Watch what I do, not what I say I do: Computer-based avatars to assess behavioral inhibition, a vulnerability factor for anxiety disorders

Distressed (Type D) personality is predicted by avoidance: evidence from a computer-based avatar task

Background

One personality type associated with poor health outcomes is distressed (Type D) personality which involves high levels of both social inhibition (SI) and negative affectivity (NA). Type D is also linked to psychopathologies such as post-traumatic stress disorder (PTSD), anxiety disorders, and depression. One mechanism through which personality temperament may result in these psychopathologies is avoidance. Recently, a computer-based measure designed to assess avoidant behaviors, in which the participant guides the behavior of an avatar interacting with strangers in social situations, has been found to be related to various forms of avoidance. In the current study, we extended this work with the avatar avoidance task to determine its relationship to distressed (Type D) personality. We hypothesized that Type D personality, along with SI, but not NA, would be positively related to avatar avoidance scores. We also hypothesized that avatar avoidance scores would be higher in Type D individuals than non-Type D individuals.

Methods

A total of 302 undergraduates completed the Distressed Type D Personality Scale (DS-14), and a computer-based avatar avoidance task.

Results

Type D and SI, and NA to a lesser degree, were positively correlated with avoidance scores on the avatar task. Furthermore, regression analyses revealed that Type D and SI scores were best predicted by a model including avoidance scores and education level while NA scores were best predicted by a model including avoidance scores. Standard cut-off scores on the DS-14 scale resulted in four groups (i.e., low SI and NA, high SI, high NA, and Type D) which significantly differed in avoidance scores. Specifically, Type D individuals had higher avoidance scores than the other three groups. Taken together these findings support a role for avoidance in Type D personality. The computer-based avatar avoidance task may be particularly relevant as an ecologically valid measure to identify avoidance in a virtual setting for use with individuals expressing Type D personality who may be unwilling or unable to accurately self-report or describe their own avoidant tendencies.

Explorations of avoidance and approach coping and perceived stress with a computer-based avatar task: detrimental effects of resignation and withdrawal

Background

Individuals differ in how they react to stress or trauma through different coping styles in which they may deal directly with a stressor by adopting approach coping styles or disengage with a stressor by utilizing avoidant coping styles. Avoidant coping styles have been linked to adverse outcomes including psychological distress, anxiety disorders, and post-traumatic stress disorder (PTSD). Recently, avoidance coping styles as measured by a subset of items on the Brief COPE were found to have a weak positive relationship with performance on a computer-based avatar task which is related to avoidant personality temperaments. This avatar task was developed as an alternative for paper and pencil self-report inventories for measuring avoidant tendencies based on possible response biases of avoidant individuals. In the current study, avoidance and approach coping styles as measured by the Brief Approach/Avoidance Coping Questionnaire (BACQ) were compared to avoidant coping as measured by the Brief COPE and performance on the avatar task. In addition to approach and avoidance coping, the BACQ also measures active avoidance coping (i.e., diversion) and passive avoidance coping (i.e., resignation and withdrawal). The relationships between approach and avoidance coping and performance on the avatar task were also analyzed with the outcome of perceived stress as measured by the Perceived Stress Scale (PSS).

Methods

One hundred undergraduates voluntarily completed the BACQ, the Brief COPE, and the PSS. Participants also completed a computer-based task in which they guided an avatar through a series of social situations where they indicated how they would interact with or avoid interacting with strangers.

Results

Approach coping had a weak negative relationship to avoidance coping as measured by the BACQ and the Brief COPE. Performance on the avatar task had a moderate positive relationship with avoidance coping (diversion as well as resignation and withdrawal) as measured by the BACQ and a moderate negative relationship with approach coping as measured by the BACQ. A model including only approach, diversion, and resignation and withdrawal coping best predicted performance on the avatar task in a linear regression model. While resignation and withdrawal coping and diversion coping had moderate positive relationships to avatar task scores, only resignation and withdrawal had a strong positive relationship to perceived stress. A model than included only resignation and withdrawal coping best predicted perceived stress in a linear regression model. Overall, passive avoidant coping styles (i.e., resignation and withdrawal), but not active avoidant coping style (i.e., diversion), were related to perceived stress. These results support the continued study of multiple aspects of avoidant coping styles as well as the avatar task to increase our understanding of the maladaptive effects of excessive avoidance in the face of stress.

Construct and Predictive Validity of an Assessment Game to Measure Honesty-Humility

Research on commercial computer games has demonstrated that in-game behavior is related to the players’ personality profiles. However, this potential has not yet been fully utilized for personality assessments. Hence, we developed an applied (i.e., serious) assessment game to assess the Honesty–Humility personality trait. In two studies, we demonstrate that this game adequately assesses Honesty–Humility. In Study 1 (N = 116), we demonstrate convergent validity of the assessment game with self-reported Honesty–Humility and divergent validity with the other HEXACO traits and cognitive ability. In Study 2 (N = 287), we replicate the findings from Study 1, and also demonstrate that the assessment game shows incremental validity—beyond self-reported personality—in the prediction of cheating for financial gain, but not of counterproductive work and unethical behaviors. The findings demonstrate that assessment games are promising tools for personality measurement in applied contexts.

Mnemonic discrimination is associated with individual differences in anxiety vulnerability

Increased generalization between fear-inducing stimuli (e.g., looking over the edge of a tall building) and perceptually-similar neutral stimuli (e.g., an aerial photograph) is observed in all subtypes of anxiety disorders, leading to avoidance behaviors that feed forward from the feared stimulus to other, seemingly unrelated stimuli. However, recent research suggests a much more nuanced relationship between generalization, discrimination, and behavior. This study seeks to extend current understanding by using a mnemonic discrimination task to explore the relationship between risk for anxiety and differences in mnemonic discrimination abilities. Participants self-reported trait anxiety and behavioral inhibition (a temperamental construct linked to risk for anxiety), and also completed a memory task. After incidental encoding of color photographs of neutral everyday objects, participants performed a surprise recognition task, where they categorized each test image as "old" (identical to a previously viewed image), "similar" (new but perceptually-similar to a studied image, with half the images being highly similar and the other half being less similar to the studied images), or "new" (new and perceptually-dissimilar to studied images). We found that those with high behavioral inhibition are more successful at discriminating between previously seen "old" items from highly similar items. In contrast, those with high trait anxiousness are less successful at the same kind of discrimination. Interestingly, these relationships were not apparent in low similarity items. Our data suggest that behavioral inhibition and trait anxiety may be associated with unique aspects of individual differences in mnemonic discrimination abilities.

Virtual Reality Treatment for Public Speaking Anxiety in Students. Advancements and Results in Personalized Medicine

Public speaking anxiety (PSA) is a common phobia in the student population. Traditionally, exposure therapy has been used as a treatment. However, the use of virtual reality (VR) is increasingly common to treat PSA. The purpose of this paper was to analyze the published scientific literature on VR as a treatment for PSA in students. The articles indexed in two databases (Web of Science and Scopus) were analyzed, with a time period from the beginning of the first publications until 2019 included. The systematic literature review was based on fixed inclusion and exclusion criteria. A total of 13 studies were identified which included 481 students. The results collected indicate that the duration of treatments to have positive effects was at least one week, where the number of sessions was between one and twelve. Furthermore, most VR treatments reported positive effects. Finally, this study showed evidence that VR treatment for PSA is effective while being less invasive than in vivo exposure.

A computer-based avatar task can differentiate avoidant and non-avoidant coping styles

Background/Objective: Coping styles play a role in how individuals respond to stress and therapy. One aspect of coping which has been linked to adverse outcomes including anxiety disorders and PTSD is avoidance. However, a tendency to avoid may affect the accuracy of paper and pencil inventories used to identify avoidant temperaments. Previously, we showed that a computer-based task in which an on-screen "avatar" is guided through a series of onscreen events could predict avoidance including behavioral inhibition, harm avoidance, and self-reported PTSD symptoms. Since some coping styles involve avoidance, we extended this work to determine whether scores on the avatar task would also differentiate avoidant and non-avoidant coping styles as measured by the Brief COPE. Methods: One hundred and fifty undergraduates voluntarily completed the avatar task and the Brief COPE. Results: Scores on the avatar task had a significant positive relationship with an aggregate score for the five avoidant coping styles and a significant negative relationship with an aggregate score for the nine non-avoidant coping styles. Conclusions: The effectiveness of the avatar task to differentiate coping styles based on avoidance further validates this task and also shows selectivity to avoidant coping styles as opposed to other non-avoidant coping styles.

A computer-based avatar task designed to assess behavioral inhibition extends to behavioral avoidance but not cognitive avoidance

Avoidance is a common feature of post-traumatic stress disorder (PTSD) as well as anxiety and depressive disorders. Avoidance can be expressed behaviorally as well as cognitively. Most personality assessments for avoidance involve self-report inventories which are susceptible to biased responding. The avatar task (Myers et al., 2016a) was developed as an objective measure of behavioral inhibition (BI) which is defined as a tendency for avoidance of unfamiliar people and situations. The avatar task has been demonstrated to screen avoidant behaviors related to BI, PTSD, as well as harm avoidance (HA) as measured by the Tridimensional Personality Questionnaire (TPQ). In the current work, the avatar task was tested with cognitive as well as behavioral avoidance as measured by the cognitive-behavioral avoidance scale (CBAS; Ottenbreit & Dobson, 2004). The CBAS includes four subscales which measure behavioral social (BS) avoidance, behavioral non-social (BN) avoidance, cognitive social (CS) avoidance, and cognitive non-social (CN) avoidance. It was hypothesized that avatar scores would be significantly positively related to behavioral, but not cognitive, avoidance. In addition, it was also hypothesized that performance on the avatar task would be more related to social than non-social behavioral avoidance. Participants completed the avatar task, the HA scale of the TPQ and the CBAS. Pearson's product moment correlations revealed that avatar scores were significantly related to CBAS total scores as well as BS and BN scores, but not CS and CN scores. In addition, BS has a stronger relationship with avatar scores than BN avoidance which fits with the social aspects of the scenarios in the avatar task. A median split of the avatar scores produced a significant difference in scores on the behavioral but not the cognitive subscales. Overall, the current results supported the idea that the avatar task is measuring behavioral avoidance, specifically in social situations, rather than cognitive avoidance. Future work could adapt the avatar task to include scenarios similar to the cognitive items on the CBAS to create an objective measure of cognitive avoidance which may be relevant in measuring avoidance in depression and behavioral avoidance associated with PTSD as well as anxiety disorders.

Beyond Behavioral Inhibition: A Computer Avatar Task Designed to Assess Behavioral Inhibition Extends to Harm Avoidance

Personality factors such as behavioral inhibition (BI), a temperamental tendency for avoidance in the face of unfamiliar situations, have been identified as risk factors for anxiety disorders. Personality factors are generally identified through self-report inventories. However, this tendency to avoid may affect the accuracy of these self-report inventories. Previously, a computer based task was developed in which the participant guides an on-screen "avatar" through a series of onscreen events; performance on the task could accurately predict participants' BI, measured by a standard paper and pencil questionnaire (Adult Measure of Behavioral Inhibition, or AMBI). Here, we sought to replicate this finding as well as compare performance on the avatar task to another measure related to BI, the harm avoidance (HA) scale of the Tridimensional Personality Questionnaire (TPQ). The TPQ includes HA scales as well as scales assessing reward dependence (RD), novelty seeking (NS) and persistence. One hundred and one undergraduates voluntarily completed the avatar task and the paper and pencil inventories in a counter-balanced order. Scores on the avatar task were strongly correlated with BI assessed via the AMBI questionnaire, which replicates prior findings. Females exhibited higher HA scores than males, but did not differ on scores on the avatar task. There was a strong positive relationship between scores on the avatar task and HA scores. One aspect of HA, fear of uncertainty was found to moderately mediate the relationship between AMBI scores and avatar scores. NS had a strong negative relationship with scores on the avatar task, but there was no significant relationship between RD and scores on the avatar task. These findings indicate the effectiveness of the avatar task as a behavioral alternative to self-report measures to assess avoidance. In addition, the use of computer based behavioral tasks are a viable alternative to paper and pencil self-report inventories, particularly when assessing anxiety and avoidance.

Beyond symptom self-report: use of a computer "avatar" to assess post-traumatic stress disorder (PTSD) symptoms

Post-traumatic stress disorder (PTSD) can occur in the wake of exposure to a traumatic event. Currently, PTSD symptoms are assessed mainly through self-report in the form of questionnaire or clinical interview. Self-report has inherent limitations, particularly in psychiatric populations who may have limited awareness of deficit, reduced attention span, or poor vocabulary and/or literacy skills. Diagnosis and evaluation of treatment efficacy would be aided by behavioral measures. A viable alternative may be virtual environments, in which the participant guides an on-screen "avatar" through a series of onscreen events meant to simulate real-world situations. Here, a sample of 82 veterans, self-assessed for PTSD symptoms was administered such a task, in which the avatar was confronted with situations that might evoke avoidant behavior, a core feature of PTSD. Results showed a strong correlation between PTSD symptom burden and task performance; in fact, the ability to predict PTSD symptom burden based on simple demographic variables (age, sex, combat exposure) was significantly improved by adding task score as a predictor variable. The results therefore suggest that virtual environments may provide a new way to assess PTSD symptoms, while avoiding at least some of the limitations associated with symptom self-report, and thus might be a useful complement to questionnaire or clinical interview, potentially facilitating both diagnosis and evaluation of treatment efficacy.