The purpose of the study was to examine the efficacy of virtual reality exposure therapy (VRET) to treat driving phobia using a multiple baseline across-subjects design. The sequence of events included a pre-treatment assessment, a baseline phase, 8 weekly VRET sessions using a standardized treatment protocol, a post-treatment assessment, and 1- and 3-month follow-up assessments. A sample of seven treatment seeking adults with a primary diagnosis of specific phobia (driving) was recruited. Five completed the treatment and follow-up phases. One individual withdrew after the pre-treatment assessment, and the other, after the first treatment session. It was hypothesized that VRET would reduce driving anxiety and avoidance symptoms between pre- and post-treatment assessments using several outcome measures. Visual and statistical analysis methods were used to assess treatment outcome. Three participants showed clear improvement in driving anxiety and avoidance symptoms between pre- and post-treatment assessments. There was a marginal improvement in these symptoms for one participant. The remaining participant showed very little improvement, and some outcome measures revealed slight deterioration in some of her symptoms. There was negligible change in actual driving frequency in any participant. Some gains were lost at the 1- and 3-month follow-up assessments, but symptoms remained far below pre-treatment results. Possibilities for future research and practice implications are discussed.

The purpose of the study was to examine the efficacy of virtual reality exposure therapy (VRET) to treat driving phobia using a multiple baseline across-subjects design. The sequence of events included a pre-treatment assessment, a baseline phase, 8 weekly VRET sessions using a standardized treatment protocol, a post-treatment assessment, and 1- and 3-month follow-up assessments. A sample of seven treatment seeking adults with a primary diagnosis of specific phobia (driving) was recruited. Five completed the treatment and follow-up phases. One individual withdrew after the pre-treatment assessment, and the other, after the first treatment session. It was hypothesized that VRET would reduce driving anxiety and avoidance symptoms between pre- and post-treatment assessments using several outcome measures. Visual and statistical analysis methods were used to assess treatment outcome. Three participants showed clear improvement in driving anxiety and avoidance symptoms between pre- and post-treatment assessments. There was a marginal improvement in these symptoms for one participant. The remaining participant showed very little improvement, and some outcome measures revealed slight deterioration in some of her symptoms. There was negligible change in actual driving frequency in any participant. Some gains were lost at the 1- and 3-month follow-up assessments, but symptoms remained far below pre-treatment results. Possibilities for future research and practice implications are discussed. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

Background: The use of telemedicine was gaining momentum. Although the strength of the therapeutic alliance (TA) correlated with treatment outcomes, there was no research exploring the skills, attitudes and behaviours that enhanced the TA during Skype consultations in palliative care. Aims: This study identified the skills, attitudes and behaviours that affected the TA between palliative care patients and health care professionals during Skype consultations and identified strategies that enhanced the TA. Study Design: Two cycles of action research engaged the participants in self-reflective inquiry and encouraged the identification of strategies that enhanced the TA and the Skype experience. Participants: Six health professionals and nine patients were recruited from a Hospice out patient service in one Health Authority in England. Data Collection: Data from the audio-recorded consultation were managed quantitatively and the TA was measured using the Working Alliance Inventory (S). Qualitative data were collected from participant interviews and focus groups attended by the professionals. Data Analysis: The analysis ran in parallel with the data collection, started after the first consultation and all sources of data were cross-referenced. Thematic analysis was used to sequentially code the qualitative data to help identify, examine and record patterns within the data set. Findings: The findings suggested that it was possible to establish and a positive therapeutic alliance between health professionals and palliative care patients when using Skype. There was a shift in perception for those health professionals who had reservations about their ability to establish a therapeutic alliance (TA) via a computer link. It was demonstrated that advanced communication skills were transferrable between face to face and video consultations. No additional communication skills training was needed to enable a strong TA when using Skype. Including some social talk, working with the patient’s as opposed to the professional’s agenda and actively offering solutions improved the Skype experience for the patients. The strategies that health professionals promoted to enhance the TA included using Skype with appropriately selected patients to complement the existing Service. Mandatory training in the effective use of Skype was recommended even for those health professionals who used Skype socially. Clarification to address the challenge of clinical governance was recommended. In keeping with an action research design the change impacted on both the health professionals own practice and the Organisation’s approach to telemedicine. The potential for using action research to engage nurses and doctors in critical self-reflective inquiry and to empower them to be change facilitators was demonstrated. Conclusion: Although a small sample size, this study identified strategies that enhanced the TA during Skype consultations. The findings were significant because they added to the current body of knowledge about using Skype to facilitate consultations within the palliative care population. Additionally, the findings may be transferable to different populations and healthcare contexts.

Cerebral Palsy (CP) is the most common condition leading to severe motor impairment in children. Children with CP must go through extensive therapy. Current therapy approaches are coming to use computer games therapeutic tools. However children with CP often have trouble using many of these virtual systems due to equipment challenges. This thesis uses the Kinect to design and create two therapeutic games (DODGEWALL and Reach+) that are tailored to be used in therapy for children with CP. It evaluates the usefulness of the system in a therapeutic context for children with CP through a study involving 6 therapists and 8 children with CP. It was found that overall, children were engaged and enjoyed playing the games. Further, the games developed were judged therapeutically relevant and will be included in a newly constructed VRT suite at Holland Bloorview Kids Rehabilitation Hospital and used in therapy with appropriate children.

Cerebral Palsy (CP) is the most common condition leading to severe motor impairment in children. Children with CP must go through extensive therapy. Current therapy approaches are coming to use computer games therapeutic tools. However children with CP often have trouble using many of these virtual systems due to equipment challenges. This thesis uses the Kinect to design and create two therapeutic games (DODGEWALL and Reach+) that are tailored to be used in therapy for children with CP. It evaluates the usefulness of the system in a therapeutic context for children with CP through a study involving 6 therapists and 8 children with CP. It was found that overall, children were engaged and enjoyed playing the games. Further, the games developed were judged therapeutically relevant and will be included in a newly constructed VRT suite at Holland Bloorview Kids Rehabilitation Hospital and used in therapy with appropriate children.

Background: Parkinson's disease (PD) is a debilitating progressive neurological disorder. The main clinical features of PD are: rigidity, bradykinesia, akinesia, and resting tremor. People living with PD often present with impaired gross- and fine upper-limb motor control and ocular tracking. The impaired motor control associated with PD results in difficulty performing basic- and instrumental activities of daily living (BADLs and IADLs). Virtual reality (VR) therapy is an emerging treatment strategy used to address movement impairment in people with neurological diseases, but has not been extensively researched in the rehabilitation of people with PD. This study aimed to determine the effectiveness of VR therapy as a treatment modality for the rehabilitation of upper-limb function during BADLs and IADLs and ocular tracking for people with PD, when compared to conventional physiotherapy. Methods: A single blind randomised control trial was done. Participants were randomly allocated to either the conventional therapy (control) or VR therapy (experimental) groups using the concealed opaque envelope method. Twenty-two participants who gave informed consent were included, if they met the following criteria: Confirmed PD diagnoses; scored above 24/30 for the Mini Mental State Examination; and did not suffer from uncontrolled co-morbid diseases. The control- and experimental groups underwent twelve intervention session of 45 minutes. The control group participated in conventional physiotherapy sessions and the experimental group used the X-box Kinect© VR apparatus during treatment. Participants were assessed at baseline and post-intervention (directly following the 12 session) with the: 9 Hole Peg Test (9HPT), Test d'Evaluation des Membres Superieurs De Personnes Agees (TEMPA) and the King Devick Test. Results: The TEMPA was used to determine unilateral- and bilateral upper-limb function during IADLs and BADLs. Three of the four items of the TEMPA that assessed bilateral upper-limb function indicated statistically significant improvement when the difference between the control and experimental groups were compared post-intervention (Task1 p=0.611; Task 2 p=0.0043; Task 3 p=0.0078; Task 4 p=0.0002). Similarly, three of the four items of the TEMPA that assessed unilateral upper-limb function indicated statistically significant improvement for the experimental group, when compared to the control- group post-intervention (Task 5 p=0.0151; Task 6 p=0.4118; Task 7 p=0.0064; Task 8 p=0.0009). The 9HPT assessed in-hand manipulation and fine upper-limb function. Results from the 9HPT for the left- and right hands of both groups showed clinically significant improvements from baseline to post-intervention, but there was no statistically significant difference between the two groups. The King Devick test was used to assess ocular tracking. The comparison of change between the two groups from baseline to post-intervention on the King Devick did not indicate clinically- or statistically significant change. Discussion and Conclusion: The findings from the bilateral IADL and BADL tasks as measured with the TEMPA are similar to findings in the literature. The results show that VR therapy improve motor control of the upper-limb significantly when both hands work together and when the upper-limbs are moving unilaterally. VR therapy might be more effective than conventional physiotherapy because it allowed for repetitive practice of functional activities, which aided the development of limb control and functional muscle strength. The VR therapy also allowed task-oriented training to occur repetitively. Task-oriented training is known to aid neural plasticity and facilitate functional rehabilitation. The insignificant differences between the groups on the 9HPT is an indication that the task performed for this outcome measure is not specific enough to detect hand function and grip strength. The King Devick test did not indicate change for the control- or experimental groups, which indicates that specific ocular tracking exercises should be included in therapy to address this impairment. / Dissertation (MPhysiotherapy)--University of Pretoria, 2016. / Physiotherapy / MPhysiotherapy / Unrestricted

Virtual reality exposure therapy (VRET) is a treatment often used to treat fear-of-flying (FOF), which research shows is effective for treating this phobia. Researchers have identified that the realism of the virtual environment is an important component in the efficacy of VRET and increased realism is likely to increase the efficacy of VRET. Guided by cognitive theory, emotional processing theory, and behaviorism, the purpose of this quantitative study was to demonstrate if a new generational technique called true reality-virtual reality exposure therapy (TR-VRET) is at least as efficacious as traditional VRET for treating the fear and anxiety associated with FOF. Repeated measures ANOVAs were used to compare the means between the pre-/posttests measuring fear and anxiety associated with FOF and between the control and experimental group. Both the active treatment experimental group (using TR-VRET) and the active treatment control group (using VRET) had a significant effect on reducing anxiety related to flying. The findings also revealed that both the active treatment experimental group and the active treatment control group had a significant effect on reducing fear related to flying. Notably, no significant differences were found between the active treatment experimental group and the active treatment control group, meaning the 2 treatments were equally effective at reducing the anxiety and fear related to flying. These findings can contribute to positive social change by allowing mental health professionals access to an advanced treatment tool (i.e., TR-VRET) that is just as effective as the older treatment tool (i.e., VRET). These findings can also contribute to positive social change by quickly allowing more tailored virtual environments to be created for clients at a lower cost.

Le trouble de l’usage de cannabis (TLUC) est une problématique complexe particulièrement lorsqu’il est comorbide à un trouble mental sévère (TMS). D’une part, aucune pharmacothérapie n’a été approuvée pour son traitement et d’une autre part, les psychothérapies existantes offrent au mieux une efficacité faible et non maintenue dans le temps. L’émergence de la réalité virtuelle (RV) en psychiatrie pourrait augmenter l’efficacité considérant le potentiel qu’elle a démontré pour une variété de conditions psychiatriques. Actuellement, aucune intervention ayant incorporé la RV visant le traitement du TLUC n’a fait l'objet de recherche. L’intervention Avatar pour le TLUC se veut une approche innovante utilisant la RV en tant qu’outil thérapeutique afin de faire des apprentissages et les pratiquer au moment où les cravings et les émotions sont d’intensité similaire à celle de leur quotidien. Cette intervention comprenant huit séances utilise des techniques provenant de thérapie recommandée (ex., thérapie cognitivo-comportementale, entrevue motivationnelle). Durant les périodes d’immersion, les participants ont interagi avec un avatar représentant une personne significative en lien avec leur consommation dont le thérapeute joue le rôle. Cet essai clinique pilote a visé l’évaluation de l’efficacité ainsi que la faisabilité et l’acceptabilité à court terme chez 19 participants ayant un double diagnostic de TMS et TLUC. Les résultats ont montré une réduction significative modérée de la quantité de cannabis consommée (d=0,545; p=0,017), laquelle a été confirmée par quantification du THC-COOH dans les urines. Une tendance a été observée pour la fréquence de l’usage (d=0,313; p=0,052). Concernant la sévérité du TLUC et la motivation aux changements, une petite (d=0,474; p=0,046) et modérée (d=0,523; p=0,046) taille d’effet ont été obtenues respectivement. Aucun effet significatif n’a été observé pour la qualité de vie et les symptômes psychiatriques sont restés stables. Les résultats à moyen et long terme seront évalués lorsque les participants auront terminé les suivis à 3, 6 et 12 mois. Un essai randomisé contrôlé à simple insu comparant l’intervention Avatar pour TLUC à une intervention classique en toxicomanie est en cours. / Cannabis use disorder (CUD) is a complex issue, particularly when it is comorbid with a severe mental disorder (SMD). On one hand, no pharmacotherapy has been approved for its treatment. On the other hand, existing psychotherapies offer, at best, low efficacy that is not sustained over time. The emergence of virtual reality (VR) in psychiatry could increase efficacy, given the potential it has demonstrated for a variety of psychiatric conditions. To date, no intervention incorporating VR for the treatment of CUD has been developed. The Avatar intervention for CUD is an innovative approach using VR as a therapeutic tool to learn and practice in real-time when cravings and emotions are of similar intensity to their everyday lives. This eight-session intervention uses techniques from commonly used therapeutic approaches (e.g., cognitive-behavioral therapy, motivational interviewing). During immersive sessions, participants interacted with an avatar played by the therapist, representing a significant person intrinsically linked with their consumption. This pilot clinical trial was designed to assess efficacy at short-term, feasibility, and acceptability in 19 participants with a dual diagnosis of SMD and CUD. Results showed a significant moderate reduction in the amount of cannabis consumed (d=0.545, p=0.017), which was confirmed by the quantification of THC-COOH in urine. Regarding the severity of TLUC and motivation to change, a small (d=0.474; p=0.046) and moderate (d=0.523; p=0.046) effect size were obtained, respectively. No significant effect was obtained for quality of life, and psychiatric symptoms remained stable. Once participants have completed the 3-, 6- and 12-month follow-ups, medium- and long-term results will also be assessed. A single-blind randomized controlled trial is currently underway to compare the Avatar intervention for CUD with a conventional addiction intervention.

À l’heure où le numérique s’est totalement imposé dans notre quotidien, nous pouvons nous demander comment évolue notre bien-être. La réalité virtuelle hautement immersive permet de développer des environnements propices à la relaxation qui peuvent améliorer les capacités cognitives et la qualité de vie de nombreuses personnes. Le premier objectif de cette étude est de réduire les émotions négatives et améliorer les capacités cognitives des personnes souffrant de déclin cognitif subjectif (DCS). À cette fin, nous avons développé un environnement de réalité virtuelle appelé Savannah VR, où les participants ont suivi un avatar à travers une savane. Nous avons recruté dix-neuf personnes atteintes de DCS pour participer à l’expérience virtuelle de la savane. Le casque Emotiv Epoc a capturé les émotions des participants pendant toute l’expérience virtuelle. Les résultats montrent que l’immersion dans la savane virtuelle a réduit les émotions négatives des participants et que les effets positifs ont continué par la suite. Les participants ont également amélioré leur performance cognitive. La confusion se manifeste souvent au cours de l’apprentissage lorsque les élèves ne comprennent pas de nouvelles connaissances. C’est un état qui est également très présent chez les personnes atteintes de démence à cause du déclin de leurs capacités cognitives. Détecter et surmonter la confusion pourrait ainsi améliorer le bien-être et les performances cognitives des personnes atteintes de troubles cognitifs. Le deuxième objectif de ce mémoire est donc de développer un outil pour détecter la confusion. Nous avons mené deux expérimentations et obtenu un modèle d’apprentissage automatique basé sur les signaux du cerveau pour reconnaître quatre niveaux de confusion (90% de précision). De plus, nous avons créé un autre modèle pour reconnaître la fonction cognitive liée à la confusion (82 % de précision). / At a time when digital technology has become an integral part of our daily lives, we can ask ourselves how our well-being is evolving. Highly immersive virtual reality allows the development of environments that promote relaxation and can improve the cognitive abilities and quality of life of many people. The first aim of this study is to reduce the negative emotions and improve the cognitive abilities of people suffering from subjective cognitive decline (SCD). To this end, we have developed a virtual reality environment called Savannah VR, where participants followed an avatar across a savannah. We recruited nineteen people with SCD to participate in the virtual savannah experience. The Emotiv Epoc headset captured their emotions for the entire virtual experience. The results show that immersion in the virtual savannah reduced the negative emotions of the participants and that the positive effects continued afterward. Participants also improved their cognitive performance. Confusion often occurs during learning when students do not understand new knowledge. It is a state that is also very present in people with dementia because of the decline in their cognitive abilities. Detecting and overcoming confusion could thus improve the well-being and cognitive performance of people with cognitive impairment. The second objective of this paper is, therefore, to develop a tool to detect confusion. We conducted two experiments and obtained a machine learning model based on brain signals to recognize four levels of confusion (90% accuracy). In addition, we created another model to recognize the cognitive function related to the confusion (82% accuracy).