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It has been proposed that virtual reality (VR) exposure may be an alternative to standard in vivo exposure. Virtual reality integrates real-time computer graphics, body tracking devices, visual displays, and other sensory input devices to... more
It has been proposed that virtual reality (VR) exposure may be an alternative to standard in vivo exposure. Virtual reality integrates real-time computer graphics, body tracking devices, visual displays, and other sensory input devices to immerse a participant in a computer-generated virtual environment. Virtual reality exposure is potentially an efficient and cost-effective treatment of anxiety disorders. VR exposure therapy reduced the fear of heights in the first controlled study of virtual reality in treatment of a psychiatric disorder. A case study supported the efficacy of VR exposure therapy for the fear of flying. The potential for virtual reality exposure treatment for these and other disorders is explored, and therapeutic issues surrounding the delivery of VR exposure are discussed.
Posttraumatic stress disorder (PTSD) is a significant public health issue. Yet, there are limited treatment options and no data to suggest which treatment will work for whom. We tested the efficacy of virtual reality exposure (VRE) or... more
Posttraumatic stress disorder (PTSD) is a significant public health issue. Yet, there are limited treatment options and no data to suggest which treatment will work for whom. We tested the efficacy of virtual reality exposure (VRE) or prolonged imaginal exposure (PE), augmented with D-cycloserine (DCS) for combat-related PTSD. As an exploratory aim, we examined whether brain-derived neurotrophic factor (BDNF) and fatty acid amide hydrolase (FAAH) moderated treatment response. Military personnel with PTSD (n = 192) were recruited into a multisite double-blind randomized controlled trial to receive nine weeks of VRE or PE, with DCS or placebo. Primary outcome was the improvement in symptom severity. Randomization was stratified by comorbid depression (MDD) and site. Participants in both VRE and PE showed similar meaningful clinical improvement with no difference between the treatment groups. A significant interaction (p = 0.45) suggested VRE was more effective for depressed participan...
OBJECTIVE A key symptom of posttraumatic stress disorder (PTSD) is hyperreactivity to trauma-relevant stimuli. Though physiological arousal is reliably elevated in PTSD, the question remains whether this arousal responds to treatment.... more
OBJECTIVE A key symptom of posttraumatic stress disorder (PTSD) is hyperreactivity to trauma-relevant stimuli. Though physiological arousal is reliably elevated in PTSD, the question remains whether this arousal responds to treatment. Virtual reality (VR) has been posited to increase emotional engagement during prolonged exposure therapy (PE) for PTSD by augmenting imaginal exposures with trauma-relevant sensory information. However, the comparative effects of VR exposure therapy (VRE) have received limited empirical inquiry. METHOD Ninety active-duty soldiers with combat-related PTSD participating in a randomized-controlled trial to receive PE, VRE, or a waitlist-control (WL) condition had their physiological reactivity, indexed by galvanic skin response (GSR), to their trauma memories assessed at pre-, mid-, and posttreatment. RESULTS Although both VRE and PE conditions showed reduced GSR reactivity to trauma memories from pre- to posttreatment, only the VRE group differed significantly from WL. Across the sample, reductions in GSR were significantly correlated with reductions in self-reported PTSD and anxiety symptoms. CONCLUSIONS This was the first study comparing effects of VRE and PE on psychophysiological variables. Given previous research finding limited differences between VRE and PE in PTSD symptom reduction, these findings lend support to the rationale for including VR in exposure therapy protocols while raising important questions about the potential benefits of VRE. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... veterans. However, the environment developed by Rizzo and others at ICT is more advanced and sophisticated than those of prior studies. ... 1994). Peritraumatic dissociation and posttraumatic stress in male Vietnam thea-ter veterans.... more
... veterans. However, the environment developed by Rizzo and others at ICT is more advanced and sophisticated than those of prior studies. ... 1994). Peritraumatic dissociation and posttraumatic stress in male Vietnam thea-ter veterans. ...
Despite an increasing number of military service members in need of mental health treatment following deployment to Iraq and Afghanistan, numerous psychological and practical barriers limit access to care. Perceived stigma about admitting... more
Despite an increasing number of military service members in need of mental health treatment following deployment to Iraq and Afghanistan, numerous psychological and practical barriers limit access to care. Perceived stigma about admitting psychological difficulties as well as frequent long distances to treatment facilities reduce many veterans’ willingness and ability to receive care. Telemedicine and virtual human technologies offer a unique potential to expand services to those in greatest need. Telemedicine‐based treatment has been used to address multiple psychiatric disorders, including posttraumatic stress disorder, depression, and substance use, as well as to provide suicide risk assessment and intervention. Clinician education and training has also been enhanced and expanded through the use of distance technologies, with trainees practicing clinical skills with virtual patients and supervisors connecting with clinicians via videoconferencing. The use of these innovative and ...
Numerous experiences can lead to acute stress disorder or posttraumatic stress disorder (PTSD) in military personnel. Combat-related experiences that can lead to PTSD include witnessing another service member being killed or wounded,... more
Numerous experiences can lead to acute stress disorder or posttraumatic stress disorder (PTSD) in military personnel. Combat-related experiences that can lead to PTSD include witnessing another service member being killed or wounded, feeling responsible for the death of a ...
As persons with disabilities age, progressive declines in health and medical status can challenge the adaptive resources required to maintain functional independence and quality of life [1]. These challenges are further compounded by... more
As persons with disabilities age, progressive declines in health and medical status can challenge the adaptive resources required to maintain functional independence and quality of life [1]. These challenges are further compounded by economic factors, medication side effects, loss of a spouse or caregiver, and psychosocial disorders [1-2]. The gradual loss of functional independence and increased reliance on others for transportation, access to general medical and rehabilitation care can be jeopardized [2]. The combination of these factors when seen in the context of the average increase in lifespan in industrialized societies has lead to a growing crisis that is truly global in proportion. While research indicates that functional motor capacity can be improved, maintained, or recovered via consistent participation in a motor exercise and rehabilitation regimen [3], independent adherence to such preventative and/or rehabilitative programming outside the clinic setting is notoriously low [1]. This state of affairs has produced a compelling and ethical motivation to address the needs of individuals who are aging with disabilities by promoting home-based access to low-cost, interactive virtual reality (VR) systems designed to engage and motivate individuals to participate with “game”-driven physical activities and rehabilitation programming. The creation of such systems could serve to enhance, maintain and rehabilitate the sensorimotor processes that are needed to maximize independence and quality of life. This is the theme of the workshop to be presented at the MMVR conference.
Research Interests:
The use of virtual-reality technology in the areas of rehabilitation and therapy continues to grow, with encouraging results being reported for applications that address human physical, cognitive, and psychological functioning. This... more
The use of virtual-reality technology in the areas of rehabilitation and therapy continues to grow, with encouraging results being reported for applications that address human physical, cognitive, and psychological functioning. This article presents a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis for the field of VR rehabilitation and therapy. The SWOT analysis is a commonly employed framework in the business world for analyzing the factors that influence a company's competitive position in the marketplace with an eye to the future. However, the SWOT framework can also be usefully applied outside of the pure business domain. A quick check on the Internet will turn up SWOT analyses for urban-renewal projects, career planning, website design, youth sports programs, and evaluation of academic research centers, and it becomes obvious that it can be usefully applied to assess and guide any organized human endeavor designed to accomplish a mission. It is hoped that...
It has long been recognized that facial expressions, body posture/gestures and vocal parameters play an important role in human communication and the implicit signalling of emotion. Recent advances in low cost computer vision and... more
It has long been recognized that facial expressions, body posture/gestures and vocal parameters play an important role in human communication and the implicit signalling of emotion. Recent advances in low cost computer vision and behavioral sensing technologies can now be applied to the process of making meaningful inferences as to user state when a person interacts with a computational device. Effective use of this additive information could serve to promote human interaction with virtual human (VH) agents that may enhance diagnostic assessment. The same technology could also be leveraged to improve engagement in teletherapy approaches between remote patients and care providers. This paper will focus on our current research in these areas within the DARPA-funded “Detection and Computational Analysis of Psychological Signals” project, with specific attention to the SimSensei application use case. SimSensei is a virtual human interaction platform that is able to sense and interpret r...
We present one of the first applications of virtual humans in Augmented Reality (AR), which allows young adults with Autism Spectrum Disorder (ASD) the opportunity to practice job interviews. It uses the Magic Leap's AR hardware... more
We present one of the first applications of virtual humans in Augmented Reality (AR), which allows young adults with Autism Spectrum Disorder (ASD) the opportunity to practice job interviews. It uses the Magic Leap's AR hardware sensors to provide users with immediate feedback on six different metrics, including eye gaze, blink rate and head orientation. The system provides two characters, with three conversational modes each. Ported from an existing desktop application, the main development lessons learned were: 1) provide users with navigation instructions in the user interface, 2) avoid dark colors as they are rendered transparently, 3) use dynamic gaze so characters maintain eye contact with the user, 4) use hardware sensors like eye gaze to provide user feedback, and 5) use surface detection to place characters dynamically in the world.
Abstract—This paper introduces a National Institutes of Healthsupported interdisciplinary project, involving researchers from the fields of Communication, Cell Neurobiology, Computer Science, and Physical Therapy. The purpose of the... more
Abstract—This paper introduces a National Institutes of Healthsupported interdisciplinary project, involving researchers from the fields of Communication, Cell Neurobiology, Computer Science, and Physical Therapy. The purpose of the project is to develop virtual ...
ABSTRACT
Despite a large number of studies that have analyzed the nature of cognitive changes associated with aging, there is little consensus. Early conceptualizations argued aging impacts fluid abilities but not crystallized abilities. More... more
Despite a large number of studies that have analyzed the nature of cognitive changes associated with aging, there is little consensus. Early conceptualizations argued aging impacts fluid abilities but not crystallized abilities. More recent work has identified specific domains more prone to age-related decline including processing speed, working memory, executive functioning and episodic memory. Whether these domains decline separately or if they decline due to a “common cause” is unclear. We determined to test the common cause hypothesis. Thirty individuals between the ages of 64 and 86 (Mean age = 73.6; Mean years education = 15.4; % women = 50) participated in a study designed to validate a new test of spatial ability administered in virtual reality. As part of this project a standard neuropsychological battery was administered. To test the common cause hypothesis, a principal component factor analysis was conducted. Extension analysis was used to control for the first principal ...
Virtual environment (VE) technology is increasingly being recognized as a useful medium for the study, assessment, and rehabilitation of cognitive processes and functional abilities. The capacity of VE technology to create dynamic... more
Virtual environment (VE) technology is increasingly being recognized as a useful medium for the study, assessment, and rehabilitation of cognitive processes and functional abilities. The capacity of VE technology to create dynamic three-dimensional (3D) stimulus environments, within which all behavioral responding can be recorded, offers clinical assessment and rehabilitation options that are not available using traditional neuropsychological methods. This work
We hypothesized that women with Alzheimer disease (AD) would perform worse on a test of semantic memory but not on tests of other cognitive domains. We did not expect that women without dementia would perform more poorly than men without... more
We hypothesized that women with Alzheimer disease (AD) would perform worse on a test of semantic memory but not on tests of other cognitive domains. We did not expect that women without dementia would perform more poorly than men without dementia on the same task. To explore the specificity of a semantic memory deficit among women with AD by exploring gender differences among a group of subjects with vascular dementia (VD). A case-control study in which differences between men and women were explored using regression models to control for the potentially confounding effects of age, education, duration of dementia, and severity of dementia. Alzheimer's Disease Research Center Consortium of Los Angeles and Orange Counties, California. Volunteers, recruited from the community or clinic referrals, who met clinical criteria for AD (n = 159) or VD (n = 117) or met criteria for control status without dementia (n = 134). Five neuropsychological measures, commonly used in the diagnosis and assessment of dementia. Women with VD scored lower than men with VD on 3 tests. However, when controlling for potential confounds, the gender difference was maintained only for the semantic memory task. Women with AD showed a strong trend to perform worse than men with AD on the test of semantic memory only. No gender differences were found among subjects without dementia. Findings support the existence of a semantic memory deficit for women with AD and suggest that a similar deficit may exist among women with VD.
We are demoing the Passive Sensing Agent (PSA), an mHealth virtual human coach, that collects multimodal data through passive sensors native to popular wearables (e.g., Apple Watch, FitBit, and Garmin). This virtual human interface... more
We are demoing the Passive Sensing Agent (PSA), an mHealth virtual human coach, that collects multimodal data through passive sensors native to popular wearables (e.g., Apple Watch, FitBit, and Garmin). This virtual human interface delivers adaptive multi-media content via smartphone application that is specifically tailored to the user in the interdependent domains of physical, cognitive, and emotional health. Initially developed for the military, the PSA delivers health interventions (e.g., educational exercises, physical challenges, and performance feedback) matched to the individual user via novel adaptive logic-based algorithms while employing various behavior change techniques (e.g., goal-setting, barrier identification, rewards, modeling, etc.). A virtual human coach leads all interactions including the first-time user experience and the brief daily sessions. All interactions were specifically designed to engage and motivate the user while continuously collecting data on their cognitive, emotional, and physical fitness. This multi-component application is integrated and deployed on an iPhone and Apple Watch prototype; a civilian version is currently in-development.
Attention-deficit/Hyperactivity disorder(ADHD) is a common neurodevelopmental disorder among children. Traditional assessment methods generally rely on behavioral rating scales (BRS) performed by clinicians, and sometimes parents or... more
Attention-deficit/Hyperactivity disorder(ADHD) is a common neurodevelopmental disorder among children. Traditional assessment methods generally rely on behavioral rating scales (BRS) performed by clinicians, and sometimes parents or teachers. However, BRS assessment is time consuming, and the subjective ratings may lead to bias for the evaluation. Therefore, the major purpose of this study was to develop a Virtual Reality (VR) classroom associated with an intelligent assessment model to assist clinicians for the diagnosis of ADHD. In this study, an immersive VR classroom embedded with sustained and selective attention tasks was developed in which visual, audio, and visual-audio hybrid distractions, were triggered while attention tasks were conducted. A clinical experiment with 37 ADHD and 31 healthy subjects was performed. Data from BRS was compared with VR task performance and analyzed by rank-sum tests and Pearson Correlation. Results showed that 23 features out of total 28 were related to distinguish the ADHD and non-ADHD children. Several features of task performance and neuro-behavioral measurements were also correlated with features of the BRSs. Additionally, the machine learning models incorporating task performance and neuro-behavior were used to classify ADHD and non-ADHD children. The mean accuracy for the repeated cross-validation reached to 83.2%, which demonstrated a great potential for our system to provide more help for clinicians on assessment of ADHD.
Vol 21 ❖ No 4 ❖ December 2010 26 using standardized equations from the American College of Sports Medicine. Results: Pearson correlation coefficient values and standard estimates of error were calculated for all sub-maximal oxygen... more
Vol 21 ❖ No 4 ❖ December 2010 26 using standardized equations from the American College of Sports Medicine. Results: Pearson correlation coefficient values and standard estimates of error were calculated for all sub-maximal oxygen consumption tests in comparison to the 1.5 mile run. Data for runners: Astrand-Rhyming (r = 0.509, SEE = 3.34); Single-Stage Treadmill Walking Test (r = 0.828, SEE = 2.17); Single-Stage Treadmill Jogging Test (r = 0.849, SEE = 2.04). Data for cyclists: Astrand-Rhyming (r = 0.724, SEE = 2.79); Single-Stage Treadmill Walking Test (r = 0.556, SEE = 4.46); Single-Stage Treadmill Jogging Test (r = 0.918, SEE = 2.12). Combined data: Astrand-Rhyming (r = 0.520, SEE = 3.34); Single-Stage Treadmill Walking Test (r = 0.516, SEE = 3.71); Single-Stage Treadmill Jogging Test (r = 0.847, SEE = 2.30). Conclusions: The Single-Stage Sub-maximal Treadmill Jogging Test had a high correlation and small standard estimate of error in both runners and cyclists. When data from runners and cyclists were combined, the treadmill jog test maintained a high correlation value of 84.7%. These data indicate that use of a simple treadmill jog test is a good clinical predictor of maximal oxygen consumption in both runners and cyclists. In contrast, the Astrand-Rhyming Cycle Ergometer test poorly correlated to maximal oxygen consumption values in runners, and only marginally correlated in cyclists. Clinical Relevance: Results from this study may be used as a reference to select appropriate sub-maximal VO2 tests to prescribe cardiovascular intensity levels. Future Studies: Different versions of sub-maximal VO2 testing should be selected for comparison to maximal tests such as the 1.5 mile run. In addition, utilizing a maximal oxygen consumption test based on cycling versus running might yield a higher correlation to the sub-maximal Astrand-Rhyming cycle test, especially in competitive cyclists.
Introduction: Gender differences and hemispheric differences in visuospatial processing is a widely studied, and controversial, topic. Some studies suggest that women have a greater degree of bilateral processing for spatial tasks,... more
Introduction: Gender differences and hemispheric differences in visuospatial processing is a widely studied, and controversial, topic. Some studies suggest that women have a greater degree of bilateral processing for spatial tasks, perhaps using left hemisphere processing to solve both verbal and nonverbal tasks. Contrariwise, men may have more specialized hemispheric lateralization. The lateralization theories would then suggest that men might solve a visuospatial task using mainly right hemisphere processing, whereas women would employ a more bilateral approach using the left hemisphere as well. The purpose of this study was to compare performance of males and females on a cross-uncrossed difference task (CUD), which measures the differences in reaction time between responses that must be transferred across the corpus callosum versus responses that are not transferred. Method: Thirty individuals between the ages of 64 and 86 (M age=73.6; M years education=15.4%; % women= 50) parti...
The incidence of posttraumatic stress disorder (PTSD) in returning OEF/OIF military personnel is creating a significant healthcare challenge. This has served to motivate research on how to better develop and disseminate evidencebased... more
The incidence of posttraumatic stress disorder (PTSD) in returning OEF/OIF military personnel is creating a significant healthcare challenge. This has served to motivate research on how to better develop and disseminate evidencebased treatments for PTSD. One emerging form of treatment for combat-related PTSD that has shown promise involves the delivery of exposure therapy using immersive Virtual Reality (VR). Initial outcomes from open clinical trials have been positive and fully randomized controlled trials are currently in progress to further validate this approach. Based on our research group’s initial positive outcomes using VR to emotionally engage and successfully treat persons undergoing exposure therapy for PTSD, we have begun development in a similar VR-based approach to deliver stress resilience training with military service members prior to their initial deployment. The Stress Resilience In Virtual Environments (STRIVE) project aims to create a set of combat simulations ...
Neuropsychological assessment of gender differences and hemispheric differences is a widely studied, and controversial, topic. Some studies suggest that females have a greater degree of bilateral processing for spatial tasks, whereas... more
Neuropsychological assessment of gender differences and hemispheric differences is a widely studied, and controversial, topic. Some studies suggest that females have a greater degree of bilateral processing for spatial tasks, whereas males may have more specialized hemispheric lateralization. Virtual reality technology offers an environment that may aid attempts at elucidating the controversy. The current study utilizes a virtual environment and a neuropsychological battery to compare performance of 15 males and 15 females on a standard neuropsychological battery and a crossed-uncrossed differences task (CUD). The CUD was used to measure the differences in reaction time between responses that must be transferred across the corpus callosum versus responses that are not transferred. Our results indicated that the differences between males and females in reaction time between two crossed and two uncrossed conditions were not significant. However, there was a trend toward significance o...
The incidence of posttraumatic stress disorder (PTSD) in returning OEF/OIF military personnel has created a significant behavioral healthcare challenge. This has served to motivate research on how to better develop and disseminate... more
The incidence of posttraumatic stress disorder (PTSD) in returning OEF/OIF military personnel has created a significant behavioral healthcare challenge. This has served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. One emerging form of treatment for combat-related PTSD that has shown promise involves the delivery of exposure therapy using immersive Virtual Reality (VR). Initial outcomes from open clinical trials have been positive and fully randomized controlled trials are currently in progress to further investigate the efficacy of this approach. Inspired by the initial success of this research using VR to emotionally engage and successfully treat persons undergoing exposure therapy for PTSD, our group has begun developing a similar VR-based approach to deliver stress resilience training with military service members prior to their initial deployment. The STress Resilience In Virtual Environments (STRIVE) project aims to create a set of combat simulations (derived from our existing Virtual Iraq/Afghanistan PTSD exposure therapy system) that are part of a multi-episode interactive narrative experience. Users can be immersed within challenging combat contexts and interact with virtual characters within these episodes as part of an experiential learning approach for delivering psychoeducational material, stress management techniques and cognitive-behavioral emotional coping strategies believed to enhance stress resilience. The STRIVE project aims to present this approach to service members prior to deployment as part of a program designed to better prepare military personnel for the types of emotional challenges that are inherent in the combat environment. During these virtual training experiences users are monitored physiologically as part of a larger investigation into the biomarkers of the stress response. One such construct, Allostatic Load, is being directly investigated via physiological and neuro-hormonal analysis from specimen collections taken immediately before and after engagement in the STRIVE virtual experience. This paper describes the development and evaluation of the Virtual Iraq/Afghanistan Exposure Therapy system and then details its current transition into the STRIVE tool for pre-deployment stress resilience training. We hypothesize that VR stress resilience training with service members in this format will better prepare them for the emotional stress of a combat deployment and could subsequently reduce the later incidence of PTSD and other psychosocial health conditions.
Research Interests:
ABSTRACT Impairments in executive functions (EF) negatively impact the capacity for independent living, damaging personal autonomy, and diminishing quality of life. Virtual environments offer an ecologically valid way to evaluate a... more
ABSTRACT Impairments in executive functions (EF) negatively impact the capacity for independent living, damaging personal autonomy, and diminishing quality of life. Virtual environments offer an ecologically valid way to evaluate a person's ability to carry out tasks that depend on EFs. The purpose of this pilot study was to evaluate the feasibility of a virtual reality office task, the Assessim Office (AO), in persons with Multiple Sclerosis and Traumatic Brain Injury, to evaluate performance of patient groups relative to each other and to healthy controls on the AO, and to explore the relationship between patient's performance on AO tasks and neuropsychological measures of EF.
... Figure 1. Prototype 3D Virtual Environments for perceptual-motor rehabilitation and a test “user ... game scenarios have similar action requirements as would occur in real world handball or participating ... their shape descriptors... more
... Figure 1. Prototype 3D Virtual Environments for perceptual-motor rehabilitation and a test “user ... game scenarios have similar action requirements as would occur in real world handball or participating ... their shape descriptors are computed at a frame rate of five frames per second. ...
An approach based on the cultural-historical theory of human activity (activity theory) to consider human affect in the analysis and the design of complex systems is put forward. The influence and importance of emotions in human behaviour... more
An approach based on the cultural-historical theory of human activity (activity theory) to consider human affect in the analysis and the design of complex systems is put forward. The influence and importance of emotions in human behaviour is emphasised. The proposed approach tries to complement current system design approaches, which focus on the cognitive aspects of human behaviour. The application
ABSTRACT

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