-.278** -.672** -.235** -.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 Control ED Depressed mooda Control ED

.024 .289† .098 .183

.131 .262† .101 .259†

.161 .170 .167 .355*

.213† .286† .025 .280†

.185 .279† .064 .280†

-.080 -.369** -.031 -.292*

-.259* -.275† -.149 -.388**

-.138 -.210 -.252* -.408**

-.137 -.310* -.127 -.398**

-.214† -.351* -.106 -.386**

Anxiety + Dep. Moodb Control ED

.144 .445**

.206† .493**

.295** .505**

.228† .541**

.229† .535**

.102 .621**

.365** .629**

.355** .594**

.231† .667**

.291** .706**

Beta; b R; † p <.10 (marginally significant); * p < .05; ** p < .01

Conclusions Mood experienced by ED patients in virtual environments, especially depressed mood, influences their body image disturbances, mainly body image dissatisfaction. Results agree with previous research done in this field. references Ferrer-García, M., Gutierrez-Maldonado, J., CaqueoUrízar, A., Moreno, E., The validity of virtual environments for eliciting emotional responses in patients with eating disorders and in controls, Behavior Modification 3 (2009), 830-854.

tion, British Journal of Clinical Psychology 38 (1999), 279–287. –––––––––––––––––––––––––––––––––––––––––––––– a myoelectric-Controlled Virtual hand for the assessment and Treatment of phantom limb pain in Trans-radial upper extremity amputees: a research protocol Andrea Gaggiolia,b,1, Amedeo Amoresanoc, Emanuele Gruppionic, Gennaro Vernic and Giuseppe RIVAa,b ATN-P Lab, Istituto Auxologico Italiano, Milan, Italy b Department of Psychology, Catholic University of Milan, Italy c Centro Protesi INAIL, Vigorso di Budrio (Bologna), Italy

Gutierrez-Maldonado, J., Ferrer-García, M., CaqueoUrízar, A., Moreno, E., Body image in eating disorders: The influence of exposure to virtual environments, CyberPsychology & Behavior (in press). Kasper, S.A., The impact of self-Esteem and depressed mood on body image dissatisfaction, Dissertation Abstracts International: Univ Microfilms International, 2001. Kulbartz-Klatt, Y.J., Florin, I., Pook, M., Bulimia nervosa: mood changes do have an impact on body width estima-

Corresponding author: Andrea Gaggioli Istituto Auxologico Italiano Via Pelizza da Volpedo 41, Milan, Italy E-mail: andrea.gaggioli@auxologico.it

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Abstracts from CT15

abstract At least 90% of individuals with limb amputations experience phantom limb pain (PLP). Recent clinical research suggests that providing patients with the mirror image representation of the amputated limb may alleviate PLP. However, mirror therapy cannot be used with bilateral amputees, as visual feedback is dependent on the movement of the intact limb. To overcome this limitation, we designed a novel myoelectric-controlled virtual reality (VR) system for the treatment of phantom limb pain in trans-radial upper extremity amputees. The proposed system allows 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 amputated 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 methodological limitations, highlighted by previous research (Murray, 2007). Mirror therapy cannot be used with bilateral amputees, as visual feedback is dependent on the movement of the intact limb. Further, conventional mirror therapy requires 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 conventional 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

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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 controlled 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 participants 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 amputees, while sensors only were used for lower-limb amputees. 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; Murray et al., 2007; Desmond, O'Neill, de Paor, MacDarby, & MacLachlan, 2006), the goal of this project is to design, 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-described technological solutions, the proposed system allows 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 possible to recognize, also from residual muscles of transradial amputees, different type of grasping and the strength related (Castellini, Gruppioni, Davalli, & Sandini, 2009). From the technical point of view, the development will concern the software interfaces, shown in Figure 1 as “To Do”, that will allow the system’s operation overall. The myoelectric-controlled virtual limb is presented in a head-mounted display equipped with head-tracking sensor.

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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 neuromatrix, Trends Neurosci 13 (1990), 88-92. 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 randomly 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 inclusion 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).

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 Journal 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: 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.

The treatment protocol for both groups consists of 1520 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 intensity of pain (the sensory dimension) as well as the degree 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.

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 others and how they "take possession" of virtual environments 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 relationships actors establish with virtual environments and

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Baus and Bouchard how actors transform "simple" cyberspaces in cyberplaces; 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 theoretical 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 relevant in that context, strategically presented and considering the interlocutor and the environment. To be understood by others during mediated interactions, subjects shape their subjectivities according to feedback and artifacts offered by the context. Subjectivity is dialogically-generated and continuously adjusted by social actors during their interactions. Every social interaction is characterized by a unique combination of subjectivities created in a specific context at one moment, a combination 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 technologies), but made of relationships and of social meanings 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 subjectivity and relational rules. Forty-eight conversations in a Shared Virtual Environment were analyzed in order to understand the specific structure, dynamics, and phenomenology 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

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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 collaborate successfully, actors need to build a shared representation 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-specific 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 creation, performed as a collaborative process. Therefore we can state that avatars may partially contribute to the definition of a kind of subjectivity brought about "intersubjectively." As a partial representation of the self, avatars act as body representations in a virtual environment. By "bringing the body" into the virtual environment, 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’ construction 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-constructed 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 Communication Conference, Barcelona, 2008.

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Cantamesse, M., Reciprocal presence: A qualitative analysis of psycho-social interaction in Virtual Reality, Doctoral Thesis, Università Cattolica del Sacro Cuore, Milano, 2008.

performance with traditional paper-and-pencil tasks for attention, memory and motor control. The results are described and discussed. Keywords: Cognitive training, Elderly, Videogames

Cilento Ibarra, F., Brivio, E, Galimberti, C., Monti, A., & Bonisolli, B., Avatar based self-presentation and self-positioning in a blended reality context, CSRPC-Dipartimento di Psicologia Università Cattolica Internal Research Report, Milano, Italy, 2009. Galimberti, C., Cilento Ibarra, F., Tra riproduzione dell'identità 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 interactions: Intersubjectivity as a Social Bridge, Annual Review of Cybertherapy and Telemedicine 7 (2009), 13-15. Galimberti, C., Segui il coniglio bianco: Strategie identitarie e costruzione della soggettività nelle interazioni mediate. 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 University of Padova, Department of Psychology

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 psychological treatments. Here we present an application for cognitive training, in which cognitive tasks are administered to elderly people through a popular videogame console, the Nintendo Wii®. The application was successfully tested in a nursing home, by comparing its

introduction The worldwide elderly population growth is expected to increase rapidly until 2050 and beyond (UN. World Population Prospects: The 2008 Revision). This expansion highlights the need to elaborate simple, quick and lowcost 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-sufficient as possible. Side by side with classic cognitive training, 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 present 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 research 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 correlation 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).

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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

Testspp

deux barrages

memory (mi)

memory (ds)

motor Control

,777*

,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 commonly considered to be close to rejecting any new technology. 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 pencil, 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 Project, 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

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Universidade Lusófona de Humanidades e Tecnologias b Clínica São João de Deus c Instituto Universitário de Lisboa

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 perspective, as a process resulting from a synchrony between cognitive and perceptive systems, the multitude of associated 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 computer experience were selected. The study design consisted of two assessments (initial and final), where the participants were evaluated with the BFI, PQ, ITQ, QC, MCSDS-SF, STAI, visual attention and behavioral measures after playing an FPS. In order to manipulate the level of VR experience the participants were trained on a dif-

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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 statistical 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.

years; SD=13.44) of both genders without computer experience.

Keywords: Presence, Immersion, Cybersickness, Anxiety, Personality, Behavioral measures, First-Person Shooters

Behavioral measures showed no statistical significant differences between assessments, although descriptive statistics have shown an overall increase in performance. Furthermore, no statistical significant interaction effects of personality type and trait anxiety on presence assessments were registered. Social desirability and visual attention levels were considered as normal.

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 teletransporting 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 patients 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 further research is needed in order to devise the effect of individual 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 personality 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

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 cybersickness.

Conclusion In general, our results showed that training and the subsequent higher computer experience levels can increase immersion 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 improvement in task performance. Also, but far being conclusive, this study points towards the prevalence of VR experience over individuals differences 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 Interactions (2009), pp. 149-152. Heeter, C., Being there: The subjective experience of presence, Presence (1992), 1(2), pp. 262-271. Sacau, A., Laarni, J. & Hartmann, T., Influence of individual factors on Presence, Computers in Human Behavior (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.

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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 University of Barcelona, Spain b University of Oviedo, Spain

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 context associated with tobacco use could be useful for smoking 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 responsible for relapse after smoking cessation (Shiffman, Paty, Gnys, Kassel, & Hickcox, 1996). Cue Exposure Treatment (CET) consists of controlled and repeated exposure to stimuli 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 diverse environments that enhance the probability of generalization of extinction in real life are needed.

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The aim of this study was to assess the validity of eight immersive virtual reality environments to produce smoking cravings as well as to determine the relationship between level of presence and nicotine dependence with self-reported craving. method Twenty-five former smokers participated in the study. Inclusion 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 complex virtual scenes with smoking-related cues that reproduce 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 visual analogical scale from 0 to 100) were assessed before the experiment and during the exposure to each environment. 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. Nevertheless, 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 significant correlation was found only between presence and craving levels (r= .480; p=.01). Conclusions These results suggest that complex virtual reality environments that simulate real situations are able to elicit craving. This technology could be useful in the improvement of CET for substance use disorders and more specifically for smoking cessation programs. Nevertheless, it is necessary 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

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Camino deVera 46020 Valencia (España) E-mail: jgil@upv.es

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 exposure therapy by using virtual environments, CyberPsychology & 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 Psychology 64 (1996), 366-379. Slater, M., Steed, A., McCarthy, J., Maringelli, F., The Influence of Body Movement on Subjective Presence in Virtual Environments, Human Factors 40 (1998), 469- 477. Traylor, A.C., Bordnick, P.S., Carter, B.L., Assessing craving 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 Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universidad Politécnica de Valencia, Valencia (España) b Servicio de Daño Cerebral de NISA; Fund. Inst. Valenciano de Neurorrehab. (FIVAN)

Corresponding author: José-Antonio Gil-Gómez Universidad Politécnica de Valencia

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 rehabilitation, 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 between 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 conclusions 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 interesting 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 patients’ motivation. In fact, since the motivation is a crucial characteristic of the rehabilitation effectiveness, by introducing the game scheme the patient would enjoy the virtual rehabilitation sessions more than the traditional rehabilitation sessions.

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141 and the physiologists. The measures were collected in the following periods of time – 15 days before starting the rehabilitation (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).

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.

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

More specifically, the patient is located on the platform, standing or seating, and controls the game by displacing his/her center of mass.

Alessandra Gorinia,1, Anna Petrovab and Giuseppe Rivac 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

The parameters of the games, such as size or speed of the elements, can be parameterized in order to adapt to the difficulty level needed for the patients. Moreover, the sensitivity 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 during the game and the time break and the hardware is composed of a standard PC and the WBB. Forty patients participated in this study. The participants had no previous experience with any virtual reality systems. All the participants did not display any balance disorder symptoms before their first stroke, and their age ranged from 18 to 70 years old. The evaluation was a twogroup comparison in which participants were divided according to their BERG scale score (i.e. a group of participants with fall risk and a group of participants without fall risk). These two groups were then randomly subdivided 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

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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-

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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 virtual reality (VR) in adjunct to in-vivo exposure therapy to provide an innovative form of exposure for patients suffering from different psychological disorders. The rationale behind the “virtual approach” is that real and virtual exposures elicit a comparable emotional reaction in subjects, even if, up to date, there are no experimental data that directly compare these two conditions. To test if virtual stimuli are as effective as real stimuli and more effective 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 nervosa (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 condition, 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 presented 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 photographs 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 appeared 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 environment. The motion-tracker included in the HMD and

a joystick allowed them to explore the environment and to interact with the virtual food. The environment represented a small restaurant with a buffet table in it (the virtual 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 virtual food, only ED patients showed a significant increase in the STAI-S questionnaire, VAS-A, HR and SCR compared 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; VASA: 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 condition; - 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.

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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, illustrating 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, 9:507513. 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 behavioral 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

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143 University of Barcelona, Spain Universitat Oberta de Catalunya, Spain a

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 selfefficacy) 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 psychological treatments will not occur. However, some authors argue that presence must be distinguished from the degree of engagement, involvement in the portrayed environment. 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 treatment'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 distraction. In fact, to be processed pain needs attention. Therefore, if attention is distracted, it could be hypothesized that pain would be perceived with less intensity. Other alternative would be to explore the use of this technology to change cognitions associated with pain adjustment in chronic pain patients. Although therapeutic mechanisms underlying the process of the pain patients’ improvement in VR, besides its attention diversion effects, 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,

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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 intensity, 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 adjustment are catastrophizing and sel-efficacy. There is growing evidence suggesting that especially catastrophizing 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 catastrophizing and pain self-efficacy in a controlled laboratory environment 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 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. The virtual environment 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 expectation of control that the subject has over a painful experience. 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 environment (analogue to a situation of no pain). This VR experience 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, GutierrezMartinez, 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

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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 presence” is used to describe the illusion of “being there” in a virtual environment. One of the most important consequences 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 psychological treatment; if patients are not able to involve themselves in a virtual world they cannot experience relevant 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 difficulties involved in its measurement, most researchers agree to define it as a multicomponent construct. Thus, some factor analysis studies (Schubert, Friedmann, & Regenbrecht, 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), Engagement/Involvement (attention devoted to the virtual environment) and Ecological Validity/Realism (the participant’s sense of believability and realism of the content). However, some authors argue that presence must be distinguished from the degree of engagement or involvement in the portrayed environment (Slater, Lotto, Arnold, & Sanchez-Vives, 2009). Presence and involvement may belong 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 without 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 effect of our VR intervention on pain, the ratings of presence were measured by means of IPQ (Igroup Presence Questionnaire; 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

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stereoscopic figure, which could be interactively manipulated with the mouse. IPQ contains three subscales, assessing 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.

related to the sense of presence have interested many researchers, 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 assumption about the relationship between presence and involvement. In fact, some studies (Kurita, 2005) have found that involvement may not necessarily be a dimension of presence.

results Presence, as measured by the IPQ, obtained medium ratings (sense of being, mean = 2.40, SD = 1.66; spatial presence, 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 ratings. 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 significant correlations were found with the “involvement” subscale.

references Brekke, M., Hjortdahl, P., & Kvien, T. Changes in self-efficacy and health status over 5 years: A longitudinal observational 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. Submitted 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 display 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 control 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.

Conclusions Since the Involvement scale of the IPQ did not correlate with any of the measures related with the treatment's efficacy, 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 efficacy. The questions of whether or how involvement is

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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 reality relaxation on pain and anxiety when added to PCA morphine in patients having burns dressings changes. Burns 35 (2009), 491-499.

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Kurita, S. Presence and time estimation. A comparison between the relative and the absolute value approaches. Paper presented at the 55rd annual conference of the International 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 efficacy of virtual reality distraction. The Journal of Pain 10 (2009), 391-397. Schubert, T., Friedmann, F., & Regenbrecht, H. The experience of presence: Factor analytic insights. Presence: Teleoperators and virtual environments 10(3) (2006), 266281. 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 perspectives on the relation between catastrophizing and pain. Clinical Journal of Pain 17 (2001), 52-64. Turner, J.A., Holtzman, S., & Mancl, L. Mediators, moderators and predictors of therapeutic change in cognitivebehavioral 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

Corresponding author: Olga Gutiérrez-Martínez University of Barcelona

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 experimental 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 demonstrate 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’ research team and consisted of a stereoscopic figure presented 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 spherical 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).

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procedure Prior to conditioning trials, participants (n=67) were asked to make ratings of the CS+, the CS− and two control stimuli (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 differential 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 valence scales.

Fear conditioning in virtual reality contexts: a new tool for the study of anxiety. Biological Psychiatry 55 (2004), 1056-1060.

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 experiment, 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, differences between CS+ and CS− at the end of the experiment remain significant after adjusting the pre-acquisition differences, F (1, 65) = 137.47, p <.001, η2 = .68. The pattern of results was the same for the valence scores. For control stimuli no pre-post shifts were found.

Olga Gutiérrez-Martineza, José Gutierrez-Maldonadoa,1, Kattia Cabas-Hoyosa, and Desirée Loretoa

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. Although 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.,

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Cote, S. Bouchard, S., Virtual reality exposure’s efficacy in the treatment of specific phobias. Journal of Cybertherapy and Rehabilitation 1 (2008), 75-91. –––––––––––––––––––––––––––––––––––––––––––––– The illusion of presence influences Vr distraction: effects on Cold-pressor pain

University of Barcelona, Spain

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 reduces pain intensity during a cold-pressor experience. Thirty-seven healthy students (mean age 23.8) underwent a cold pressor task while interacting with a VR distraction 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. Results 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 thermal 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

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time and pain stimulation duration were brief. Other laboratory-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 coldpressor pain.

withdraw at any time. The immersion was limited to fiveminute 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.

method Vr intervention and equipment The VR intervention consisted of a stereoscopic environment named “Surreal World” that involves attention-diversion techniques. It was presented via two BARCO ID R600 projectors onto a 2.43 by1.82 meter Maxwell polarized screen. The "Surreal World" is a virtual environment with auditory and visual inputs based on art images designed to surprise the participant with unreal objects that challenge the laws of physics. These features and the interactive 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.”

results VR distraction decreased levels of pain intensity by an average of 51%, across male and female students. The ratings 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.

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

discussion Levels of VR presence were associated with lower intensity 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 influences VR analgesia when a brief thermal pain stimulus was administered. Future studies concerning the conditions that maximize VR presence seem crucial to design VR systems that increase analgesic effectiveness for patients. 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 analgesia. The Journal of Pain 7 (2006), 843-850. Slater, M., Usoh, M., Steed, A., Depth of presence in immersive virtual environments. Presence Teleoperator Virtual Environment 6 (1994), 130-144.

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Abstracts from CT15 –––––––––––––––––––––––––––––––––––––––––––––– The effects of augmented reality on learning Kuei-Fang Hsiaoa,1 Deptartment of Information Management, Ming-Chuan University, Taiwan

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 performance compared to the traditional Keyboard-Mouse CAI (KMCAI). The improvement is most evident for the non-memorized knowledge component of science. Moreover, the students in the AR group with the "muscle strength" physical activity had a significantly higher positive learning attitude change toward science than those in the KMCAI group. A great additional benefit of our approach 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 physical exercise has decreased, whilst the time spent on computers 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

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149 daily life routines and health condition (Chou & Peng, 2007). However, it is not clear that increased computerrelated 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 explore 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 activity 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 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. Students (n=673) from five high schools were divided into four groups. The first three groups used the CARLS learning system while a control group used a traditional way to operate the computer – a keyboard and a mouse. We explored changes in academic achievement as well as attitudes 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 significantly higher academic performances compared to the traditional Keyboard-Mouse CAI (KMCAI). The improvement is most evident for the non-memorized knowledge 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, comprehensive 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.

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Conclusions This study provides a new approach to increasing students’ extra physical activity without diminishing students’ academic performance. In addition, better academic achievement 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 learning. 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 profile, 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 The Hong Kong Polytechnic University

Corresponding author: 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

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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 related 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 current, 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 provide 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 concerning whether the paretic muscle groups could achieve movements with the desired kinematic qualities, such as speed and trajectory. It is possible that a combined rehabilitation 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

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is shown in Fig 1. The system could assist wrist training for persons after stroke continuously and interactively according to their voluntary electromyography (EMG) from the paretic upper limb. A subject would be asked to conduct 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 extension phase.

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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 person after stroke. The FES-robot assisted wrist training introduced 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 patients 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," Neurosci, vol. 124, pp. 71-79, 2004.

Figure 1. Experimental setup diagram of the FES-robot system. Five subjects with chronic stroke were recruited in a 20session wrist training program assisted with the FESrobot, 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 coordination was found by the decreasing in the muscle cocontraction phase (Hu, Tong, Song, X. Zheng, & Leung, 2009) between muscle pairs of ECR&FCR, FCR&BIC, and ECR&BIC (P<0.05).

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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. 314319, 2004. –––––––––––––––––––––––––––––––––––––––––––––– internet delivered images for exposure in specific phobia, design Considerations for self-directed Therapy Kenneth C. Kirkbya,1, Allison Matthewsa and Joel Scanlana Psychiatry, University of Tasmania, Australia

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 phobias typically results in increased anxiety, ranging from mild to severe, followed by gradual habituation. The Internet is a candidate medium for the delivery of phobic stimuli to phobic subjects, in the form of pictures, video

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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 requirements in the design of an Internet-based exposure program (FEARDROP). This employs a database repository of pictures 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 images 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 stimuli. Exposure is typically preceded by anticipatory anxiety and followed by a peak of anxiety that reduces with continued or repeated exposure, a process referred to as habituation. This anxiety response can be conveniently assessed by asking the subject to rate their subjective distress on a visual analogue scale, at intervals. The Internet contains many millions of images and mentions of phobic stimuli, easily located using a search engine (for example by Googling “spider”) but lacks the structure, assessments and outcome evaluation that anchor systematic desensitization. A person undertaking self-exposure 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

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 desensitization in the design and implementation of an internet program 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 downloaded 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 hierarchies relevant to diverse phobias may be delivered in this way. Further, stimuli may be attenuated, realistic, hyperrealistic, stationary or moving and so forth, essentially any aspect of a phobic stimulus that can be conveyed by images, 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 current 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 repeated measures at relatively brief intervals is of particular interest in Internet delivery since it secures pertinent information about the treatment process and potential mediating 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 following 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,

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Hsiao each with a thumbnail preview so that the user has the option 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 (approximately 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 stimulus on random straight paths. The user is required to follow the tracking circle with the computer mouse and if they fall more than a set amount behind the circle the phobic stimulus fades. This device serves two purposes. Firstly, it is an indication of treatment adherence and confirms that the user is observing the screen containing the phobic stimulus. In other words, the stimulus is being delivered to the user and not merely their computer. Secondly, 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 manâ&#x20AC;&#x2122;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 research within the constraints of online-treatment delivery. All users register and give informed consent. Session data including exposure stages, SUDS scores and tracking circle accuracy are stored in the database for analysis. Questionnaires 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 investigator 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 responses. 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 exposure 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.

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53 However, adherence rates were low. Of the 220 participants 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 proposition and can be designed to support self-directed exposure, using measures such as those outlined above. Currently the Internet can only deliver a limited range of sensory inputs to most users â&#x20AC;&#x201C; visual and auditory â&#x20AC;&#x201C; and online phobic stimuli are limited to those which are symbolic, that is they represent but are not the real thing (for example a video of a spider, not a real spider). Accordingly, therapeutic effects are likely to be circumscribed, although Internet delivery may play a useful and definable 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 efficacy can be rigorously pursued. The Internet also accesses 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 interventions, adherence rates are a key issue (Christensen, Griffiths, & Farrer, 2009). In principle this can be addressed systematically in future research, including randomization 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: Systematic 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 psychological disorders (pp. 99-136). New York: The Guildford 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.

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–––––––––––––––––––––––––––––––––––––––––––––– psychophysiological indicators of acute stress disorder and posttraumatic stress disorder: predictive Value of peritraumatic dissociation Dragica Kozaric-Kovacica,1, Andrea JambrosicSakomana and Tanja Jovanovicb Referral Centre for Stress Related Disorders of the Ministry 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. a

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 Disorder was introduced to the DSM-IV, research of acute reactions 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 disorders six months after the traumatic event. Standardized diagnostic procedures based upon psychiatric standardized interviews and scales were administered. In addition, psychophysiological measures of electromyographic activity, electrodermal activity, electrocardiogram activity, and respiration 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 resulting from interpersonal assault trauma exhibited more similarities in psychophysiological parameters with PTSD patients than those individuals with ASD that resulted from traffic-related trauma.

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Keywords: ASD, PTSD, Psychophysiology, Peritraumatic Dissociation introduction The diagnosis of Acute Stress Disorder (ASD) was introduced to the DSM-IV (American Psychiatric Association, 1994) to emphasize acute stress reactions that could be predictive of Posttraumatic Stress Disorder (PTSD) (Bryant & Harvey, 2007). ASD and PTSD share the same diagnostic 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 factor 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 psychophysiological studies of ASD have attempted to clarify the questions regarding autonomic nervous system activation during peritraumatic 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 psychological and biological sequelae, including activation of sympathetic and parasympathetic nervous systems as an integral part of the emotional response which can be measured through different peripheral targets of the body. Physiological 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 dissociation to regulation of the extreme hyper-arousal in the aftermath of the traumatic event (Nixon & Bryant, 2003). Results of some of the physiological studies have indicated suppression of autonomic response (sympathetic and parasympathetic) in individuals who developed high peritraumatic 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 psychophysiological responses and the development of PTSD and other psychiatric disorders six months after the traumatic event.

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Abstracts from CT15 Standardized diagnostic procedures based upon psychiatric standardized interviews and scales were applied. We recorded electromyographic (EMG) activity, electrodermal 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 disorders were assessed by administering the Mini International Neuropsychiatric Interview, Croatian version (MINI) (Lecrubier et al., 2006), Acute Stress Disorder Structured Interview (ASDI) (Blake, 1990), Clinician Administered PTSD Scale (CAPS) (Berstein & Putnam, 1986), CAPS Life Events Checklist C. The Dissociative Experience Scale (Birmes et al., 2003) and The Peritraumatic Dissociative Experiences Questionnaire (Marmar, Weiss, & Metzler, 1997) were used to evaluate the dissociative 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 threeminute resting phase was followed by a startle phase during 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 individuals, age and gender matched to the patient group. The MINI was administered to this group to exclude psychiatric disorders, and the identical psychophysiological session 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-

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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 habituated to the startle probe to the same degree as healthy controls. 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 victims of interpersonal trauma compared to ASD patients who survived traffic-related traumas. This result is consistent with increased peritraumatic dissociation during interpersonal 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 disorders (198-0982522-0075). Conclusion Psychophysiological parameters can provide better clarification between ASD and PTSD, as well as differentiation between ASD as a result of interpersonal trauma versus traffic-related trauma. Peritraumatic dissociation may be more commonly associated with interpersonal trauma. references American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders 4th edn. American Psychiatric 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 ThreeMonth Prospective Study, Am J Psychiatry 160 (2003), 1337–1339. Blake, D., Weathers, F., Nagy, L., Kaloupek, D., Klauminzer, G., Charney, D., Keane, T., Clinician-Administered PTSD Scale (CAPS), National Center for Post-Traumatic Stress Disorder, Behavioral Science Division, Boston, 1990. Bremner, J.D., Southwick, S., Bret, E., Fontana, A., Rosenheck, R., Charney, D.S., Dissociation and posttraumatic stress disorder in Vietnam combat veterans, Am J Psychiatry 149 (1992), 328– 332. Bryant, R.A., Harvey, A.G., Acute stress disorder: a critical review of diagnostic issues, Clin Psychol Rev 17 (1997), 757–773. Bryant, R.A., Harvey, A.G., Dang, S., Sackville, T., Assessing 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: Psychophysiological Indicators, Am J Psychiatry, 154 (1997), 1081– 1088. Harvey, A.G., Bryant, R.A., Acute stress disorder: a synthesis and critique, Psychol Bull 128 (2002), 886–902. Jovanovic, T., Norrholm, S.D., Jambrošić Sakoman, A., Esterajher, S., Kozarić-Kovačić, D., Altered Basal Psychophysiology and Startle Response in Croatian Combat Veterans with PTSD, International Journal of Psychophysiology 71 (2009), 264-268. Jovanovic, T., Norrholm, S., Fennell, J., Keyes, M., Fiallos, A., Myers, K., Davis, M., Duncan, E., Posttraumatic stress disorder may be associated with impaired fear inhibition: Relation to symptom severity, Psychiatry Research 167 (2009), 151-160.

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Koopman, C., Classen, C., Spiegel, D., Predictors of posttraumatic stress symptoms among survivors of the Oakland/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. NATO Security through Science Series, E: Human and Societal Dynamics, IOS press 15 (2007), 13-41. Lecrubier, Y., Weiller, E., Hergueta, T., Amorim, P., Bonora, L.I., Lépine, J.P., Sheehan, D., Janavs, J., Baker, R., Sheehan, K.H., Knapp, E., Sheehan, M., Miniinternational neuropsychiatric Interview (MINI). Croatian version 5.0.0 /DSM-IV/ current, August 1998. Prijevod na 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., Peritraumatic dissociation and posttraumatic stress disorder in male Vietnam theater veterans, Am J Psychiatry 151 (1994), 902–907. Marmar, C.R., Weiss, D.S., Metzler, T.J., The peritraumatic dissociative experiences questionnaire. In: Wilson JP and Keane TM, Editors, Assessing psychological trauma and PTSD, Guilford Press, New York,1997. Nixon, R.V.D., Bryant, R.A., Peritraumatic and persistent panic attacks in acute stress disorder, Behav Res Ther 41 (2003), 1237–1242. 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 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

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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 primary school are described in this work. Results showed that robotics activities may be implemented as a new metacognitive environment that allows children to monitor themselves and control their learning actions in an autonomous 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 create 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 interaction 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 different ages to improve their planning, reasoning and problem-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 conflict resolution, group decision-making and so on (Barfurth, 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 possibility of using robotics kits as metacognitive tools. In general, metacognition consists of two basic processes occurring simultaneously. The first is monitoring the

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progress of learning and the second is making changes or adapting learning strategies when subjects perceive that they are not successful (Winn & Snyder, 1996). Specifically, 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 occurring once a week. After becoming familiar with the hardware and software elements of the kit, the children were given four construction 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). During the construction and programming sessions the children's metacognitive strategies were registered using two observational grids that provided quantitative and qualitative 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 controlling 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

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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 possibility 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 children’s disagreements. In Schnase L. & Cunnius, E. L. (Eds.), Proceedings of CSCL95: computer support for collaborative learning. Mahwah, NJ: Erlbaum, (1995), 8-13. Caci, B. & D’Amico, A., Children’s Cognitive Abilities in Construction and Programming Robots. Proceeding of the 11th IEEE International Workshop on Robot and Human Interactive Communication, IEEE Roman 2002, September 25-27 2002, Berlin – Germany (2002). Caci, B., D’Amico, A., & Cardaci, M., Costruire e Programmare Robots, Tecnologie Didattiche, 27(3), (2002), 36-40. Caci, B., D’Amico, A., & Cardaci, M., New frontiers for psychology and education: robotics, Psychological Reports, 94, (2004), 1372-1374. Dautenhahn, K., Design issues on interactive environments for children with autism. Proceeding International Conference on Disability, Virtual Reality and Associated Technologies, ICDVRAT 2000, 23-25 September, Alghero, Sardinia, Italy (2000), 153-161. Michaud, F., & Théberge-Turmel, C., Mobile robotic toys and autism. In Dautenhahn, K., Bond, A., Canamero, L., & Edmonds, B. (Eds.) Socially Intelligent Agents - Creating Relationships with Computers and Robots. London: Kluwer Academic (2002). Miglino, O., Lund, H.H., & Cardaci, M., Robotics as an Educational Tool, Journal of Interactive Learning Research, 10 (1), (1999), 25-48.

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Ridley, D.S., Schutz, P.A., Glanz, R.S., & Weinstein, C.E., Self-regulated learning: the interactive influence of metacognitive awareness and goal-setting, Journal of Experimental Education, 60 (4), (1992), 293-306. Winn, W., & Snyder, D., Cognitive perspectives in pyschology. In D.H. Jonassen, ed. Handbook of research for educational communications and technology, New York: Simon & Schuster Macmillan (1996), 112-142. –––––––––––––––––––––––––––––––––––––––––––––– use of immersive Virtual reality for Treating anger Sarah D. Miyahiraa, Raymond A. Folenb, and Melba Stetzb Pacific Islands Health Care System, Honolulu, Hawaii, U.S.A. b Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.

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 authors 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 behavior 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 pressure, 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 nonimmersive flat screen. In addition, presence was found to moderate the effects of VR. Low presence resulted in low reactivity regardless of the display modality.

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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 adverse effects on cardiovascular disease (Chang, Ford, Meoni, Wang, & Klag, 2002) domestic violence (Maiuro, Cahn, Vitaliano, Wagner, & Segree, 1988) and Posttraumatic 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 reframing after exposure to anger-arousing stimuli, and rehearsal of adaptive thoughts and behaviors during imaginal or role play exposure to anger-provoking situations. Reactivity to anger stimuli during exposure is critical to successful treatment outcomes that will generalize to real life situations. Studies have shown that virtual reality (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 environment with multiple anger-provoking video vignettes to examine 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. Participants in the immersive HMD condition viewed the vignettes in a 360째 panoramic format through a high resolution HMD. All participants viewed the same six anger video vignettes of unpleasant encounters with a supervisor. The order of presentation was counterbalanced to control for sequencing effect. Outcome measures included 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 occurred 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 physiological measures.

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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 reported by the HMD group during the video vignettes than the FSM group. Analysis of high and low presence revealed significant differences between the high presence HMD group on the STAXI-2 and EAS and HMD low presence group, and FSC low presence group, respectively. 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 moderate 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. Cognitve 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 subthreshold 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 nicotine craving through cue exposure. CyberPsych & Behavior 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.

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–––––––––––––––––––––––––––––––––––––––––––––– effectiveness of brief Vr Treatment for pTsd in Warfighters Sarah D. Miyahiraa, Raymond A. Folenb, Hunter G. Hoffmanc, and Azucena Garcia-Palaciosd 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 a

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 authors 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 developing Posttraumatic Stress Disorder (PTSD), a complex and challenging condition to treat. Cognitive behavioral therapies (CBT) have been empirically validated as effective treatment for PTSD resulting from sexual assault, vehicular accidents, and disasters. Exposure, imaginal or in vivo, to the traumatic event is a central component of successful CBT treatment. Early studies indicate that CBT with brief virtual reality exposure (VRE) is beneficial in treating PTSD. The current work is a randomized controlled 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

Posttraumatic Stress Disorder (PTSD) (Tanielian & Jaycox, 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, traumatic brain injury (TBI) and serious physical injuries. Exposure-based cognitive behavior therapy (CBT) has been empirically validated to reduce PTSD symptoms (Institute of Medicine, 208). Recall of the traumatic event is essential 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 compares 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 assigned to VR exposure treatment (VRTx) or a minimal attention 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-treatment and MA conditions. They include the Clinician Administered PTSD Scale (CAPS-criterion measure), PTSD Diagnostic Scale (PDS), and measures of depression, combat exposure, quality of life, guilt, and presence. Physiologic 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 measures and combat exposure showed no significant differences. 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.

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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 contributed 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 approach. Additional treatment sessions may be needed to achieve remission. Future research is needed to further refine 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. Washington (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 b Universidad de Valencia, Valencia, Spain c de Fisiopatología de la Obesidad y Nutrición (CIBEROBN)

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

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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) program 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 interacting 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 Interoceptive Exposure Traditional Condition (IET; N=15). Results obtained showed that both treatment conditions significantly reduced the main clinical variables at posttreatment and these results were maintained or even improved 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) programs 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 efficacy of the interoceptive exposure (IE) component (Ito et al., 2001). In traditional CBT programs the exposure component is applied in vivo and in a consultation room to expose the patient to agoraphobic situations. Exposure is induced by producing different bodily sensations, using different 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 developed by Botella et al. (2004) makes it possible to simultaneously 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 consultation 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 exposure 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.

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method Twenty-nine patients diagnosed with PDA (N=27) or Agoraphobia without Panic Disorder history (N=2) participated 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 treatment 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 maximum of eight sessions and applied in an individual format. Finally, participants were assessed again at post-treatment and at a three-month follow-up. results The results obtained showed that both treatment conditions significantly reduced all clinical variables at posttreatment. However, no significant differences were found between the two treatment conditions. Comparisons between post-treatment and a three-month follow-up revealed 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 emphasizes the utility of available new technologies to improve psychological treatments. references Barlow, D.H. & Craske., M.G. Mastery of your anxiety and panic (MAPII). Albany, New York: Graywind Publications, 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. 301335). London: Oxford University Press, 2002. Botella, C., Villa, H., García-Palacios, A., Baños, R., Perpiñá, C., & Alcañiz. M. Clinically significant virtual environments 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 controlled 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 Psychiatry 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 School of Creative Technologies, University of Portsmouth, UK b School of Physical & Occupational Therapy, McGill University, Canada a

Corresponding author: 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 reaching tasks varies widely, but there has been little work exploring the effect of different characteristics of objects on target acquisition time. This study investigates how target acquisition times vary for virtual objects with different visual cues. Results suggest that the visual properties 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 standard sphere. Keywords: Virtual Reality, Virtual Rehabilitation, Visual Cues, Depth Perception

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Abstracts from CT15 introduction Virtual Reality (VR) is being used with increasing success for a wide variety of rehabilitation goals, facilitating increased 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 (Crosbie, Lennon, McNeill, & McDonough, 2006; Sveistrup et al., 2003.) The virtual objects used for these tasks vary from representations of real-world objects to abstract shapes, commonly spheres. However, there has been little work exploring the effect of these different visual object properties 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 stereoscopic 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 proximity (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 condition.

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 subjects, 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 considered when designing timed reaching tasks for rehabilitation 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 findings 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-intensive solution. The results also suggest that VR environments 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 Peripersonal Space, Annual Review of CyberTherapy and Telemedicine 4(2006) 183. Crosbie, J., Lennon, S., McNeill, M., McDonough, S., Virtual Reality Rehabilitation in Chronic Stroke: Two Case Studies. Annual Review of CyberTherapy and Telemedicine 4 (2006).

Descriptive statistics of mean time-to-target for each condition were calculated, and a two-way ANOVA was used to determine if there was a difference between target objects at an alpha level of p<0.05.

Frenz, H., Lappe, M., Kolesenik, M., Buhrmann, T., Estimation 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.

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

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), 119146.

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Sveistrup, H., et al, Experimental studies of Virtual Reality-Delivered Compared to Conventional Exercise Programs 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 Portsmouth, UK b School of Physical & Occupational Therapy, McGill University, Canada a

Corresponding author: 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 influence of audio cue tempo on treadmill walking with and without visual flow. The walking speeds of 11 individuals 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 influence step frequency and effort in exercise (Ahmaniemi, 2007), and there is some evidence that audio cues can be used to improve walk speed in patients with

Parkinson’s disease (Suteerawattananon, Morris, Etnyre, Jankovic, & Protas, 2004). However, to date there is little investigation into the effects of audio cues in Virtual Reality (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 treadmill walking in VE's. method Eleven healthy adults, four males and seven females, aged 23-54 years old, participated in the study. All participants were familiarized with the self-paced motorized treadmill placed in front of a large (5mx3m) display screen. A virtual walkway lined with pillars was backprojected 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 camera (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 cadence were recorded during treadmill walking. Participants 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 compared to matched audio cue tempo. There was no significant 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 difference between the other conditions. There was also no significant effect of visual flow on gait cadence.

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Abstracts from CT15 Table 1 The combination of audio cue rate and visual flow used in the experimental conditions audio Cue rate as % of none (basebaseline cadence line) Visual flow linked to treadmill motion

75%

100%

125%

absent (no VR)

Conclusion and discussion 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 visual flow the participants walked faster in the 125% condition 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 Rating of Music in Step Frequency of Running in 8th International 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 Interface for Virtual Reality vs Overground Walking: A comparison 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

none (baseline)

75%

100%

present (VR)

University Hospital, Rehabilitation Instytution, Cracow, Poland

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 software 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; Kitowski et al., 2009). In this paper we describe a multimedia rehabilitation method developed in our medical center, exercises implemented in the computer system (equipped with special devices) and their applications for stroke patients. 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 assessment phase (this phase uses specially developed multimedia 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

Jagiellonian University, Cracow, Poland Department of Computer Science, AGH University of Science and Technology, Cracow, Poland a

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a Division of Psychology Nanyang Technological University

166 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 motivation behind microblogging. We conducted two studies to investigate 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 microblog. Our studies are the first empirical ones that employed 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 communication 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 understand 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 hypothesize 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 microblogging. 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 corresponding 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 envelopes 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 regular tweets (such as “helping my friend with her work” “feeling 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 microblogging. We hypothesize that existential anxiety will lead to a higher tendency to microblog. Existential anxiety was manipulated by making mortality salient (Schmeichel, Gailliot, 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 exclusion 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 phenomenon that has affected millions of people. While studies have been conducted to understand why and how people participate in microblogging, they mostly rely on interviews, surveys, or the analysis of the microblogging content. Our studies are the first empirical ones that employed a betweensubjects 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 Auxologico Italiano, Milan, Italy b Department of Human Sciences, University of Bergamo, 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 Professions, Ono Academic College, Kiryat Ono, Israel f Department of Neurology and Laboratory of Neuroscience, “Dino Ferrari” Center, University of Milan, IRCCS Istituto Auxologico Italiano, Milan, Italy

167 of the Multiple Errands Test (MET) (Shallice & Burgess, 1991; Fortin et al., 2003). The MET is an assessment of executive 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 information 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 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 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 according 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).

Corresponding author: Simona Raspelli Applied Technology for Neuropsychology Laboratory Istituto Auxologico Italiano Milano, Italy E-mail: s.raspelli@gmail.com

According to the Mann-Whitney Test, the mean rank for control 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 completion” (Asym. Sig. = 0.08; M = 9.43 vs. 8.33; SD = 1.34 vs. 1.03).

abstract Our goal was to develop a tool for the assessment of executive functions by customizing a virtual reality (VR) version

With regard to patients, correlations between neuropsychological tests and the variables of the virtual test (Table 1) in part support the content validity of the adopted procedure as

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

errors p

searched item in the correct area

TMT (BA)

.96**

.00

Corsi’s mem.span Street Compl.Test SemanticFluencies

-.87*

.02

Tol

-.82*

.05

sustained attention

maintained sequence

no perseveration

. 84*

.04

. 84*

.04

. 84*

.04

- 86*

.03

- 86*

.03

- 86*

.03

Corsi’s supra-span StateAnxietyIndex

- 89*

.02

Instituto Salud Carlos III Neurology Service, Hospital Universitari La Fe, Valencia, España

the performances were correlated to the traditional tests aimed at assessing memory, attention and executive functions. 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 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 application following frontal lobe damage in man, Brain 114 (1991), 727-741. –––––––––––––––––––––––––––––––––––––––––––––– analysis of Visual perception aspects of the Virtual reality experience with Transcranial doppler monitoring Beatriz Reya,b,1, Mariano Alcañiza,b, Valery Naranjoa, Vera Parkhutikc and José Temblc Instituto en Bioingeniería y Tecnología Orientada al Ser Humano, Universidad Politécnica de Valencia, España b Ciber Fisiopatología Obesidad y Nutrición (CB06/03)

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 virtual 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 spectral 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 maximum 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-

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Abstracts from CT15 olution used to measure blood flow velocity (BFV) in cerebral arteries. In normal conditions, these BFV variations reflect 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 (Alcañiz, 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 inside the different experimental conditions were not analyzed. BFV percentage variations were positive in all the experimental conditions, and differences were found between conditions. 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 presence. Simpler experiments have to be proposed to analyze individual variables that contribute to the VR experience. Furthermore, the kind of analysis that is applied to the BFV signal should be improved to also study the temporal evolution of the signal. method In a recent study (Rey, Naranjo, Parkhutik, Tembl, & Alcañiz) we have focused on visual perception. Maximum BFV data in Posterior Cerebral Arteries (PCA) was monitored during 10 cycles of alternating darkness and illumination for 23 subjects. A spectral analysis of the BFV signal was performed separately for the repose and activation periods. A peak was located in the low-frequency band of the spectrum and the component of the maximum BFV signal at this frequency was estimated, as shown in Fig. 1. The percentage variation was calculated between the initial value of the low-frequency estimation signal and its peak. The response time was calculated as the elapsed time until the peak was achieved. results Percentage variations were positive in the periods corresponding to visual stimulation. A mean BFV percentage variation of 4.572% was observed in left PCA and 4.114% in right PCA. Negative percentage variations were observed in repose periods. Mean response times ranged between 8.544 s and 10.726 s. Conclusions The study has shown that in the presence of visual stimuli, BFV rises to a maximum that is achieved after a few seconds. This increment in BFV has its origin in the brain activity that appears in the occipital lobe regions in response to visual perception, as long as PCA are the vessels that supply this part of the brain.

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Figure 1. Representation of the BFV and low-frequency estimation during visual perception in a subject. references Alcañiz, M., Rey, B., Tembl, J., and Parkhutik, V. A Neuroscience Approach to Virtual Reality Experience Using Transcranial Doppler Monitoring. Presence: Teleoperators & Virtual Environments, 18 (2009), 97-111. Rey, B., Alcañiz, M., Tembl, J., Parkhutik, V. Brain Activity and Presence: a Preliminary Study in Different Immersive Conditions Using Transcranial Doppler Monitoring. Virtual Reality (in press). Rey, B., Naranjo, V, Parkhutik, V., Tembl, J., Alcañiz. M. A New Visually Evoked Cerebral Blood Flow Response Analysis Using a Low-Frequency Estimation. Ultrasound in Medicine and Biology (in press). –––––––––––––––––––––––––––––––––––––––––––––– The use of advanced Technologies in the Treatment of Psychological Stress Giuseppe Rivaa,b,1, Davide Algeria, Federica Pallavicinia,c, Claudia Repettoa,b, Alessandra Gorinia,d, and Andrea Gaggiolia,b Applied Technology for Neuro-Psychology Lab., Istituto Auxologico Italiano, Italy b ICE-NET Lab., Università Cattolica del Sacro Cuore, Italy c Centre for Studies in Communication Sciences, University of Milan-Bicocca, Italy d Research Institute Brain and Behaviour, Maastricht University, The Netherlands a

Corresponding author:

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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 Database of Systematic Reviews, the best validated approach covering both stress management and stress treatment is the Cognitive Behavioral Therapy (CBT) approach. We aim to design, 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 scenario is also presented and discussed with the participant Rosa, a 55 year old nurse, with a mother affected by progressive senile 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) approach. Here we aim to design, develop and test an advanced ICT-based solution for the assessment and treatment of psychological 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).

–––––––––––––––––––––––––––––––––––––––––––––– using Virtual humans to alleviate social anxiety: preliminary report from a Comparative outcome study

The interreality approach To reach this goal the project will use the “Interreality” paradigm that integrates assessment and treatment within a hybrid 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.

Geneviève Robillarda,1, Stéphane Boucharda, Stéphanie Dumoulinaa, Tanya Guitarda, and Évelyne Klingerb

By creating a bridge between virtual and real worlds, Interreality allows a full-time closed-loop approach actually missing in current approaches towards the assessment and treatment of psychological stress – the assessment is conducted continuously throughout the virtual and real experiences. It enables tracking of the individual’s psychophysiological 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 creates a conditioned association between effective performance state and task execution behaviors. To illustrate the proposed concept, a clinical scenario is also presented 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-traumatic stress disorder (PTSD). (2007) Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD003388. DOI: Cohen, S., Janicki-Deverts, D., Miller, G.E. (2007) Psychological 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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a Université du Québec en Outaouais Arts et Métiers ParisTech-LAMPA Angers-Laval

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 traditional CBT treatment (with in vivo exposure), CBT-VR combined treatment, or a waiting list. Results show significant reduction of anxiety on all questionnaires as well as statistically 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). According 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 quality 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-behavior intervention in the treatment of SAD (Barlow, 2002; Stein, 2006; Stangier, Heidenreich, Peitz, Lauterbach, & Clark, 2006; Clark et al., 2006; Hofmann, 2005; Wilson &

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Rapee, 2005.) CBT treatment packages typically include exposure to the feared situation(s), social skills training and cognitive-restructuring. One significant limitation of the traditional in vivo exposure is the difficulty for the therapist to provide adequate and controlled social interactions (e.g., audience to conduct the exposure, 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 significant 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) receiving a DSM-IV-TR diagnosis of social anxiety have completed 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 sessions 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 traditional CBT with in vivo exposure, CBT with in virtuo exposure and a waiting list control condition. Results on anxiety rated scales and self-report questionnaires showed a significant improvement in both treatment conditions comparing the waiting-list (see Table 1). The ANOVAs revealed significant 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 treatments 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 contrasts 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 CBTVR 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 hypothesis that both treatment conditions were superior to the waiting 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 combined 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 similar to be considered equivalent and exploratory analyses will

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Abstracts from CT15 Table 1 Descriptive results and repeated measures ANOVA for pre post data. N = 45 CbT

CbT-Vr

mean (sd) – pre/post

interaction f

LSAS

72.44 (23.91) 50.38 (23.87)

82.93 (32.23) 47.50 (17.83)

79.60 (25.90) 77.93 (22.23)

8.40***

SPS

30.25 (14.84) 20.19 (10.51)

38.29 (16.65) 18.07 (10.87)

33.53 (13.40) 37.47 (15.28)

13.31***

ASC-P

46.22 (24.49) 26.88 (20.24)

53.39 (16.99) 23.84 (17.08)

49.25 (12.89) 50.24 (14.60)

7.06**

ASC-C

62.40 (22.42) 34.92 (24.43)

70.32 (18.58) 33.70 (23.63)

55.15 (18.07) 53.57 (15.71)

6.06**

FNE

23.69 (6.23) 18.50 (7.66)

25.64 (6.13) 18.00 (8.21)

24.27 (4.51) 24.73 (4.51)

6.02**

SESM

50.31 (20.61) 70.63 (14.59)

46.79 (19.48) 69.57 (13.25)

42.83 (17.24) 46.00 (19.48)

4.08*

BDI-II

14.19 (12.88) 7.75 (9.16)

11.57 (7.35) 4.07 (4.32)

12.40 (7.48) 16.13 (13.33)

6.30**

STAI-Y2

49.40 (10.78) 43.33 (10.71)

53.71 (9.55) 42.43 (11.22)

49.33 (9.19) 50.07 (9.96)

9.94***

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= Selfefficacy 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, immersive tendency and cognitive variables. references American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision. Washington, DC: American Psychiatric Association, 2000. Barlow, D.H. Anxiety and its disorders: the nature and treatment of anxiety and panic 2nd edition. New York: Guilford Press, 2002. Clark, D.M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., et al. Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology 74 (2006), 568-578. Garcia-Palacio, A., Hoffman, H., See, S., Tsai, A., Botella, C. Redefining therapeutic success with virtual reality exposure therapy. CyberPsychology and Behavior 4 (2001), 341-348.

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Garcia-Palacios, A., Botella, C., Hoffman, H.G., Villa, H., & Fabregat, S. Comparing the acceptance of VR exposure vs. in vivo exposure in a clinical sample. Presented at CyberTherapy Conference 2004, January 10 – 12, San Diego, CA. Hofmann, S.G.. Perception of control over anxiety mediates the relation between catastrophic thinking and social anxiety in social phobia. Behaviour Research and Therapy, 2005, 885-895. Kessler, R.C., McGonagle, K.A., Zhao, S., Nelson, C.B., Hughes, M., Eshelman, S., et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Archives of General Psychiatry 51 (1994), 8-19. Klinger, E., Bouchard, S., Légeron, P., Roy, S., Lauer, F., Chemin, I., Nugues, P. Virtual reality therapy for social phobia: A preliminary controlled study. Cyberpsychology and Behavior 8 (2005), 76-88. North, M., North, S., Coble, J.R. Virtual reality therapy: An effective treatment for the fear of public speaking. International Journal of Virtual Reality 3 (1998), 2-6.

174 Statistics Canada, Enquête sur la santé dans les collectivités canadiennes. Santé mentale et bien-être. 82-617-XIF Retrieved August 25, 2004, from Statistics Canada Website: http://www.statcan.ca/daily/francais/030903/q030903a.htm, 2003 (September). Stangier, U., Heidenreich, T., Peitz, M.,Lauterbach, W., Clark, D.M. Cognitive therapy for social phobia: individual versus group treatment. Behaviour Research and Therapy 41 (2003), 991–1007. Stein, M. Evidence-based treatment of anxiety disorders. International Journal of Psychiatry in Clinical Practice 10 (2006), 16-21. Wiederhold, B.W., Wiederhold., M.D. Virtual-reality therapy for anxiety disorders: Advances in evaluation and treatment. New York: American Psychological Association Press, 2004. Wilson, J.K., Rapee, R.M. The interpretation of negative social events in social phobia: changes during treatment and relationship to outcome. Behaviour Research and Therapy 43 (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 Science in Medicine, Yonsei University College of Medicine, Seoul b Department of Biomedical Engineering, Hanyang University, Seoul, Korea

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 compulsive ordering and arranging, and a preoccupation with symmetry 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 conditions, with or without target and distraction. Primary dependent 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, Ordering 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 ordering 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 psychiatric 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 settings, 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 measures for OCD that extend beyond self-report inventories and clinical interviews, Kim et al. (2008) developed a computer-based behavioral assessment of checking be-

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Abstracts from CT15

havior in OCD and examine the validity of a novel behavioral assessment.

175 Table 1 Correlations between behavioral parameters and other variables in normal subjects

Given the results of epidemiological data indicating that ordering and arranging is one of the more common presentations of OCD, in adults, and in children, the neglect is surprising. The purpose of the present study was to develop and obtain preliminary psychometric data for a computerbased behavioral measure of symmetry and arrangement symptoms. methods 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 environments and objects were constructed using 3D–MAX (Discreet, USA), and were converted for rendering in the A6 GameStudio Engine (Conitec, Germany). Twenty-eight normal volunteers were enrolled with four different conditions, with or without target and distraction. Primary dependent variables included several indices of time and number of clicks relating to arranging behaviors. Construct validity for the task was examined by comparing the novel behavioral measures with standardized measures such as SOAQ, Obsessive OCI-R, BDI, BAI and QOL. results There was 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 ordering and arranging (see Table 1). There was significant main effect of target only on total time (F=22.00, p<0.001) and number of clicks (F=4.66, p<0.05). discussion To our knowledge, this is the first study to utilize VR technology in a behavioral measure of symmetry and arrangement symptoms in OCD. Construct validity was demonstrated by the significant positive correlations between task performance and both self-reported measures. Our findings indicate that the behavioral task is capable of measuring a range of parameters associated with symmetry and arrangement symptoms in OCD. references Kim, K., Kim, S.I., Cha, K.R., Park, J., Rosenthal, M.Z., Kim,

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Variable

Total time

Total number of clicks

SOAQ

0.623†

0.536†

OCI-R(ordering subscore)

0.495*

0.541†

OCI-R(total score)

0.401

0.541†

BDI

0.145

0.157

BAI

0.095

0.020

QOL

-0.247

-0.347

*:p<0.05, †:p<0.01

J.J., Han, K., Kim, I.Y., Kim, C.H. Development of a computer-based behavioral assessment of checking behavior in obsessive-compulsive disorder. Compr Psychiatry 2009; doi:10.1016/j.comppsych.2008.12.001. –––––––––––––––––––––––––––––––––––––––––––––– indoor orientation and mobility for learners Who are blind Mauricio Sáenza,1 and Jaime Sáncheza Department of Computer Science, University of Chile

Corresponding author: Mauricio Sáenz Department of Computer Science University of Chile Blanco Encalada 2120 Santiago de Chile E-mail: msaenz@dcc.uchile.cl

abstract This study consisted of designing a mobile technology to identify the position and orientation of people who are blind in closed environments such as a school, building or home, and identifying the necessary infrastructure based on criteria of usability, reliability and accessibility, in order for PocketPC device interface developers to be able to define the technol-

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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 evaluations 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 position 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 applications – 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 application 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 software, it was essential to learn end users’ opinions and their apprehensions when navigating through unfamiliar environments. 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 disorders. The data and information obtained was used to redesign 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 vision, 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 evaluations. We used three instruments – a PYOM Evaluation Questionnaire specially designed for this software which consists of three open questions focusing on the problems directly related to the use of the software, another evaluation questionnaire with open questions was also used, which contains 10 questions regarding the use of the software and its applicability, 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 orienting themselves, by means of key places or the clock technique that they already knew through the use of the aGPS software. In the first usability test the results were low compared to expected 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 differences. 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 results in the end-user evaluation guideline and the open questions 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

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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 manipulation 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 Department of Psychology, Peking University

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 “Facebook,” 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 techniques, 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 Acceptance 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

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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 acceptance 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 methodological complications as multiple regression has been the key tool in testing the relationship among variables, where statistical 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 determine Chinese Internet users’ SNSs use intensity based on TAM and using structural equation modeling instead of multiple 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 equation modeling was used to test the pathway relationship between the variables in our proposed model. results In short, our results are depicted in Figure 1. All the relationships directly and indirectly are significant (dotted lines indicate indirect effects), indicating our proposed model is well-tested. Conclusion As described above, perceived ease of use might determine

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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 & Behavior 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 Command Simulation and Training Technology Center, Orlando, Florida, U.S.A. a

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 debated over the past several decades. This is due to the lack of empirical data to support such claims. The U.S. Army developed a game-based simulation to support Tactical Combat Casualty Care (TCCC) Training. The TC3 game-based simulation 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 Department of Combat Medic Training (Ft. Sam Houston) in an effort to explore the capability of the game-based simulation as a potential tool to support the TCCC program of instruction. Reaction to training, as well as acquisition of knowledge and transfer of skills, was explored using Kirkpatrick’s Model

of Training Effectiveness Evaluation. Results from the evaluation 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 battlefield (Center for Army Lessons Learned, 2006). TCCC principles have proven highly effective and are a major reason why combat deaths in Operation Iraqi Freedom and Operation 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 environment. 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 Casualty Care Simulation (TC3 Sim) for the U.S. Army Medical Department (AMEDD) Center & School at Fort Sam Houston. 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 benefits of games have been debated (Clark, 1983; Kozma, 1994). Claims that games can increase the motivation and interest of trainees, and improvement of learning and improvement 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 effectiveness of the TC3 Sim as an instructional game developed

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Abstracts from CT15 to teach the concepts of tactical combat casualty care. Experiments were conducted to evaluate the training effectiveness 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 casualty 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 conducted at AMEDD, Fort Sam Houston, Texas. The experimental group consisted of 180 Soldiers participating in the TCCC program of instruction at the U.S. Army Medical Department Center and School, Department of Combat Medic Training. Three defined media sets were available for instruction of TCCC principles – Multimedia, Interactive and Experiential. The multimedia consisted of PowerPoint-based training on three areas of TCCC – Hemorrhage Control, Airway Management, and Breathing. The interactive set consisted 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 Combat 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 conditions – TCCC PowerPoint Training, TCCC Interactive Courseware, and TCCC Interactive Courseware and TC3Sim game-based simulation. Reaction data was obtained via questionnaires, knowledge acquisition was measured using prepost 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 traditional content training. An experiment was designed that enabled to discern statistical differences in effectiveness between treatments at α = 0.05 and β = 0.20. Statistically significant findings were the following:

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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 technology should be incorporated into the program of instruction. 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 experimental 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 training and TC3 Sim game-based simulation scored higher in the transfer task (paper and pencil scenario exercise) than participants in the TCCC PowerPoint group. discussion and Conclusions There has been an increasing trend advocating gaming technologies to support training in recent years. This research focused on a particular instructional game developed 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 developed to support specific learning objectives could augment current content training delivery mechanisms. Games appeal 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 explore whether or not trainees would use the game as a tool to improve critical thinking skills after training hours during 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 objectives and skills. references Bredemeier, M.E. & Greenblat, C.S. (1981). The educational effectiveness of simulation games. Simulation & Games, 12(3)(1981), 307-332.

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Center for Army Lessons Learned (CALL). Handbook 0618 tactical combat casualty care handbook. (2006) Retrieved May 30, 2006, from https://call2.army.mil/products/handbooks/asp/06-18/fwd.asp. Clark, R.E., Reconsidering research on learning from media. Review of Educational Research, 53(4) (1983), 445-459.

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Wiebenga, S.R., Guidelines for selecting, using, and evaluating 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

Dorn, D.S., Simulation games: One more tool on the pedagogical shelf. Teaching Sociology, 17(1989), 1-18.

Department of Psychology, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.

Fowler, S., Smith, B., & Litteral, D.J., A TC3 game-based simulation for combat medic training. Proceedings of the Interservice/Industry Training, Simulation and Education Conference (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 literature review and discussion (Tech. Rep. No. 2005-004) (2005) Orlando, FL: Naval Air Warfare Center Training Systems 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 debate. 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 recent research. Simulation & Gaming, 23(3) (1992), 261-276. Whitley, T.R. & Faria, A. J., A study of the relationship between student final exam performance and simulation game participation. Simulation & Games, 20(1) (1989), 44-64.

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 technology. The purpose of this symposium is to share some of the experiences encountered in studying warfighters with virtual 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 technology in sessions with warfighters. non-technological studies One way to study military stress is by obtaining archival information. In a study on 5,671 records of warfighters that had been removed from the battle-zone, behavioral health problems accounted for about 7% of all cases (Stetz, McDonald, Lukey, Gifford, 2005). In another study Stetz (author) administered surveys to aviators (n = 283) in order to learn about their main stressors and coping strategies (Stetz et al., 2009).

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Abstracts from CT15 Main stressors ranged from difficulty sleeping (21%) to anhedonia (12%). Some of their coping strategies were going to the gym (66%), watching movies (62%), and playing computer 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 typically involves a game pad and a computer screen. A benefit of VR is that stressors can be systematically added and monitored to virtual environments in sessions. Additionally, this approach can easily be complemented by paper-andpencil/computerized surveys and physiological measurement equipment (e.g., biofeedback).

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 Conference, Lago Maggiore, Verbania-Intra, Italy, June 2009.

Tools and results Wiederhold and others have reported success when applying VR to mitigate the negative effects of combat stress (Wiederhold, Bullinger, & Wiederhold, 2006). Similarly, Stetz, Long, Wiederhold, and Turner (2008) examined the usefulness 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 rigorous and data collection had to take place during limited work-free time.

Headquarters Department of the Army. Field Manual 7.0 “Training for Full Spectrum operations” (2009).49.

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 during 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.

Stetz M.C., Bouchard, S., Wiederhold, B.K., & Folen, R.A. The Receptiveness of Stress Management Techniques by Military Personnel. 14th Annual CyberTherapy and CyberPsychology Conference, Lago Maggiore, Verbania-Intra, Italy, June 2009.

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

Wiederhold, B.K., Bullinger, A.H., Wiederhold, M.D., (2006) Advanced technologies in military medicine. Novel approaches to the diagnosis and treatment of posttraumatic stress disorder. Amsterdam: IOS Press, pp. 148–60.

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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 Evacuation. 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 & Rehabilitation, 239-246.

Stetz, M.C., Ganz, M., Jenkins, C.M., et al. Stressors and coping choices while in Operation Iraqi Freedom. Hawaii Psychological Association (HPA), Honolulu, Hawaii., Nov. 9–10, 2009.

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–––––––––––––––––––––––––––––––––––––––––––––– 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 Laboratoire Cognition et Facteurs humains, Université Victor Segalen Bordeaux II

novelty/discussion The study of virtual/real transfer allows to determine optimisation situations for spatial learning and to propose recommendations for constructing cognitive rehabilitation programmes. Several factors can have an influence on the transfer of knowledge. In this experiment, we tested the influence of retention delay and mode of navigation.

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 beforehand 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 maintained 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 virtual-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 virtualreal transfer was as efficient 48 hours later as it was in immediate recall. For the "sketch" task, the use of spatial knowledge was even better when delayed by 48 hours. Finally, for the "classification" task, the performances were similar 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

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 configurational 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 efficient 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 rehabilitation 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-dimensional 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. Presence: 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

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Abstracts from CT15 Virtual Reality Medical Center, San Diego, CA Naval Center for Combat and Operational Stress Control, 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 a

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 increasing 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 outpatient 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 reported as being effective with 37-54% of those treated. Virtual 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 treatment 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 Disorder (PTSD), Naval Medical Center San Diego (NMCSD), Naval Hospital Camp Pendleton (NHCP) introduction A Department of Defense (DOD) Task Force report concluded that 11-25% of Operation Iraqi Freedom (OIF) and/or Operation Enduring Freedom (OEF) veterans have been diagnosed 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

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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 adequate care (Tanielian & Jaycox, 2008). Further, improving access to high-quality care has been identified as cost-effective 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 reductions 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 presentation will describe the estimated cost benefits of traditional 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 significant reduction in their PTSD symptoms. The training costsavings 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 diagnosed 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 multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry 2005; 162: 214 â&#x20AC;&#x201C; 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

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traumatic stress disorder in active duty service members with combat-related PTSD. Journal of the American Medical Association, 2009 (submitted for consideration for publication). Milliken, C.S., Auchterlonie, J.L., Hoge, C.W. Longitudinal assessment of mental health problems among active and reserve component soldiers return from the Iraq war. The Journal 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 consequences, 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. Effectiveness of virtual reality graded exposure therapy with physiological monitoring for combat related post traumatic stress disorder. Presented during Medicine Meets virtual Reality 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 Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universidad Politécnica de Valencia, Valencia, España b Paris Descartes University, Laboratoire Adaptation Travail Individu, Paris, France c Departamento de Psicologia Basica y Psicobiologia (UJI) d CIBER Fisiopatología Obesidad y Nutrición (CB06/03) Instituto Carlos III a

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 Recent research presents Augmented Reality Exposure Therapy (ARET) for treatment of phobia of cockroaches as a potentially 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 distributed between individuals, consisting of the patient and therapist, and artifacts, for example the AR cockroaches, a computer screen, a Head Mounted Display (HMD), a keyboard, 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 effective therapies such as Augmented Reality Exposure Therapy (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 published. 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 collaboration 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 performed 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

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Abstracts from CT15

185 tidisciplinary perspective. The analysis allowed us to propose the following improvements – a more structured and conceptually easy to remember set-up of the functions on the keyboard and improved spacial set-up of the individuals and the artifacts in order to diminish the therapists’ discomfort. Finally, 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 approach, which does not give preferential treatment to any of the actors or artifacts, can offer a great contribution to the improvement of ARET activity.

Figure 1. The distributed therapeutic process. between individuals and artifacts (Figure 1). The results also show an existence of a consistent therapeutic pattern that corresponds to the therapeutic treatment protocol, and a frequent presence of a patients’ instantaneous fear. The researchers observed as well that the therapists often hesitated before choosing a function to apply on the keyboard. discussion and conclusions The DCog allows ARET activity to be presented from a mul-

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references Botella, C., Juan, C., Baños, R.M., Alcañiz, M., et al., Mixing Realities? An application of Augmented Reality for the treatment 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 experience in psychiatry7 (2004), 220-223. Hutchins, E., Cognition in the wild, MIT Press, Cambridge Massachusetts, 1995.

Volume 13, Number 1

Februar y 2010

1SSN: 2152-2715

ǇďĞƌƉƐǇĐŚŽůŽŐǇ͕ ĞŚĂǀŝŽƌ͕ ĂŶĚ ^ŽĐŝĂů EĞƚǁŽƌŬŝŶŐ Special Issue on Posttraumatic Stress Disorder

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Lessons Learned from VR Sessions with Warriors with Combat-Related PTSD Behavioral Treatment of Earthquake Survivors PTSD Due to Motor Vehicle Accident Therapeutic Alliance in Telepsychotherapy Virtual Reality in Iraq And More...

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–––––––––––––––––––––––––––––––––––––––––––––– Virtual reality environments to Treat pTsd for Criminal Violence Victims Georgina Cárdenas-Lópeza,1 and Anabel De La Rosaa National Autonomous University of Mexico, Ciudad de México, Mexico

of danger and vulnerability. According to the World Health Organization (WHO) (2002), violence has important implications – both psychologically and physically, such as depression, alcohol use and substance abuse. The most important psychological difficulties experienced by victims, are related to posttraumatic stress disorder (PTSD).

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 problems such as depression and substance use and abuse. However, one of most important psychological problems linked with victims of violence is posttraumatic stress disorder (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 symptoms. Due to this socially relevant problem and based on efficacy treatments, it is important to design treatments involving the use of Virtual Reality (VR), because it can help overcome some of the limitations of traditional therapy using exposure. The present paper expounds on the framework and preliminary description of four virtual environments 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 implications. Assaults in the public streets create an atmosphere

In Mexico, according to data reported by the National Survey 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 management, 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 environments 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 validity of VR exposure treatment for victims of criminal violence suffering from PTSD.

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–––––––––––––––––––––––––––––––––––––––––––––– online psychotherapy: from Training to dissemination Georgina Cárdenas-Lópeza,1 and Lorena Flores-Platab Laboratory of Virtual Education and Cyberpsychology Faculty of Psychology National Autonomous University of Mexico (UNAM)

a,b

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 virtual environments for the treatment of PTSD. The environments, created in Studio Max, are dynamic, 3-D and highly acoustical and tactile, modeled through a computeroriented 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 environments are designed considering the social and cultural context appropriate for the target users of the system. The VR models contain exteroceptive variables such as number of people, physical characteristics of virtual characters (type of clothing, gestures), environmental sounds (sound of beating or shooting a firearm, activation of car alarms, etc.), and interoceptive variables such as environmental sounds. Internal physiological functions (palpitations, 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.

abstract The current work describes the development, implementation and evaluation of the project Online Psychotherapy that aims at three objectives – providing a practical training scenario for the clinical formation of students from the last semesters of Psychology at UNAM, developing a platform for offering services and creating an electronic patient’s profile, and providing cognitive-behavioral treatments via the Internet to patients suffering from anxiety, depression and adaptive disorders. In this study, 17 students were trained and 50 patients were assisted. Results obtained from pre and post evaluations and follow-ups show positive changes in five students and 28 patients. In addition, patients and therapists reported satisfaction using the available resources and instruments. 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 Technologies (ICT) and its application to health and education services generated the need to create research spaces in the behavioral field and specifically, offered the opportunity to develop and implement new therapeutic alternatives. The evolution of ICT and particularly the growth of the Internet have changed the way in which we communicate and relate to each other.

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Some of the original motivations for offering services through technologies such as the Internet were a difficulty in accessing psychological services (bodily problems, 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 depression and anxiety (Marks, Cavanagh, & Lina, 2007), addictions (Finfgeld-Connett, 2006) and eating disorders, mainly, under Cognitive Behavioral Treatment (CBT) (Barak, Hen, Boniel-Nissim & Shapira, 2008). method The program was executed in three phases. First, 17 students were trained in the acquisition of therapeutic skills (theory and practice) under a competence model, measuring their performance through pre, post and follow-up evaluations. Second, a CBT-based therapeutic service platform was developed. Finally, the third phase consisted 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 concluded, 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 depression measurements decreased with respect to those obtained 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 follow-ups, an average of 4 persisted. Figure 1. Screenshot of Psychological services platform.

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Both students and patients reported high satisfaction in using the

technology as a therapeutic means and taking into account 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 Interventions, Journal of Technology in Human Services 26 (2008), 109-160. Finfgeld-Connett, D., Web-Based Treatment for Problem 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 Faculty of Psychology, National Autonomous University of Mexico (UNAM)

abstract Obsessive Compulsive Disorder (OCD) constitutes a chronic anxiety disorder that is characterized by the emergence 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 affects the quality of life of people who suffer from it. Cognitive-Behavioral Treatment (CBT) for this disorder has had such an impact on efficiency, which is currently considered 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

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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 2535% of patients stop treatment because of anxiety they experience 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-compulsive patients. The virtual scenarios show the trigger stimulus 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 persistent 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 psychological intervention refuse treatment or drop out prematurely (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-

Figure 1. Dirty toilet for cleaning obsessions.

nology, it has the advantage that the clinician can modify different variables in everyday life situations which would be difficult to manage and control, besides being less aversive environments for patients than in vivo exposure therapy.

The complete treatment protocol include sessions of psychoeducation, 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 contextualized to their culture, so the therapist can expose patients 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., Rheingold, 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 Science Education, National Taiwan Normal University, Taiwan, ROC b Department of Earth Sciences, National Taiwan Normal University, Taiwan, ROC a

Corresponding author: Chun-Yen Chang

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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) system 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 toward science (AAAS, 1993; Chang, C. Y., 2004; NRC, 1995; Smith D.G.W. & Abley M.W., 1996). Some researchers 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 preparatory work for students to familiarize themselves with actual field sites. Keywords: 3-D Virtual Reality, Field Trip introduction We built the 3-D Compound Virtual Field Trip (3DCVFT) system by combining the technology of Graphicbased 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 various 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 instructional 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 Wiimote in the proper direction will allow the user to pick up a rock on the ground and activate the testing mechanism. 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

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Figure 1. Screenshots of Hsiaoyukeng

Figure 2. Inspecting the site

Figure 4. Swinging the Figure 3. Picking up Wiimote the stone 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 controller 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 always feasible. The 3-D Compound Virtual Field Trip (3DCVFT) 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 information about a post-volcanic activity area using a 3-DCVFT 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 physically visit Hsiaoyukeng to expose themselves to the sulfurous 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.

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references Kent, M., Gilbertson, D. D., Hunt, C. O., Fieldwork in geography 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 Science Education, National Taiwan Normal University, Taiwan, ROC b Department of Earth Sciences, National Taiwan Normal University, Taiwan, ROC a

Corresponding author: Chun-Yen Chang No. 88, Sec. 4, Ting-Chou Rd. Wunshan District, Taipei Taiwan 11677 E-mail: changcy@ntnu.edu.tw

Figure 1. Using The 3-D Virtual Field Trip System. Figure 2 (right) Tools.

named 3-D Virtual Hsiaoyukeng Field Trip System was recently developed as an undergraduate earth science field trip (module to the Hsiaoyukeng area in northern Taiwan). A pilot test study was conducted to investigate students’ perceptions and experience in field trip learning through this 3-D system. The data collected from this study could provide information useful for better integration of multimedia 3-D modules into earth science teaching and learning.

abstract This pilot study explores students’ perceptions and experience in a 3D field trip curriculum module. It is our intention to understand how the system can facilitate field trip learning 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 towards 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 alternative 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

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 technologies require users to wear stereoscopes so that the users’ right and left eyes receive separate images from different 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 technologies in meeting their individual learning needs at their own paces. In addition, nearly 80% of the participants also expressed positive feedbacks on using this 3D system as a helpful tool in “motivating their learning” and “enhancing understanding” in the earth science learning of this study. 3-D Virtual Reality as Field Trip Facilitation—Seeing the 3-D virtual field trip system as an effective tool in enhancing 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

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Abstracts from CT15 it was employed after an actual field trip (for learning review/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 reflections 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 student 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 dizziness when they were working on this 3-D VR system while wearing the stereoscopes – two out of the 18 students reported 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 3D VR system helped enhance their field trip learning effectively. 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 dizziness and focus difficulty were observed when using the 3D 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 geography teaching: A critical review of the literature and approaches, Journal of Geography in Higher Education, 21(1997), 313-332. Smith, D.G.W. and Abley, M. Multi-media computer- assisted instruction in mineralogy. Journal of Geoscience Education 44 (1996), 189-196. Tuthill, G. and Klemm, E. B., Virtual field trips: Alternatives to actual field trip, International Journal of Instructional 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 Science Education Center and Graduate Institute of

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Science Education, National Taiwan Normal University, Taiwan, ROC b Department of Earth Sciences, National Taiwan Normal University, Taiwan, ROC 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 compares 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 developed not only functioning as a multimedia Virtual Reality (VR) software which supplies close-to-real-field trip experiences (Lin & Chang, 2007, 2008) but also trying to tailor the 3D-CVFT to diverse students’ learning needs by leveraging on auto grading and feedback interfaces in the system. method The online 3-D Compound Virtual Field Trip (3DCVFT) system is built by integrating the 3D-CVFT System with a streaming video server, an instant message server, an auto-grading server and a feedback system as shown in Fig.1.

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results We compare the actual field trip with the online 3DCVFT System as shown below in terms of their major functions before, during, and after the geological field trip.

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–––––––––––––––––––––––––––––––––––––––––––––– 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 Education Center and Graduate Institute of Science Eduation, National Taiwan Normal University, Taiwan b

Corresponding author: 1 Chun-Yen Chang No. 88, Sec. 4, Ting-Chou Rd. Wunshan District Taipei, Taiwan 11677 E-mail: changcy@ntnu.edu.tw

Conclusion Several pilot studies have been conducted using the 3D-CVFT System, either as a teaching material to supplement 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 responded 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 characteristics of Hsiaoyukeng into the streaming video server. We will also examine how the online 3D-CVFT System can function most effectively in facilitating students’ learning. references Lin, M.C. and Chang, C.Y. (2007): The Pilot Study on the Impacts of 3D Virtual Reality Field Trip toward Students’ Academic Achievements. Paper presented at the 11th Global Chinese Conference on Computers in Educaion (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 Asosciation of Research in Science Teaching (NARST) (Baltimore, Marriott, U.S.A.)

abstract In this study, we integrated interactive functions into animation (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 animationbased instruction. Keywords. Computer-assisted learning, multimedia, interactive animation introduction In recent years, within the framework of cognitive load theory (CLT), the instructional multimedia comparison between 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 empirical research, the transitory nature of animation imposes highly ECL on a learner, so that animation often overwhelms his/her WM (Höffler & Leutner, 2007; Mayer, Hegarty, Mayer, & Campbell, 2005). For comprehending

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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 objects; in addition, they must manipulate their mental representations of external objects as well as project their inferences onto the objects being represented. The traditional 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 manipulating mental representations may still be an impediment to learning. In this study, we integrated interactive functions 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 measurements: horizontal leveling and trigonometric leveling. Trigonometric leveling is more complex than horizontal leveling, because it is based on the triangulation. The instructional conditions included the following: (1) Static Figure 1. Screenshots of IAG.

Illustrations Group (SIG): Static graphics next to corresponding text; (2) Continuous Animation Group (CAG): Continuously dynamic demonstrations synchronized with explanations; (3) Interactive Animation Group (IAG): Interactive 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 illustrations 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 equivalent 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 estimate the mental efforts encountered in learning. The mental effort scale, originally developed by Paas (1993), was responded by circling 1 (very, very low) through 9 (extremely high). The user information, such as time-spans and frequencies 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

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learner temporarily holds previously presented information in their WM and later connect it with his/her inferences. IAG allows students to directly manipulate the representations externally rather than mentally, and serves to aid in the productive process of “representational holdings”. Hence, students no longer need to use the backward function of recalling previous mental image information repeatedly. 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’ learning outcomes. references Hasler, B.S., Kersten, B., & Sweller, J., Learner control, cognitive load and instructional animation, Applied Cognitive Psychology 21 (2007), 713-729. Höffler, T.N., & Leutner, D., Instructional animation versus static pictures: A meta-analysis, Learning and Instruction 17 (2007), 722-738. Mayer, R.E., & Chandler, P., When learning is just a click away: Does simple user interaction foster deeper understanding of multimedia messages? Journal of Educational 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 instruction, 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 mental-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 difficult to learn, Cognition and Instruction 12 (1994), 185233. Sweller, J., van Merriënboer, J. J. G., & Paas, F., Cognitive architecture and instructional design, Educational Psychology Review 10 (1998), 251-296.

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––––––––––––––––––––––––––––––––––––––––––––– pseudoneglect regulation using optokinetic stimulation in a Virtual environment Ara Choa,1 and Jang Han Leea Clinical Neuro-Psychology Lab, Department of Psychology, Chung-Ang University, Seoul, Republic of Korea

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. Optokinetic 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 orientation. Participants revealed corrections of their leftwardbias after receiving rightward-OKS. Keywords: Pseudoneglect, Hemispatial Neglect, Optokinetic Stimulation (OKS) introduction Hemispatial neglect is the difficulty in detecting or reacting to sensory stimuli presented in the visual hemispace contralateral to the lesioned cerebral hemisphere (Kerkhoff, Keller, Ritter, & Marquardt, 2006). Healthy individuals also show a small leftward bias known as "pseudoneglect" (Bultitude & Aimola Davies, 2006). Although visual scanning training (VST) has been successful 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, & Marquardt, 2006). In this study, we applied OKS to a virtual environment which allows control of the participant’s visual 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

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Abstracts from CT15 uses a background of typical city streets, allowing participants 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, righthanded participants received a baseline assessment using a paper-based line-bisection task, followed by a computer-based line-bisection and erase task. Participants received 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 conducted a line-bisection test and an erase test. Treatment was conducted using the GDS Side View Neglect program, which we created for OKS treatment in a virtual environment, presented using a see-through head mounted display with a head motion-tracking device.

references Bultitude , J.H. & Aimola Davies, A.M., Putting attention on the line: Investigating the activation-orientation hypothesis of pseudoneglect, Neuropsych 44(2006), 1849-1858. Kerkhoff, G., Keller, I., Ritter, V., & Marquardt, C., Repetitive optokinetic stimulation induces lasting recovery from visual neglect, Restorative Neurology and Neuroscience 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, Christchurch, New Zealand b Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand a

Corresponding author: Andreas Duenser The HIT Lab NZ, University of Canterbury Private Bag 4800 8140 Christchurch, New Zealand E-mail: andreas.duenser@hitlabnz.org

Figure 1. Erase task in a virtual environment.

Figure 2. OKS in a virtual 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]. Completion 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 pseudoneglect in a virtual environment. We expect that these results will help provide a valuable treatment method for hemispatial neglect patients. Acknowledgements This work was supported by National Research Foundation of Korea Grant funded by the Korean Government(KRF-2006-332-H00021).

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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, training, education, immersive learning, virtual patient project aim The aim of the project is to create virtual clients that can

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be used in the training of students in the Master of Audiology program. The simulator will allow students to practice 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 accessible and easy-to-use as possible. The intended use-scenario is for students to utilize the application on a standard desktop computer.

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 desktop-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 disorders that are not very common. –Timesaving both during training and review of the students’ performance. –Self-assessment through formative and summative feedback, enabling students to reflect on learning progress during and after completion of the simulation –––––––––––––––––––––––––––––––––––––––––––––– mindfulness influence on sense of presence in Virtual environment: an exploratory study

In coordinated meetings application designers, developers and domain experts in audiology and communication disorders worked on the requirement analysis and discussed what aspects the new learning platform should encompass. As a result, a prototype simulation aimed at audiology students was designed and implemented. We conducted an initial pilot study with students to gather feedback on the platform and to inform the design and implementation 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 alongside the application developers to design content and meaningful scenarios for the simulation. We also plan to gather more data for the application development through a study with communication disorders and audiology students. FiFigure 1. First prototype.

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 (CIBEROBN), Spain b Universidad Jaume I, Spain c Universidad de Valencia, Spain

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 mindfulness. Fifty participants completed a questionnaire that evaluates mindfulness (FFMQ), then walked through a virtual environment (VE) and completed two questionnaires 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

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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 presence in virtual environments (VE), it is necessary to consider not only the technological aspects involved, but psychological aspects such as consciousness, memory, attention, emotions or personality (Botella, Baños, & Alcañiz, 2003), as well. Specifically, several authors highlighted the role of consciousness and attention as fundamental 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 reflexive 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 maintenance of a nonjudgmental attitude toward current experience. Taking into account these aspects, it could be hypothesized that a relationship exists between mindfulness and presence and people with a high mindfulness disposition 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 presence. 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

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199 scores in depression (BDI score > 18) are excluded. Participants in this study take a walk through a VE that simulates 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 questionnaire consists of 39 items assessing five facets of mindfulness – observing, describing, acting with awareness, non-judging of inner experience, and non reactivity to inner experience. Items are rated on a Likert scale ranging 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 presence, 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 disagree 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

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presence of clinical symptoms in depression have been discarded, the FFMQ questionnaire is administered. Afterward, all participants do a walk through a VE (represented by a "Sad Park" or "Happy Park"), which last approximately 20 minutes. Finally, all participants complete the following ITC-SOPI and SUS Presence Questionnaires. 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 emotion induced (sadness or happiness). Also, it is expected to find a positive correlation between the non-judging factor of inner experience (FFMQ) and those factors related to the ecological validity of VE, captured in the questionnaires regarding presence. Conclusion The findings of the present study could have both theoretical 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 experiential profiles. The investigation on presence could benefit from an analysis of the concept of mindfulness. Furthermore, if results show that mindfulness and presence 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 (SEJ200614301/PSIC), “CIBER of Physiopathology of Obesity and Nutrition, an initiative of ISCIII and the Excellence Research 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 psychological approach to presence. Paper presentado en PRESENCE 2003, 6th Annual International Workshop on Presence. http://www.presence-reserach.org/paper.html.

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Damoiseaux, J.S., Rombouts S.A., et al., Consistent resting-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 neural 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 Environment, 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. 303318. Tanielian, T., L.H. Jaycox, L.H., editors, Invisible wounds of war: psychological and cognitive injuries, their consequences, and services to assist recovery. RAND Corporation, 2008. Slater, M., Usoh, M. and Steed, A. (1995). Taking steps: The influence of a walking metaphor on presence in nvirtual 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 training, 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: Hyperion.

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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 b Department of Psychology, Catholic University of Milan, Italy

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 imagery, or mental practice (MP) improves motor performance 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 training 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 improvement after training, but no significant differences were found between training conditions. However, analysis of results within each experimental condition showed training-specific effects on selected variables. MMP players improved both coordination and rhythm, while players assigned to MP improved coordination skills. These results 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).

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201 Mentally-simulated movements can include visual, auditory, tactile and kinesthetic components. There is compelling 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 (Karageorghis & Terry, 2001). However, no study so far has investigated 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 physical training alone (PT). The target motor task was the layup 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 selected because it is one of the most commonly used techniques in basketball. Players in the MP group received a mp3 file containing audio instructions that guided the participant in performing 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 independently 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 acquisition and performance of specific motor skills components.

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references Driskell, J.E., Copper, C., and Moran, A., Does Mental Practice Enhance Performance?, Journal of Applied Psychology 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, Istituto Auxologico Italiano, Milan, Italy

Corresponding author: 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 effectiveness 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 regulation 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 competences on physical and psychological reactions, the second phase is based on learning coping strategies, and the third phase progressively exposes the subject to stressful situations in a controlled setting, in order to practice the previously acquired relaxation techniques. With this background to support the present study, the authors defined a protocol based on Stress Inoculation Training to support teachers in managing work stress disease.

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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 relationships 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 stimulate 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 understand the sense of engagement in the video content proposed 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 mobile phone, DVD, mp3 player and audio CD. The protocol is made up of eight sessions and a mood induction is included 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-physiological reactions and on coping strategies, and the seventh and eighth sessions present the stressful situation (a classroom) 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

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Abstracts from CT15 player (M3) (Nonar), only audio content on an audio CD (CD), and the control group (Ctrl). The second independent variable refers to time as a unit of measure – pre and post-intervention. The two dependent variables are emotional 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 completed the following questionnaires before and after each virtual experience – State questionnaire, STAI (Spielberger, Gorush, & Lushene, 1970) (State Trait Anxiety Inventory, state version), and Vas (Gross & Levenson, 1995) (Visual Analogue Scale). and the Presence questionnaire: Itc-Sopi (Lessiter, Freeman, Keogh, & Davidoff, 2001).

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 Environments, 10, 282-298. Long, B.C. (1988), Stress management for school personnel: 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.

expected results At the moment the study is in progress. Results are expected on two subjects. First, authors aim to evaluate the effectiveness of the Stress Inoculation Training, implemented using new media, to enhance wellbeing, to promote 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 regulation and emotion induction process. Final results will be presented at the 2010 CyberTherapy Conference.

Salami, S.O., (2007), Management of Stress among Trainee-Teachers Through Cognitive Behavioral Therapy, Pakistan Journal of Social Science, I, 4 (2), 299-307.

references Cecil, M.A. & Forman, S. (1990), Effects of Stress Inoculation Training and Coworker Support Groups on Teacher’s Stress, Journal of School Psychology, 28, 105118.

–––––––––––––––––––––––––––––––––––––––––––––– feasibility of a new ambulatory rehabilitation system for acquired brain injury patients

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 Psychology, 20, 180-187. Gross, J.J., & Levenson, R.W. (1995). Emotion elicitation using films. Cognition and Emotion, 9, 87

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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: Consulting Psychologists Press.

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 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

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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 Acquired Cerebral Damage, in order to make global and continuous rehabilitation plausible. The first needed element is a new platform for ambulatory rehabilitation. This device makes use of inertial sensors for tracking patient motor exercises and a software platform for motivational reinforcement, an aspect as important as rehabilitation itself. A mobile platform and computer platform control and set reinforcement stimuli for the patient, adapting the messages for the rehabilitation process. A study has been designed with ten patients for testing the usability for patients with different degrees of cerebral damage to verify the functional validity of the tool and the possibility of autonomous use on the part of the patients. Keywords: Virtual Rehabilitation, Wireless Inertial Sensors, 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 happens 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 opportunity to complete exercises that foment rehabilitation. For that reason their rehabilitation should be global and continuous. [Alvaro Bilbao. Neuropsychologist] method The first element of a new platform for ambulatory rehabilitation 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 orientation of the sensors with a high degree of accuracy by

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fusing gyroscope, accelerometer, and magnetometer signals (Luinge, 2004; Roetenberg, 2005). –Two working modes (autonomous or distributed): In autonomous mode, all signals are gathered and processed internally, 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 autonomous 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 correctly. This will be validated in the case study. –Reinforcement and Motivation Platform: It has been designed two software applications for the user. The first one on a computer will let the patient see a“virtual therapist”, 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 performs 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 automatic messages relating to the rehabilitation and showing the results obtained. One of the main difficulties that physicians found when they implemented ambulatory exercises 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 reinforcement messages and stimulating the subject whenever an objective conduct is fulfilled. These systems allow the subject to always feel accompanied and completion 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).

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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?

Roetenberg, D., "Compensation of magnetic disturbances improves inertial and magnetic sensing of human body segment orientation", IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2005 vol. 13, no. 3, pp. 395-405. –––––––––––––––––––––––––––––––––––––––––––––– Variation of egocentric reference in neglect patients by head movement

2. Does the patient accomplish the exercises planned by therapist with this platform?

Kiwan Hana, Jeonghun Kua,1, Hyeongrae Leea, Jinsick Parka, Deog Young Kimb, In Young Kima, and Sun I. Kima

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 accomplishment based on usability and functional point of view for the experiment.

Department of Biomedical Engineering, Hanyang University, Seoul, Korea b Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea a

discussion Our first conclusions aim to answer:

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

–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 systems for ABI patients? –As important as motor rehabilitation is to help the patient to confront its situation and to reinforce its behavioral motivation. 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 exploratory 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 Movement 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". Accepted as poster to the Eight International Conference on Intelligent Virtual Agent, IVA 2008.

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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 conclusion, it is considered that egocentric reference would influence 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 following 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-

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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/restrained condition, different from real life. In this investigation 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 diagnosed with hemispatial neglect by conventional bedside tests and did not have any problem understanding the task and were able to control the experimental apparatus. Participanst 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 appeared 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 center of the screen. In each trial, when participants made a response after the ball was placed at an egocentric reference 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-

tion is deployed since the direction of gaze is generally considered to be tightly coupled with the orienting of attention (Hoffman & Subramaniam, 1995). Moreover, head movement also corresponds with eye movement (spatial attention) in searching with the head in an unrestrained 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. Egocentric 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 peripersonal and extrapersonal space, Neuropsychologia 47 (2009), 869-878. Hoffman J.E., and Subramaniam, B., The role of visual attention in saccadic eye movements, Perception & Psychophysics 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), 198206. Parton, A., Malhotra, P., Husain, M., Hemispatial neglect, Journal of Neurology, Neurosurgery and Psychiatry 75 (2004), 13-21.

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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 Pschology Chung-Ang University, Seoul, Republic of Korea

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 Behavioral Approach System (BAS) and the Behavioral Inhibition System (BIS) affect decision-making following different feedback types. In accordance with the joint subsystem 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 experimentally manipulated winning and losing experiences, 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.

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 between 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 conducted the modified GDT, a modified version of the original GDT (Brand, 2005). The task examines repeated decision-making processes during experimentally-manipulated winning and losing experiences, while participants are aware of the rules. procedure An experimenter explains the task, the interface, and information regarding choices and winning probabilities. Before starting the task, participants conducted an eightblock exercise trial. After the task, participants were debriefed, and paid according to how much money they won or lost during the task.

Keywords: Decision-making, Game of Dice Task, Behavioral Approach System, Behavioral Inhibition System

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.

introduction Gambling consists of continuous decision-making processes while being provided information about gain and loss probabilities. Personality traits, such as impulsivity or anxiety, affect decision-making processes during gambling tasks (Martin & Potts, 2009). Gray (1981) proposed the Reinforcement Sensitivity Theory (RST), which suggests an independent relationship exists between the BAS and BIS, to explain impulsivity. There are

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 gambling task. The modified GDT, which activated the sensitivity of both reward and punishment through winning or losing experiences, provided valuable information regarding the relative characteristics between the BAS and the BIS.

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Acknowledgement This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2009-0084146). references Brand, M., Fujiwara, E., Borsutzky, S., Kalbe, E., Kessler, J., & Markowitsch, H. J. Decision-making deficits of Korsakoff 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 impulsivity, Personality and Individual Differences 33(2002), 511-532. Martin, L. E., & Potts, G. F. Impulsivity in decision-making: 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 Pschology Chung-Ang University, Seoul, Republic of Korea

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 treatment aiming to decrease cravings and induce aversion to abused drugs. Although an advantage of CS is that its effectiveness relies mainly on an individual’s ability to use their imagination, this can also be a limitation. In the present study, we will use Virtual Reality (VR) to enhance the effects of CS. VR-CS should be effective in reducing alcohol cravings by offering a vivid experience, which should also make up for the possibility of one’s poor

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 imagery-based aversive therapy designed to decrease cravings 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) program 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 environments. 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 cravings 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 attentional bias is decreased, we may be able to suggest that cravings have decreased as well. method Participants will conduct the AUDIT (Alcohol Use Disorders Identification Test) along with a questionnaire about unpleasant experiences likely to occur as a result of excessive drinking. Using the AUDIT results, 20 harmful drinkers will be assigned to the Harmful Drinkers (HD) group, and 20 non-harmful drinkers will be assigned 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 hospital and a virtual subway using the NeuroVR software. The

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Abstracts from CT15 alcohol-Stroop task, an alcohol image-related eye movement task, and the Alcohol Urge Questionnaire (AUQ) will be administered before and after six sessions of treatment to test the effectiveness of the treatment. The alcohol-Stroop task will be presented using E-prime 2.0., and an SMI iView Red-IV will be used to track eye movements. 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 alcoholStroop 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 eyemovement 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 significant change will be observed in the NHD group. Conclusion These results will demonstrate that a decrease in attentional bias suggests a decrease in cravings. This will allow us to assume that cravings were decreased due to the VRCS 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 Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2009-0084146) (No. 2009-0083866). references Kearney, Albert J., A Primer of Covert Sensitization, Cognitive and Behavioral Practice 13 (2006), 167–175. Moon, J., & Lee, J. H. (2008). Development of virtual aversive environment: Preliminary study of covert sensitization for alcohol craving. 13th Annual Cyber Therapy Conference, San Diego, CA. –––––––––––––––––––––––––––––––––––––––––––––– analysis of brainwave Characteristics during a Computer-based deception simulation Task

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SuJin Kima Kyu Hee Junga and Jang-Han Leea,1 Clinical Neuro-Psychology Lab, Department of Pschology Chung-Ang University, Seoul, Republic of Korea

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 computer-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 possibility 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 responses, 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 situations. 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 essential 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 experimental situation. Our deception task encourages participants to lie spontaneously because deceptive responses are necessary to achieve the goal of the task, which is compensated with a financial reward that further motivates the participants.

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Task immersion is also increased by presenting immediate feedback based on participant response during the deception task. An advantage of the task is that it allows a comparison between spontaneous deception and instructed deception within the same experimental session. We measured Event-Related Desynchronization (ERD) during the task. Alpha band ERD is the percentage of decrease in alpha power from a reference (prestimulus period) to an activation interval (task performance). EEG alpha power desynchronizes when individuals are mentally active, and reflects increasing task demands (Fink, Grabner, Neuper, & Neubauer, 2005). When lying, relatively 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.

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dation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2009-0084146) references Fink, A., Grabner, R.H., Neuper, C.,& Neubauer, A.C.,(2005). EEG alpha band dissociation with increasing 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 Psychiatry, University of Tasmania, Australia

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 number (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 increased 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 PolyG-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 controlled experimental situation. Acknowledgements This work was supported by the National Research Foun-

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 exposure with response prevention, pertinent to their OCD sympomatology. Computer-aided vicarious exposure (CAVE) uses computer graphics to depict a person undertaking exposure with response prevention. The behavior of the observed person, a screen figure, is controlled by the “point and click” method, in the manner of a computer 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 behaviors. These features facilitate exploratory skill learning. 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 constraints in delivery of VR approaches on the Internet, a hybrid Internet site has been designed for clinical research

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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 observer is able to incorporate or omit that behavior from their repertoire. This is an adaptive mechanism that serves to bypass 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 obsessivecompulsive 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 thermometer.” Repeated exposure results in reduction of the anxiety response, simulating habituation. The desired approach behaviors are reinforced by a feedback score that augments towards a target of 2000 points. results In previous research the CAVE programs used were evaluated 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, Menzies, 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, Romano, 1999) and OCD (Clark, Kirkby, Daniels, & Marks, 1998; Kirkby, 2000.) Conclusions Internet-based computer games are increasingly available. These are generally in the non-immersive virtual reality (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-

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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 download, 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 obsessive-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 exposure vs. live graded exposure for spider phobia in children, Journal of Behavior Therapy and Experimental Psychiatry 32 (2001), 17-27. Fraser, J., Kirkby, K.C., Daniels, B.A., Gilroy, L.J., Menzies, R.G., Three versus six-sessions of computer-aided vicarious exposure treatment for spider phobia, Behaviour Change 18 (2001), 213-223 Gilroy, L., Kirkby, K.C., Daniels, B.A., Menzies, R.G., Montgomery, I.M., A controlled comparison of computeraided 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 computeraided 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 computerbased treatment of agoraphobia, Comprehensive Psychiatry 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, Behaviour Change 18 (2001), 103-113.

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Kirkby, K.C., Daniels, B.A., Harcourt, L., Romano, A., Behavioral analysis of computer-administered vicarious exposure in agoraphobic subjects: The effect of personality 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 disorder, Comprehensive Psychiatry 41 [2000], 259-265. Smith, K.S. Kirkby, K.C., Montgomery, IM., Daniels, B.A., Computer-delivered modeling of exposure for spider 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 Wee Kim Wee School of Communication and Information, University of Nanyang, Singapore a

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 possibility of tackling social anxiety in an efficient, safe and controlled manner. A key question, however, is how effective are immersive VR environments in helping people 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 situation 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 correlation between anxiety and the level of immersion, which can inform the development of virtual reality exposure

therapy for job interview related anxiety. The results are discussed in terms of how best to offer a flexible therapeutic environment to manage anxiety stimulus parameters 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 anxiety 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 environment can be used as a tool for treatment of the fear of interviewing, 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 immersive 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 evidence 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

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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 MDRNC60) 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 between 21 and 31 years old. In order to minimize the confounding 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 environments, and measured their physiological responses. At the end of the course of virtual job interview, participants submitted Measure of Anxiety in Selection Interviews (MASI) to report their anxiety experience (McCarthy & Goffin, 2004). results The level of increment of pulse rate from baseline (PRb) 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, respectively. The participants who were exposed to the virtual job interview through HMD (fully immersive environ-

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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 anxiety 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 correlated. However, this experiment proved that this assumption 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 simulation, at least some level of immersive display is required. 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-provoking stimuli in a gradual order. references Bullinger, M. and Riva, G., Treating acrophobia in a virtual environment, Proceeding in the cybertherapy conference 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, Behaviour Research and Therapy 42(2)(2004), 229-239. Liebowitz, M.R., Social phobia, Modern Problems of Pharmacopsychiatry 22 (1987), 141-173.

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McCarthy, J.M., and Goffin, R.D., Measuring interview anxiety: Beyond weak knees and sweaty palms, Personnel 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 Department of Biomedical Engineering, Hanyang University, Seoul, Korea b St. Peter’s Hospital, Seoul, Korea

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

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 environments. 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. However, it is unclear how the interactive manner affects social cognition on interacting with another. Therefore, in this study, we aimed to explore how the effect of interactive manner relates to social cognition using a handshake paradigm by a conventional interactive manner and a real interactive manner.

abstract In previous studies, interactive manner affects the user’s feeling of presence. The different feelings of presence influence the user’s cognition, performance of tasks, immersion level, memory and other factors. In this study, we aimed to investigate how interactive manner affects social cognition using a handshake paradigm by a conventional 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 condition. 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 presence affects a part of the mirror neuron system. Keywords: Social Cognition, Interactive Manner, Handshake

methods subjects Sixteen healthy participants were recruited for the fMRI experiment. experimental environments We conducted an fMRI study using an interactive handshake paradigm in which the user shook hands with a virtual 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 calculating 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 different clothes for the acceptance action and the refusal action. After the fMRI experiment, subjects were asked to complete the questionnaire about the their feelings towards the virtual other’s response. The fMRI data were analyzed with AFNI. We conducted ANOVA with factorial 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. Different 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-

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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 interactive manners, but the IFG, which is related with imitation of action and processing a symbolic gesture, was significantly more activated with the acceptive response in the real interactive manner, but was not differently activated in the conventional manner. Conclusion In this study, we explored how interactive manner affected social cognition with shaking hands using a conventional interactive manner and a real interactive manner. The subjects felt more presence and social presence in the real interactive manner, and this different presence 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 University of Southern California Institute for Creative Technologies, Marina del Rey, California, U.S.A.

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 Alternative Medicine (CAM) and virtual technologies suggest some potentially new and beneficial therapies that may help returning servicemen who present symptoms of psychological stress. CAM therapies are now being validated 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-

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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 Second 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 solution. 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 psychological stress, and also that gaps exist in the ongoing efforts 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 Complementary 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 Military 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 Bailenson and colleagues at the Stanford Virtual Human Interaction 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 exercising reported significantly higher levels of exercise in the real world after their session than those who

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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 person 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 research, 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 simply 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 breathing accompanied by biofeedback for as little as ten minutes a day can be effective in lowering blood pressure (Grossman 2001), as well as by the technique of being attentive to one’s breathing that is often employed in Mindfulness-Based Stress Reduction, a CAM therapy that is used for stress reduction. Several challenges were anticipated in the early development cycle. These included virtual world limitations such as seamless region crossing while jogging, lack of specific types of avatar movement and user control, and native 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 microphones, 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 completed these revisions and the second round of testing is in progress through the month of January and early February. Results are being analyzed to determine if a third round of adjustments are necessary.

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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 validity of our approach as part of a novel CAM therapy to help reduce stress. We believe that real world controls 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, Mexico City, Mexico

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 rabbits with no complications. Keywords: Night Vision, Open Surgery, Cybertherapy method In 2009, at the Department of Surgery at the Panamericana 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, Results. It was possible to perform eight surgeries on rabbits without surgical complications. Surgeries performed included one laparotomy, one appendectomy, three nephrectomies, one splenectomy, one left thoracotomy, and one right thoracotomy, which were done under general anesthesia.

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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 microcameras and all participants in the operating room must use the same equipment. Future surgical procedures which could be performed on humans using this technique include non-complicated hernia repairs, large lipomas in soft tissues, subclavian catheter insertions and leg amputations. This technology could be improved with technology such as augmented reality and 3-D vision. Cybertherapy 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

Corresponding author: 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 activities. There are many studies examining adolescents’ activities and also their behaviors online and comparing 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 adolescents choosing friends that are similar to themselves or that friends become similar over time – in turn, they

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217 influence each others behavior (Hamm, 2000; Hogue & Steinberg, 1995; Jaccard, Blanton, & Dodge, 2005; Kirke, 2004). There have been studies examining smoking and drinking habits, among various problem behaviors. However, there is a question of whether or not adolescents choose best friends in real life that are similar to themselves or not according to their behaviors online. 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 1217 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; personality 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 adolescents and characteristics of the network. Visone software helps to visualize the social network. results According to demographic characteristics younger adolescents 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 problem behavior, would be included and tested to see if personality could have a stronger affect on adolescents online activities and friendship per se, or not. Prelimi-

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nary results of this model suggest that adolescents tend to choose friends who are similar according to their activities online, but not personality traits. Also, adolescents 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 adolescents’ friendship characteristics, such as reciprocity, hierarchy, or similarity.

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Kirke, M., Chain reactions in adolescents’ cigarette, alcohol 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 Clinical Neuro-Psychology Lab, Department of Psychology, Chung-Ang University, Seoul, Republic of Korea

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 adolescents 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 online. 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? Individual, contextual, and relationship bases for African American, Asian American, and European American adolescents' selection of similar friends, Developmental Psychology 36 (2000), 209-219. Hogue & Steinberg, L., Homophily of internalized distress in adolescent peer groups, Developmental Psychology 31 (1995), 897–906. Jaccard, J., Blanton, H., & Dodge, T., Peer influences on risk behavior: An analysis of effects of a close friend, Developmental Psychology 41 (2005), 135-147.

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 eyewitnesses to crimes involving weapons focus more on weapons than on details of the perpetrator or the crime scene. We will investigate whether witnesses remain focused 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 eyetracker, we will measure eye movement and visual fixations 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 performance. Expected results are decreased memory and identification 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 presence 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

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Abstracts from CT15 introduction The weapon focus effect (WFE) states that crimes involving weapons cause attention to be focused on central details – the weapon – leaving little attention to be spent elsewhere. This causes memory impairment for peripheral 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 presented on a 22” wide LCD monitor, which will be connected 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 computer 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 critical 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 central 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 fixating 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.

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Conclusion Until now, researchers have only been able to show that the WFE causes memory impairment for peripheral details 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 involving weapons more effectively. Acknowledgements This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (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 Cognitive Psychology, 20(7), 871-893. –––––––––––––––––––––––––––––––––––––––––––––– new Technologies and highly specialized rehabilitation Caterina Pistarinia, and Giorgio Maggionia Neurorehabilitation Unit, IRCCS Salvatore Maugeri Foundation, Scientific Institute of Pavia, Pavia, Italy

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 Society of High Specialisation Rehabilitation) recently organized 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 opportunity to swap experiences at different levels and was structured around the following main topic areas – telerehabilitation, nanotechnology, robotics, imaging, and

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ethical considerations. The meeting fulfilled its aim, which was to compare the various clinical and research activities conducted in highly specialized areas of interest to SIRAS, including cardiology, pneumology and neurology, bringing together a large number of experts interested in contributing to the rehabilitation of disabilities associated with various diseases that can reduce 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 personal 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, electronics and information technology have led to the availability, at increasingly accessible costs, of components, devices and systems offering solutions to improve 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 aspects of the rehabilitation process. Furthermore, in recent years the change of the concept of rehabilitation has led to a strengthening of this tendency – rehabilitation 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 extensive and meaningful clinical investigations to provide evidence on biomechanical, functional and cognitive aspects, as well as on individual performances. Some potentially complicating issues exist. One is the difficulty of correlating real rehabilitation needs and the outcome of technological research with the necessary 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-

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 connect? 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 functionality and its possible benefits. Increasingly, ICT today is no longer a major constraint issue but an accessible, fast and reliable supporting tool for applications and devices for the actual development by Health Organization of Telemedicine Integrated Solutions. Concerning actual European policies, European member 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 Ministerial Conference. method and our experience With the aim of fostering in-home rehabilitation, we studied and used a kinesthetic garment (with piezo-resistive 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 patients and physicians. The core outcomes of our e-rehabilitation program are the continuity of rehabilitation at home for stroke patients with limb movement disabilities after being hospitalized and fostering the patients’ 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-monitoring 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 operator. 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’ performing 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-

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Abstracts from CT15 tial phase of movement recognition and patients are often helped by the operator first, then caregivers. During the treatment, we provided several movement algorithms’ recognition since there is an important need for a tolerance range for movement recognition, particularly 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 design of the user’s interface (changed several times while performing the observation), on the contrary, was revealed to be well-accepted and widely understood. Patients' 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 calibration 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 technological innovations can make an important contribution to rehabilitation, favoring correct, effective and safe – appropriate – use of the different applications available. Within the bounds of what is currently available, appropriate 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, social and working environment. –––––––––––––––––––––––––––––––––––––––––––––– shoulder restriction influenced by rotation Tasks in Virtual reality Vaughan Powella,1, Brett Stevensa, Steve Handa, and Maureen Simmondsb School of Creative Technologies, University of Portsmouth, U.K. b School of Physical & Occupational Therapy, McGill University, Canada

221 abstract Virtual Reality (VR) has been shown to increase engagement and reduce pain in some patient groups, but there is little work reporting the benefits for the challenging area of chronic shoulder pain and restriction. This pilot study investigates the feasibility of an interactive VR task for shoulder range of motion (ROM) exercises. We recorded the upper limb motion of five individuals with shoulder pain and dysfunction performing a range of motion tasks with and without exposure 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 atraumatic aetiology, and can lead to progressive loss of mobility 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 rehabilitation, both by increasing engagement (Rizzo & Kim, 2005) and providing distraction from pain (Hoffman 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 investigating the feasibility of an interactive VR task for shoulder range of motion (ROM) exercises.

Corresponding author: Vaughan Powell University of Portsmouth Eldon Building Winston Churchill Avenue PO1 2DJ Portsmouth, U.K. E-mail: vaughan.powell@port.ac.uk

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method Five subjects, two male and three female aged between 34-45 years, participated in the study. All were suffering from pain and restriction in one shoulder. Motion and position data was obtained using Ascension Technology “Flock of Birds” magnetic motion tracking, with sensors placed on the acromion process, lateral epicondyle of the humerus and radial styloid. Participants were immersed in a large-screen Virtual Environment (representing an orchard), and were encouraged to grasp 10 virtual target objects (apples) using shoul-

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der flexion and abduction and place them in virtual baskets 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 distance between the shoulder and wrist sensors was calculated 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.

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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 School of Creative Technologies, University of Portsmouth, U.K.

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 conditions 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 unaffected shoulders. Interestingly, all participants reported 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 restriction is an area of ongoing challenge for therapists, and the potential of VR to increase engagement and adherence to therapy, combined with the potential to increase ROM and reduce pain, suggests that this may have significant 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-Related Brain Activity with Virtual Reality: Evidence from fMRI, Neuroreport 15(8)(2004), 1245-1248.

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 orient the camera position with respect to the user position 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 reorientation to allow the virtual camera to be oriented towards the desired visual target. We present an alternative solution which allows a more ecologically valid camera movement by orienting the camera towards 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) applications is updated in real time to reflect the user's position and orientation. Although the virtual camera

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Abstracts from CT15 simulates the position of the users eye (both eyes for stereo display), it is impractical to mount tracking devices on the eyes themselves, and therefore the tracking device is generally head-mounted, with an offset being calculated to calibrate the virtual view to the eye position. For most applications, whether delivered via Head Mounted Display (HMD) or Flat Screen Display (FSD), this type of tracking is considered both acceptable and efficient. Indeed, in healthy individuals there is generally only around 27o of eye movement without concomitant head movement (Stahl, 2001), so this could be argued to be the most ecologically valid solution to the problem of view updating. However, in individuals with restricted head movement, such as occurs with neck or shoulder dysfunction, there is an increase of this eye-only movement to around 66o (Stahl, 2001), For these individuals head-tracking alone is clearly insufficient to simulate eye-gaze, and this may lead to a lower sense of presence and decreased perceptual stability (Foxlin, 2002). It has been observed that during reaching tasks the eye gaze typically is directed towards the reaching hand during active target acquisition (Crawford, Medendorp, & Marotta, 2004) and regardless of whether this is achieved by head, eye or whole body movement, it does suggest an alternative approach to view updating. We present a novel solution to simulate this natural gaze direction in VR shoulder rehabilitation.

223 initial acceptability Testing Twenty healthy volunteers and thirteen volunteers with neck and shoulder pain carried out a series of reaching tasks in the orchard VE using the new camera tracking algorithm. After a short training period all the volunteers completed the tasks successfully. All were easily able to manipulate and visually track the virtual hand and acquire the target apples, and none of the volunteers reported any negative experiences or side effects. The volunteers generally did not realize that the camera was tracking their hand movements, and indeed a number of them were convinced that it was their head or eye movements that were controlling the camera view. There was complete acceptance of the transfer of the camera to straight-ahead gaze when the hand moved out of the natural visual boundary, and in fact very few volunteers even noticed the transition of control to and from the hand tracker. discussion We present a novel approach to view-updating in VR which overcomes the limitations of conventional head tracking for patients with restricted neck and shoulder movement. Initial testing suggests that this is both acceptable and ecologically sound, and further evaluation and refinement is underway. references Crawford, J.D., Medendorp, W.P., Marotta, J.J., Spatial Transformations for Eye-Hand Coordination, J. Neurophysiol 92(1)(2004), 10-19.

procedure 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: DeFlock 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 propencalculated to simulate eye position. The camera was sity. Experimental Brain Research, 139(2)(2001), 201then directed along a vector calculated from the eye to 208. hand position, and this was updated in real-time to simulate the natural eye-hand gaze. A visual cue of a virtual –––––––––––––––––––––––––––––––––––––––––––––– a neuroVr based Version of the multiple errands hand was linked to the hand tracker to facilitate sensoTest for the assessment of executive functions in rimotor recalibration in the VE. Observation of volunpatients with different etiologies teers testing the VE revealed that they broke 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, Barbara Polettig, Barbara Corrag, Vincenzo Silanig, to revert to forward gaze while the active hand was outside either of these boundaries. Francesca Morgantib, Laura Carellib and Giuseppe Rivaa.c

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Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy b Department of Human Sciences, University of Bergamo, 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 Professions, 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 Neuroscience, “Dino Ferrari” Center, University of Milan, IRCCS Istituto Auxologico Italiano, Milan, Italy a

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

Abstracts from CT15

by certain rules and is performed in a mall-like setting or shopping center. The tasks vary in terms of complexity and there are a number of “hidden” problems in the tasks that have to be acknowledged and the possible 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 stimulated are numerous, from the ability to plan a sequence of actions, to problem solving and cognitive and behavioral flexibility. The present work the MET procedure, previously modified according 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.

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, Godbout, & Braun, 2003). This is an assessment of executive functions in daily life which consists of tasks that abide by certain rules and which is performed in an actual shopping mall-like setting where there are items to be bought and information to be obtained. The specific 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, Godbout, & Braun, 2003). This consists of tasks that abide

results and conclusions Twelve patients suffering from Parkinson’s disease (PD) (mean age=65.4 years, std.dev=11.2; mean number of school years=7.1 years, std.dev.=3.4; MMSE=26.5, std.dev.=2.7) and 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) 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 errors of specific tasks than the other group and in particular for the task of buying a chocolate bar (Asym. Sig. = 0.04; M = 13.25 vs. 9; SD = 3.88 vs. 1.67); buying 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 products 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-

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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 patients break fewer rules and use more strategies than PD patients. These comparison results show more consistent impaired performance at the VMET test in PD patients, with respect to stroke patients. This can be partly explained 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 recruited. For these reasons, comparison results reflected the planning and set shifting deficits typically associated with PD. As a whole, these results provide support for the feasibility of using the VMET as an assessment tool of executive functions in these two clinical samples. Employing 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 application 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 Applied Technology for Neuro-Psychology Lab.,

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Istituto Auxologico Italiano, Italy ICE-NET Lab., Università Cattolica del Sacro Cuore, Italy c Centre for Studies in Communication Sciences, University of Milan-Bicocca, Italy d Research Institute Brain and Behaviour, Maastricht University, The Netherlands b

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 variety of events and situations. Anxiety and worry are often accompanied by additional symptoms like restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension and disturbed sleep. GAD is usually treated with medications and/or psychotherapy. In particular, the two most promising treatments seem to be cognitive therapy and applied relaxation. In this study we integrated these approaches through the use of a biofeedback enhanced Virtual Reality (VR) system used both for relaxation and controlled 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 results 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 Reality, 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

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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 INTREPID research project aims to improve the treatment of GAD using some advanced technologies including Virtual Reality (VR), biofeedback and mobile 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 relaxation and controlled 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. 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 received an eight-session VR-based treatment including both relaxation and exposure, and techniques supported by HR biofeedback. In sessions one through six, the patient explored a beautiful tropical island experienced with a head-mounted display and head-tracking, following a predefined path leading to different relaxing 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 experienced a non-navigable version of the same VR environment experienced during the therapy at home, using a mobile phone. The patient was asked to train relaxation 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 patients 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

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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 features of the virtual environment: a. Campfire (sessions 1-2). HR controls the fire intensity: a reduction of the patient's physiological activation 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 stimulus until it disappears; 3.Waiting List Condition (WL). This was a control condition, 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 improvements at the end of therapy. –––––––––––––––––––––––––––––––––––––––––––––– analysis of heart rate Variability in Virtual environments 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,

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Instituto Salud Carlos III 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

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.

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

method Physiological signals were recorded on 118 volunteers. Twenty-three of them were assigned to a neutral condition (control group, without emotional induction) and the others were grouped in 4 experimental conditions and were placed in a VE with the aim of inducing relaxation (a different version of the VE was used in each group).

abstract This paper aims to identify differences in heart rate variability (HRV) before and after an inducted state of relaxation. Several physiological variables (electrocardiogram -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 subsequently calculate its mean, typical deviation, maximum, 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 investigated for several years, but a solid conclusion about the relationship between physiological variables and mood has not been achieved (Stern, Ray, & Quigley,

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The first step to analyze HRV is to obtain the RR signal. 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 between 0.04 and 0.15 Hz –HF: power spectral density sum for frequencies between 0.15 and 0.4 Hz These features were calculated in two specific baselines (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 neutral 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 component, which are observed in the neutral group, indi-

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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 relaxation 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; Circulation 1996; 93: 1043-1065. Kim, J., André, E., Emotion Recognition Based on Physiological Changes in Music Listening; IEEE Transactions on Pattern Analysis and Machine Intelligence, Vol 30, Nº 12 December 2008: 2067-2083. Stern, R.M., Ray, W.J., Quigley, K.S., Psychophysiological Recording; Oxford University Press 2001; Second Edition. –––––––––––––––––––––––––––––––––––––––––––––– expectation for future achievement: Key to online gamer loyalty

for future achievements. This study surveyed 307 online gamers with scales used in previous studies. Confirmatory factor analyses demonstrated sufficient reliability (four indices) and validity (convergent validity and discriminant validity) by comparing the statistics 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 achievements (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 expectation for future achievements and its role in online game play, indicating a significant research gap. Filling this gap is important in academics. Academic research on a novel construct (as expectation for future achievements) and its impact can help understand individual psychology and behavior in cyberspace.

Ching-I Tengaa,1 Chang Gung University, Taiwan

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 reason for playing online games. However, no studies have investigated expectation for future achievements and its role in online game play. The goal-setting theory (Locke, 1996) can be used to hypothesize that skill and challenge may antecede expectation for future achievements and then predict gamer loyalty to a certain game. This study thus investigated if the goal-setting theory can actually predict the role of expectation

When predicting user psychology or behavior with regard to achievement, the goal-setting theory (Locke, 1996) is useful for identifying relevant constructs. The goal-setting theory (Locke, 1996) posits that confidence in achieving goals and payoff of the goals positively 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 achievements. This study thus investigates if gamer skill and challenge influence expectation for future achievements, and if it influences gamer loyalty as well.

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Abstracts from CT15 method This study solicited online gamers to complete an online 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. Average variance extracted (AVE) exceeded .66, indicating 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-setting. 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 structural modeling approach. Marketing Science 19 (2000), 22-42.

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229 Yee, N., Motivations for play in online games. CyberPsychology & Behavior 9 (2006), 772-775. Zeithaml, V.A., Berry, L.L., Parasuraman. A., The behavioral 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 National ChengChi University, Taiwan b National Taipei University, Taiwan

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 results indicated that the time spent in using instant messaging and participating in online communities was relative to the preference for solitude and level of social 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 activities 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 significant amounts of time on the Internet. Previous studies have linked heavy Internet usage to the negative consequences of the Internet. However, some personality traits, including preference for solitude and social anxiety, cause heavy Internet users to spend their time on the Internet.

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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 relative to the individuals' personality traits. Individuals with personality traits of preference for solitude and tendencies towards social anxiety do not like communicating 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 community which is the most widely known online community Web site in Taiwan. The original sample was comprised of 772 participants. To focus on heavy Internet 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 questionnaire survey to examine the relationship among preference for solitude, social anxiety, and Internet usage. The first section consisted of four items to measure individuals’ 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 Negative 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 messaging services and participating in online community

Abstracts from CT15

activities is positively related to preference for solitude and social anxiety. Time spent on online auction sites was significantly negatively related to preference 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 significantly relative. discussion Based on the empirical survey results, this study revealed that heavy Internet users who prefer solitude and have tendency towards social anxiety prefer to use instant messaging services to communicate with others. 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 preference for solitude and social anxiety. Another finding of the study was the negative relationship between time spent on online auction sites and preference for solitude. The possible reason is that individuals with a preference for solitude and social anxiety do not like communicating with strangers, while it is necessary for online auction buyers to communicate with sellers. references Craddock, A.E., The measurement of privacy preferences 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

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Abstracts from CT15 Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universidad Politécnica de Valencia, Valencia, Spain a

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 science 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 participants. The results and their implications are discussed. Keywords: Interactive Learning Environments, Virtual Reality, Ecology introduction Serious Virtual Worlds (SVWs) have proven to be potentially effective educational tools in numerous application domains as shown by De Freitas (2006), for example, and games used for educational purposes represent 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 promoting 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 encourage 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

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231 interactive-gaming part. Students then participate in learning about photosynthesis, distinguish between different 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 learning session (E-Junior). The following qualitative measures 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 3D effect were also appreciated – “[ really enjoyed] that it was real.” The frequently mentioned negative criticism 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 virtual aquatic environment. The majority of the students collaborated collectively and helped each other to understand 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 satisfied and engaged in the virtual learning session and had a lot of fun while interacting with the system. According 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 demanding 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 elements of the lecture should be transformed into inter-

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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 Computers 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

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 central to cognitive-behavioral weight control programs. Traditionally, these conventional diaries have been created 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 treatment of eating disorders Keywords: Mobile Device, Eating Disorder, Obesity, Electronic Diary

introduction Self-register techniques are considered necessary for both assessment and treatment phases in eating disorder 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 behavior is recorded immediately in order to minimize memory bias (Beasley, Riley, Davis, & Singh, 2008). The information obtained allows the clinic to identify behavior cues and the thoughts and emotions associated with the behavior. A more accurate evaluation can then be made, and the treatment effects and the patient’s progress can be properly assessed. New technologies are becoming more and more present 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. Secondly, 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 collection method is more attractive. The patient is more satisified and comfortable completing self-registers on a mobile device than on paper because the information 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 children. This diary allows children to record information about food intake and activity. The food diary allows the child to record everything he has eaten,

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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 before and after eating. In the exercise diary the child records information about physical activity completed, and time and intensity of exercise. The second application is related to adult eating disorders (especially binge eating disorders). The application 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 compensatory behavior undertaken. It also asks about the emotion of the user before and after eating. To simplify the maximum the use of the mobile device, in both cases the application is started automatically 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 manipulating the device to start the application. As mentioned before, all the data collected with these

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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 mentioned 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., Evaluation of a PDA-based dietary assessment and intervention 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.

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CyberproJeCTs IN THIS FEATURE, we will try to describe the characteristics of current cyberpsychology and rehabilitation research. In particular, CyberProjects aims at describing the leading research groups and projects, actually running 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 efficient driving experience. No road rage required. Your cooperative dashboard flashes a warning: “Emergency 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 diversion 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 SafeRoute 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 cooperative co-pilot reads a message from the car behind

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you. It’s your colleague, asking if you have time for coffee. 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 Intelligent Transport Systems (ITS). The U.S.A., Japan and Europe are all thinking of cooperative 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 reserved 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 something 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 communication, and still other initiatives for mobile ITS and

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mapping, but except for GPS none have really broken through.

applications which run across the CVIS platform – a kind of "ITS app store."

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

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 deployed in the short- to medium term.

First off, CVIS has developed a complete communications infrastructure, running from hardware, through protocols, 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 infrared. 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 framework – traffic management, vehicle-to-vehicle (V2V) communications, floating vehicle data collection, appropriate integration of city traffic networks with public communication networks, and so on. But it also creates a series of APIs and an open application development suite that will allow third-party software developers and service providers to create

The project coordinator is ERTICO, a European publicprivate partnership representing all the stakeholders, including 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 become the model for how other Intelligent Transport Systems will be developed in the future. The CVIS project was demonstrating its main applications at the Cooperative Mobility Showcase 2010 in Amsterdam, held March 23-26, 2010. The general public was welcomed and present to see some of the cooperative 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).

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CyberfoCus New technologies are developing at a rapid pace. To help you stay abreast of the latest trends in advanced technologies and healthcare, this feature showcases upcoming, 2009- 2010 events, which will provide you with the opportunity 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 Annual 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 includes 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 prevention 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 Technologies” 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. ----------------------------------------------------------------------------------------------------------------------------------------2010 Conferences WCbCT 2010-World Congress of behavioral and Cognitive Therapies June 2 - 5 Boston, Massachusetts, USA http://www.wcbct2010.org/ ----------------------------------------------------------------------------------------------------------------------------------------Cyberpsychology & CyberTherapy 15 June 13 - 15 Seoul, Korea www.e-therapy2010.org ----------------------------------------------------------------------------------------------------------------------------------------siggraph 2010 July 25 - 29 Los Angeles, California, USA http://www.siggraph.org/s2010/

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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/ ----------------------------------------------------------------------------------------------------------------------------------------2010 american psychological association Conference August 12 - 15 San Diego, California, USA http://www.apa.org/convention/ ----------------------------------------------------------------------------------------------------------------------------------------8th iCdVraT with artabilitation August 31 - September 2 Valparaiso, Chile http://www.icdvrat.rdg.ac.uk/ ----------------------------------------------------------------------------------------------------------------------------------------The 5th international Conference on interactive mobile and Computer aided learning September 16 - 17 Hasselt University, Belgium http://www.imcl-conference.org/ ----------------------------------------------------------------------------------------------------------------------------------------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

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general informaTion Journal of CyberTherapy & Rehabilitation ISSN: 1784-9934 GTIN-13 (EAN): 9771784993017 Journal of CyberTherapy & Rehabilitation is published quarterly by the Virtual Reality Medical Institute, Rue de la Loi, 28/7, B-1040 Brussels, Belgium. The journal explores the uses of advanced technologies for therapy, training, education, prevention, and rehabilitation. Areas of interest include, but are not limited to, psychiatry, psychology, physical medicine and rehabilitation, neurology, occupational therapy, physical therapy, cognitive rehabilitation, neurorehabilitation, oncology, obesity, eating disorders, and autism, among many others. publishing house Virtual Reality Medical Institute Rue de la Loi, 28/7 B-1040 Brussels, Belgium Telephone: +32 2 286 8505 Fax: +32/2/286 8508 E-mail: office@vrphobia.eu Website: www.vrphobia.eu

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