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

This study assessed the efficacy of using visual and auditory biofeedback while immersed in a tridimensional videogame to practice a stress management skill (tactical breathing). All 41 participants were soldiers who had previously received basic stress management training and first aid training in combat. On the first day, they received a 15-minute refresher briefing and were randomly assigned to either: (a) no additional stress management training (SMT) for three days, or (b) 30-minute sessions (one per day for three days) of biofeedback-assisted SMT while immersed in a horror/first-person shooter game. The training was performed in a dark and enclosed environment using a 50-inch television with active stereoscopic display and loudspeakers. On the last day, all participants underwent a live simulated ambush with an improvised explosive device, where they had to provide first aid to a wounded soldier. Stress levels were measured with salivary cortisol collected when waking-up, before and after the live simulation. Stress was also measured with heart rate at baseline, during an apprehension phase, and during the live simulation. Repeated-measure ANOVAs and ANCOVAs confirmed that practicing SMT was effective in reducing stress. Results are discussed in terms of the advantages of the proposed program for military personnel and the need to practice SMT.

Delivering psychotherapy by videoconference has been studied in a number of clinical trials, but no large controlled trial has involved generalized anxiety disorder (GAD). This multicenter randomized controlled non-inferiority trial was conducted to test if cognitive-behavior psychotherapy delivered by videoconference (VCP) is as effective as cognitive-behavior psychotherapy delivered face-to-face, using a strict margin of tolerance for non-inferiority. A total of 148 adults received a 15-session weekly manualized program. The treatment was based on the intolerance of uncertainty model of GAD. The impact of treatment was assessed using primary (GAD severity), secondary (worry, anxiety, and intolerance of uncertainty) and tertiary (general functioning) variables measured before and after treatment and at 6-month and 12-month follow-ups. Results showed that: (a) the treatment was effective; (b) VCP for GAD was statistically non-inferior to face-to-face psychotherapy on primary, secondary and tertiary measures at all assessment points; (c) change in intolerance of uncertainty significantly predicted change in the primary outcome measure over and above important clinical factors common to all psychotherapies (motivation, working alliance, perceived therapist competence, and client satisfaction). These findings support the use of VCP as a promising treatment option for adults with GAD. Clinical trial registry: ISRCTN#12662027.

The effectiveness of in virtuo exposure-based treatment of performance-only social anxiety disorder (SAD) has been demonstrated in several studies. However, few studies have validated virtual environments with participants suffering from generalized SAD. The goal of this study is to confirm the potential of a virtual environment in inducing anxiety in adults suffering from generalized SAD, compared to adults without SAD, when engaged in awkward social interactions. Differences between participants from two different countries were also explored. The sample consisted of 15 participants with SAD from Canada, 17 participants without SAD from Canada, 16 participants with SAD from Spain, and 21 participants without SAD from Spain. All participants were immersed in a control virtual environment and in an experimental virtual environment considered potentially anxiety-inducing for individuals with generalized SAD. As hypothesized, results showed that the experimental virtual environment induced a higher level of anxiety than the control environment among participants with SAD compared to those without SAD. The impact on anxiety of each socially threatening task performed during the experimental immersion was statistically significant. In terms of anxiety responses, no significant differences were found between participants from Canada and Spain. However, spatial presence and ecological validity were higher in Canadians than in Spaniards. Unwanted negative side effects induced by immersions in virtual reality were higher in the SAD group. This study highlights the importance for therapists to engage people with SAD in clinically relevant tasks while immersed in VR psychotherapeutic applications.

Predictors Change in GAD Severity at Posttreatment Factors potentially associated with treatment efficacy, as measured by the residualized change in ADIS-IV scores from pre to post-treatment, were examined in a hierarchical regression analysis. Consistent with the non-inferiority finding for the Time by Condition interaction with the IUS, testing the direct impact of treatment conditions on the residualized change in intolerance of uncertainty was not statistically significant (F change (1,112) = 0.031, p = 0.86, change in R2 = 0.00) and did not reduce the significant role of intolerance of uncertainty in the regression (t = 6.99, p < 0.001, semi-partial correlation = 0.52). VCP (n = 69) FF (n = 79) Statistical Test (Chi-Square or t Test) Age, mean (SD) 41.35 (14.80) 39.38 (16.23) −0.77, p > 0.05 Sex (female) 57 (82.60%) 65 (82.30%) 0.003, p > 0.05 Presence of at least one comorbid disorder * 36 (52.2%) 44 (55.7%) 0.184, p > 0.05 Living alone 15 (21.70%) 8 (10.10%) 3.784, p > 0.05 Education High school 12 (17.40%) 13 (16.50%) 0.235, p > 0.05 College 21 (30.40%) 27 (34.20%) University 36 (52.20%) 39 (49.40%) Work status Full-time (35 h or +) 23 (33.30%) 26 (32.90%) 3.694, p > 0.05 Part-time (less than 35 h) 23 (33.30%) 23 (29.10%) Retirement 9 (13.00%) 11 (13.90%) Unemployment 11 (15.90%) 9 (11.4%) Other 3 (4.30%) 10 (12.70%) Annual income Lower than 29,999$ 14 (20.90%) 27 (35.10%) 4.628, p > 0.05 (3 refused to answer) 30 k–59,999$ 25 (37.30%) 19 (29.70%) 60 k–89,999$ 11 (16.40%) 14 (18.20%) 90 k and more 17 (25.40%) 17 (22.10%) Taking medication 32 (46.4%) 25 (31.6%) 3.38, p > 0.05 Previous psychotherapy 49 (71.00%) 57 (72.20%) 0.23, p > 0.05 Motivation toward therapy (Session 1) 12.38 (4.60) 12.70 (3.67) 0.46, p > 0.05 Working alliance (Session 7) 233.18 (18.05) 225.80 (17.52) −2.36, p < 0.05 Perception of therapist competence (Session 7) 164.00 (12.99) 156.47 (19.32) −2.49, p < 0.05 Client Satisfaction (post-treatment) 28.32 (3.78) 27.77 (3.46) −0.92, p > 0.05 Note. M = Mean; SD = Standard deviation; VCP = Videoconference Psychotherapy; FF = Face-to-face; ADIS = Anxiety Disorders Interview Schedule for DSM-IV, PSWQ = Penn-State Worry Questionnaire, WAQ = Worry and Anxiety Questionnaire, IUS = Intolerance of Uncertainty Scale, BDI-II = Beck Depression Inventory-II, QOL-Psychol = WHO-QOL-Psychological subscale, QOL-Social = WHO-QOL-Social relations subscale.

To adapt the content and functionalities of a web-based multidomain program designed to increase dementia literacy, to the context and needs of users, providers and community organisations across Québec, Canada. Five consecutive qualitative co-creation focus group sessions 30-90 min in duration each, exploring potential barriers and facilitators to usability, accessibility, comprehensibility, participant recruitment and retention. Virtual meetings. A 15-member team based in Québec and Ontario, Canada, consisting of 9 researchers (including a graduate student and the project coordinator), representing occupational therapy, sensory rehabilitation, neuropsychology, psychology, health science and research methods, 3 informal caregivers of older adults living with cognitive decline and 3 members of the Federation of Quebec Alzheimer Societies. Session recordings were summarised through both qualitative description and thematic analysis. The synthesised recommendations included adjustments around diversity, the complexity and presentation styles of the materials, suggestions on refining the web interface and the measurement approaches; it influenced aspects of participant recruitment, retention efforts and engagement with the content of . Co-creation in dementia prevention research is important because it involves collaboration between researchers, community support and service providers, and persons with lived experience as care providers, in the design and implementation of clinical studies. This approach helps to ensure that the content and presentation of educational material is relevant and meaningful to the target population and those involved in its delivery, and it leads to a greater understanding of their needs and perspectives.

CD34+ cell counts in peripheral blood (PB) and corresponding numbers of CD34+ cells and colony-forming units-granulocyte/macrophage (CFU-GM) in 299 leukapheresis products of 209 patients undergoing PB progenitor cell (PBPC) mobilization for autologous transplantation in two different centers were analyzed and compared according to diagnosis: non-Hodgkin lymphoma (NHL, 94 leukaphereses), multiple myeloma (MM, 75), Hodgkin's disease (HD, 37), solid tumors (35), and chronic myeloid leukemia (CML, 32). Without separating disease entities, correlations between PB CD34+ cell counts and leukapheresis content of CD34+ cells (r>0.83, P<0.01) and CFU-GM (r>0.81, P<0.01) were excellent. In both centers, a PB CD34 threshold ensuring a leukapheresis yield > 10(6) CD34/kg was determined. This threshold was higher in center 1 than in center 2, and its predictive accuracy (91.4%, i.e., prediction correct 91.4% of the time) was significantly lower than in center 2 (98.4%, P=0.02). When data were analyzed by pathology, PB CD34+ cell counts and leukapheresis content of CD34+ cells and CFU-GM remained well correlated, and in both centers PB CD34 thresholds predictive of a yield > 10(6) CD34/kg per leukapheresis could be determined for each pathology. For most patients, pathology-specific PB CD34 thresholds could be obtained directly from the equation of the PB CD34/leukapheresis CD34 correlation curve; they varied depending on both pathology and center (range: 7-20 x 10(6) CD34/l). Pathology-specific thresholds predicted a leukapheresis yield > or = 10(6) CD34/kg accurately 100% of the time for MM patients in center 2 and HD and solid tumor patients of both centers, resulting in overall rates of accurate prediction of sufficient graft CD34 content of 96.6% in center 1 and 98.9% in center 2.