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Quintana P, Bouchard S, Botella C, Robillard G, Serrano B, Rodriguez-Ortega A, Torp Ernst M, Rey B, Berthiaume M, Corno G. Engaging in Awkward Social Interactions in a Virtual Environment Designed for Exposure-Based Psychotherapy for People with Generalized Social Anxiety Disorder: An International Multisite Study. J Clin Med 2023; 12:4525. [PMID: 37445561 DOI: 10.3390/jcm12134525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/11/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
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.
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Affiliation(s)
- Pamela Quintana
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada
| | - Stéphane Bouchard
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada
- Department of Psychology, University of Ottawa, Ottawa, ON K1S 5L5, Canada
| | - Cristina Botella
- Universitat Jaume, 12006 Castellón de la Plana, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28031 Madrid, Spain
| | - Geneviève Robillard
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada
| | - Berenice Serrano
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28031 Madrid, Spain
| | | | - Mathias Torp Ernst
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Beatriz Rey
- Departamento de Ingeniería Gráfica, Universitat Politècnica de València, 46022 Valencia, Spain
| | - Maxine Berthiaume
- Department of Psychology, University of Ottawa, Ottawa, ON K1S 5L5, Canada
| | - Giulia Corno
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada
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Ørskov PT, Lichtenstein MB, Ernst MT, Fasterholdt I, Matthiesen AF, Scirea M, Bouchard S, Andersen TE. Cognitive behavioral therapy with adaptive virtual reality exposure vs. cognitive behavioral therapy with in vivo exposure in the treatment of social anxiety disorder: A study protocol for a randomized controlled trial. Front Psychiatry 2022; 13:991755. [PMID: 36299540 PMCID: PMC9589352 DOI: 10.3389/fpsyt.2022.991755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) has a high prevalence and an early onset with recovery taking decades to occur. Current evidence supports the efficacy of cognitive behavioral therapy (CBT) with virtual reality (VR) exposure. However, the evidence is based on a sparse number of studies with predominantly small sample sizes. There is a need for more trials investigating the optimal way of applying VR based exposure for SAD. In this trial, we will test the efficacy of CBT with adaptive VR exposure allowing adjustment of the exposure based on real-time monitoring of the participants's anxiety level. METHODS The trial is a randomized controlled, assessor-blinded, parallel-group superiority trail. The study has two arms: (1) CBT including exposure in vivo (CBT-Exp), (2) CBT including exposure therapy using individually tailored VR-content and a system to track anxiety levels (CBT-ExpVR). Treatment is individual, manual-based and consists of 10 weekly sessions with a duration of 60 min. The study includes 90 participants diagnosed with SAD. Assessments are carried out pre-treatment, mid-treatment and at follow-up (6 and 12 months). The primary outcome is the mean score on the Social Interaction Anxiety Scale (SIAS) with the primary endpoint being post-treatment. DISCUSSION The study adds to the existing knowledge by assessing the efficacy of CBT with adaptive VR exposure. The study has high methodological rigor using a randomized controlled trial with a large sample size that includes follow-up data and validated measures for social anxiety outcomes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT05302518.
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Affiliation(s)
- Per Trads Ørskov
- Research Unit for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Mia Beck Lichtenstein
- Research Unit for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mathias Torp Ernst
- Research Unit for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Iben Fasterholdt
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | | | - Marco Scirea
- Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Stephane Bouchard
- Department of Psychoeducation and Psychology, University du Québec en Outaouais, Gatineau, QC, Canada
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Skjødt MK, Ernst MT, Khalid S, Libanati C, Cooper C, Delmestri A, Rubin KH, Javaid MK, Martinez-Laguna D, Toth E, Prieto-Alhambra D, Abrahamsen B. The treatment gap after major osteoporotic fractures in Denmark 2005-2014: a combined analysis including both prescription-based and hospital-administered anti-osteoporosis medications. Osteoporos Int 2021; 32:1961-1971. [PMID: 33721032 PMCID: PMC8510950 DOI: 10.1007/s00198-021-05890-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/11/2021] [Indexed: 12/11/2022]
Abstract
UNLABELLED This study demonstrates a substantial and persistent anti-osteoporosis treatment gap in men and women ≥50 years old who sustained major osteoporotic fracture(s) between 2005 and 2014 in Denmark. This was not substantially reduced by including hospital-administered anti-osteoporosis treatments. Strengthened post-fracture organization of care and secondary fracture prevention is highly needed. INTRODUCTION The purpose of this study was to evaluate the Danish anti-osteoporosis treatment gap from 2005 to 2014 in patients sustaining a major osteoporotic fracture (MOF), and to assess the impact of including hospital-administered anti-osteoporosis medications (AOM) on the treatment gap among these patients. METHODS In this retrospective, registry-based study, we included men and women aged 50 years or older and living in Denmark, who sustained at least one MOF between 2005 and 2014. We applied a repeated cross-sectional design to generate cohorts of patients sustaining a first MOF, hip, vertebral, humerus, or forearm fracture, respectively, within each calendar year. We evaluated the treatment gap as the proportion of patients within each cohort not receiving treatment with AOM within 1 year of the fracture. Hospital-administered AOM was identified by SKS code. RESULTS The treatment gap among MOF patients decreased from 85% in 2005 to 79% in 2014. The gap was smaller among hip and vertebral fracture patients as compared to humerus and forearm fracture patients, and it was smaller in women than in men. The use of hospital-administered AOM was relatively uncommon, with a maximum of 0.9% of MOF patients initiating hospital-administered AOM (in 2012). We observed substantial variations in this proportion between fracture types and gender. Hospital-administered AOM was most commonly used among vertebral fracture patients. CONCLUSION A significant treatment gap among patients sustaining a major osteoporotic fracture was present throughout our analysis, and including hospital-administered AOM did not significantly improve the treatment gap assessment. Improved secondary fracture prevention is urgently needed.
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Affiliation(s)
- M K Skjødt
- Department of Medicine, Hospital of Holbaek, Smedelundsgade 60, DK-4300, Holbaek, Denmark.
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark.
| | - M T Ernst
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Department of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - S Khalid
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
| | | | - C Cooper
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, England, UK
| | - A Delmestri
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
| | - K H Rubin
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - M K Javaid
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
| | - D Martinez-Laguna
- GREMPAL Research Group, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), CIBERFES, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - E Toth
- UCB Pharma, Anderlecht, Belgium
| | - D Prieto-Alhambra
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
| | - B Abrahamsen
- Department of Medicine, Hospital of Holbaek, Smedelundsgade 60, DK-4300, Holbaek, Denmark
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
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