Publications

@article{lerner_transcranial_2019,

title = {Transcranial Current Stimulation During Sleep Facilitates Insight into Temporal Rules, but does not Consolidate Memories of Individual Sequential Experiences},

author = {Itamar Lerner and Nicholas A. Ketz and Aaron P. Jones and Natalie B. Bryant and Bradley Robert and Steven W. Skorheim and Arno Hartholt and Albert S. Rizzo and Mark A. Gluck and Vincent P. Clark and Praveen K. Pilly},

url = {http://www.nature.com/articles/s41598-018-36107-7},

doi = {10.1038/s41598-018-36107-7},

issn = {2045-2322},

year  = {2019},

date = {2019-02-01},

journal = {Scientific Reports},

volume = {9},

number = {1},

abstract = {Slow-wave sleep (SWS) is known to contribute to memory consolidation, likely through the reactivation of previously encoded waking experiences. Contemporary studies demonstrate that when auditory or olfactory stimulation is administered during memory encoding and then reapplied during SWS, memory consolidation can be enhanced, an effect that is believed to rely on targeted memory reactivation (TMR) induced by the sensory stimulation. Here, we show that transcranial current stimulations (tCS) during sleep can also be used to induce TMR, resulting in the facilitation of high-level cognitive processes. Participants were exposed to repeating sequences in a realistic 3D immersive environment while being stimulated with particular tCS patterns. A subset of these tCS patterns was then reapplied during sleep stages N2 and SWS coupled to slow oscillations in a closed-loop manner. We found that in contrast to our initial hypothesis, performance for the sequences corresponding to the reapplied tCS patterns was no better than for other sequences that received stimulations only during wake or not at all. In contrast, we found that the more stimulations participants received overnight, the more likely they were to detect temporal regularities governing the learned sequences the following morning, with tCS-induced beta power modulations during sleep mediating this effect.},

keywords = {MedVR, Virtual Humans},

pubstate = {published},

tppubtype = {article}

}

@article{rizzo_clinical_2019-1,

title = {Clinical Results Using Virtual Reality},

author = {Albert Rizzo and Sebastian Thomas Koenig and Thomas B. Talbot},

editor = {Gabor F. Fulop and Charles M. Hanson and Bjørn F. Andresen},

url = {https://www.tandfonline.com/doi/full/10.1080/15228835.2019.1604292},

doi = {10.1080/15228835.2019.1604292},

issn = {1522-8835, 1522-8991},

year  = {2019},

date = {2019-02-01},

booktitle = {Infrared Technology and Applications XLV},

journal = {Journal of Technology in Human Services},

volume = {37},

number = {1},

pages = {51–74},

publisher = {SPIE},

address = {Baltimore, United States},

abstract = {Virtual Reality (VR) technology offers new opportunities for the development of innovative clinical research, assessment, and intervention tools. VR-based testing, training, teaching, and treatment approaches that would be difficult, if not impossible to deliver using traditional methods are now being developed that take advantage of the assets that are available with VR technology. As research evidence continues to indicate clinical efficacy, VR applications are being increasingly regarded as providing innovative options for targeting the cognitive, psychological, motor, and functional impairments that result from various clinical health conditions. VR allows for the precise presentation and control of stimuli within dynamic multisensory 3-D computer generated simulations as well as providing advanced methods for capturing and quantifying behavioral responses. These characteristics support the rationale for the use of VR applications in clinical assessment, intervention, and training. This article begins with a brief review of the history and rationale for the use of VR with clinical populations. We then detail one use-case for the clinical application of VR—the exposure therapy treatment of anxiety disorders and post-traumatic stress disorder. While significant work is cited in other areas of Clinical VR (e.g., pain management, cognitive/physical assessment/rehabilitation, eating disorders, social skills/clinical training, etc.), a full overview of such a broad literature is beyond the scope of this article. Thus, we have opted to provide more in-depth analysis of one specific clinical area that clearly illustrates how VR has been successfully applied and is supported by an encouraging and evolving scientific literature.},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{chu_emotion_2019,

title = {Emotion Regulation in the Prisoner’s Dilemma: Effects of Reappraisal on Behavioral Measures and Cardiovascular Measures of Challenge and Threat},

author = {Veronica C. Chu and Gale M. Lucas and Su Lei and Sharon Mozgai and Peter Khooshabeh and Jonathan Gratch},

url = {https://www.frontiersin.org/article/10.3389/fnhum.2019.00050/full},

doi = {10.3389/fnhum.2019.00050},

issn = {1662-5161},

year  = {2019},

date = {2019-02-01},

journal = {Frontiers in Human Neuroscience},

volume = {13},

abstract = {The current study examines cooperation and cardiovascular responses in individuals that were defected on by their opponent in the first round of an iterated Prisoner’s Dilemma. In this scenario, participants were either primed with the emotion regulation strategy of reappraisal or no emotion regulation strategy, and their opponent either expressed an amused smile or a polite smile after the results were presented. We found that cooperation behavior decreased in the no emotion regulation group when the opponent expressed an amused smile compared to a polite smile. In the cardiovascular measures, we found significant differences between the emotion regulation conditions using the biopsychosocial (BPS) model of challenge and threat. However, the cardiovascular measures of participants instructed with the reappraisal strategy were only weakly comparable with a threat state of the BPS model, which involves decreased blood flow and perception of greater task demands than resources to cope with those demands. Conversely, the cardiovascular measures of participants without an emotion regulation were only weakly comparable with a challenge state of the BPS model, which involves increased blood flow and perception of having enough or more resources to cope with task demands.},

keywords = {ARL, DoD, MedVR, UARC, Virtual Humans},

pubstate = {published},

tppubtype = {article}

}

@article{shawn_green_improving_2019,

title = {Improving Methodological Standards in Behavioral Interventions for Cognitive Enhancement},

author = {C. Shawn Green and Daphne Bavelier and Arthur F. Kramer and Sophia Vinogradov and Ulrich Ansorge and Karlene K. Ball and Ulrike Bingel and Jason M. Chein and Lorenza S. Colzato and Jerri D. Edwards and Andrea Facoetti and Adam Gazzaley and Susan E. Gathercole and Paolo Ghisletta and Simone Gori and Isabela Granic and Charles H. Hillman and Bernhard Hommel and Susanne M. Jaeggi and Philipp Kanske and Julia Karbach and Alan Kingstone and Matthias Kliegel and Torkel Klingberg and Simone Kühn and Dennis M. Levi and Richard E. Mayer and Anne Collins McLaughlin and Danielle S. McNamara and Martha Clare Morris and Mor Nahum and Nora S. Newcombe and Rogerio Panizzutti and Ruchika Shaurya Prakash and Albert Rizzo and Torsten Schubert and Aaron R. Seitz and Sarah J. Short and Ilina Singh and James D. Slotta and Tilo Strobach and Michael S. C. Thomas and Elizabeth Tipton and Xin Tong and Haley A. Vlach and Julie Loebach Wetherell and Anna Wexler and Claudia M. Witt},

url = {http://link.springer.com/10.1007/s41465-018-0115-y},

doi = {10.1007/s41465-018-0115-y},

issn = {2509-3290, 2509-3304},

year  = {2019},

date = {2019-01-01},

journal = {Journal of Cognitive Enhancement},

abstract = {There is substantial interest in the possibility that cognitive skills can be improved by dedicated behavioral training. Yet despite the large amount of work being conducted in this domain, there is not an explicit and widely agreed upon consensus around the best methodological practices. This document seeks to fill this gap. We start from the perspective that there are many types of studies that are important in this domain—e.g., feasibility, mechanistic, efficacy, and effectiveness. These studies have fundamentally different goals, and, as such, the best-practice methods to meet those goals will also differ. We thus make suggestions in topics ranging from the design and implementation of control groups, to reporting of results, to dissemination and communication, taking the perspective that the best practices are not necessarily uniform across all study types. We also explicitly recognize and discuss the fact that there are methodological issues around which we currently lack the theoretical and/or empirical foundation to determine best practices (e.g., as pertains to assessing participant expectations). For these, we suggest important routes forward, including greater interdisciplinary collaboration with individuals from domains that face related concerns. Our hope is that these recommendations will greatly increase the rate at which science in this domain advances.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{birckhead_recommendations_2019,

title = {Recommendations for Methodology of Virtual Reality Clinical Trials in Health Care by an International Working Group: Iterative Study},

author = {Brandon Birckhead and Carine Khalil and Xiaoyu Liu and Samuel Conovitz and Albert Rizzo and Itai Danovitch and Kim Bullock and Brennan Spiegel},

url = {https://mental.jmir.org/2019/1/e11973/},

doi = {10.2196/11973},

issn = {2368-7959},

year  = {2019},

date = {2019-01-01},

journal = {JMIR Mental Health},

volume = {6},

number = {1},

pages = {e11973},

abstract = {Background: Therapeutic virtual reality (VR) has emerged as an efficacious treatment modality for a wide range of health conditions. However, despite encouraging outcomes from early stage research, a consensus for the best way to develop and evaluate VR treatments within a scientific framework is needed. Objective: We aimed to develop a methodological framework with input from an international working group in order to guide the design, implementation, analysis, interpretation, and communication of trials that develop and test VR treatments. Methods: A group of 21 international experts was recruited based on their contributions to the VR literature. The resulting Virtual Reality Clinical Outcomes Research Experts held iterative meetings to seek consensus on best practices for the development and testing of VR treatments. Results: The interactions were transcribed, and key themes were identified to develop a scientific framework in order to support best practices in methodology of clinical VR trials. Using the Food and Drug Administration Phase I-III pharmacotherapy model as guidance, a framework emerged to support three phases of VR clinical study designs—VR1, VR2, and VR3. VR1 studies focus on content development by working with patients and providers through the principles of human-centered design. VR2 trials conduct early testing with a focus on feasibility, acceptability, tolerability, and initial clinical efficacy. VR3 trials are randomized, controlled studies that evaluate efficacy against a control condition. Best practice recommendations for each trial were provided. Conclusions: Patients, providers, payers, and regulators should consider this best practice framework when assessing the validity of VR treatments.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{maples-keller_when_2018,

title = {When translational neuroscience fails in the clinic: Dexamethasone prior to virtual reality exposure therapy increases drop-out rates},

author = {Jessica L. Maples-Keller and Tanja Jovanovic and Boadie W. Dunlop and Sheila Rauch and Carly Yasinski and Vasiliki Michopoulos and Callan Coghlan and Seth Norrholm and Albert Skip Rizzo and Kerry Ressler and Barbara O. Rothbaum},

url = {https://linkinghub.elsevier.com/retrieve/pii/S0887618518301993},

doi = {10.1016/j.janxdis.2018.10.006},

issn = {08876185},

year  = {2018},

date = {2018-10-01},

journal = {Journal of Anxiety Disorders},

abstract = {Posttraumatic stress disorder (PTSD) is characterized by exaggerated expression of fear responses to danger and safety cues. Translational research suggests that dexamethasone facilitates fear extinction in animal and human fear conditioning models. For this randomized, placebo-controlled trial (N = 27), we aimed to translate these findings to the clinic by using virtual reality exposure (VRE) therapy for OEF/OIF/OND veterans with PTSD to determine whether dexamethasone will increase the efficacy of exposure therapy for VRE relative to placebo. VRE sessions involved imaginal exposure to the most traumatic war memories while viewing a computer-generated view of virtual Iraq or Afghanistan with multisensory stimulus options used to match patient’s description of the trauma. VRE was effective in reducing PTSD symptoms but there was no interaction with dexamethasone. Drop-out rate was significantly higher in the dexamethasone group, with 10 of 13 (76.9%) participants in this group discontinuing, compared to only 4 of 14 (28.5%) in the placebo group, χ2 = 6.31},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{reger_does_2018,

title = {Does Virtual Reality Increase Simulator Sickness During Exposure Therapy for Post-Traumatic Stress Disorder?},

author = {Greg M. Reger and Derek Smolenski and Amanda Edwards-Stewart and Nancy A. Skopp and Albert "Skip" Rizzo and Aaron Norr},

url = {https://www.liebertpub.com/doi/full/10.1089/tmj.2018.0175},

year  = {2018},

date = {2018-10-01},

journal = {Telemedicine and eHealth},

abstract = {Purpose: Measurement of simulator-related side effects (SSEs) is an integral component of competent and ethical use of virtual reality exposure (VRE), but common SSEs may overlap with symptoms of anxiety. Limited research exists about the frequency of SSEs during VRE treatment for PTSD and no research compares self-reported SSEs for those undergoing VRE to those participating in exposure therapy without virtual reality. This study compared the SSEs of active duty soldiers with PTSD randomly assigned to exposure therapy via traditional prolonged exposure or VRE. Methodology: A total of 108 soldiers participated in up to 10-sessions of exposure therapy. Of those, 93 provided data on simulator sickness both prior to and after initiation of imaginal exposure. Approximately half (n = 49) used the Virtual Iraq/Afghanistan system to support engagement with their trauma memory. Soldiers completed a four-item, self-reported measure of SSE after each session. Results: Controlling for age, sex, baseline anxiety symptoms, and SSE symptom counts at the first two sessions of therapy (before initiating imaginal exposure), there was no statistically significant difference between the treatment groups in SSEs at the beginning of imaginal exposure or over the course of treatment. This finding suggests that caution should be exercised in the interpretation of SSE measurements during the use of VRE for PTSD. VR did not account for any increase in self-reported SSE. It is possible that anxiety accounts for a meaningful proportion of SSE reports during VRE.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{rizzo_clinical_2018-1,

title = {Clinical Virtual Reality: Emerging Opportunities for Psychiatry},

author = {Albert "Skip" Rizzo and Sebastian Thomas Koenig and Thomas B Talbot},

url = {https://focus.psychiatryonline.org/doi/abs/10.1176/appi.focus.20180011},

year  = {2018},

date = {2018-07-01},

journal = {Focus: The Journal of Lifelong Learning in Psychiatry},

abstract = {Virtual reality (VR) technology offers new opportunities for the development of innovative clinical research, assessment, and intervention tools. VR-based testing, training, teaching, and treatment approaches that would be difficult, if not impossible, to deliver with traditional methods are now being developed that take advantage of the assets that are available with VR technology. As research evidence continues to indicate clinical efficacy, VR applications are being increasingly regarded as providing innovative options for targeting the cognitive, psychological, motor, and functional impairments that result from various clinical health conditions. VR allows for the precise presentation and control of stimuli in dynamic, multisensory, 3D computer-generated simulations as well as providing advanced methods for capturing and quantifying behavioral responses. These characteristics support the rationale for the use of VR applications in clinical assessment, intervention, and training. This article begins with a brief review of the history of and rationale for the use of VR with clinical populations. It then details one use case for the clinical application of VR—the exposure-therapy treatment of anxiety disorders and posttraumatic stress disorder. Although significant work is cited in other areas of clinical VR (e.g., pain management, cognitive and physical assessment and rehabilitation, eating disorders, social skills, and clinical training), a full overview of such a broad literature is beyond the scope of this article. Thus, the authors have opted to provide more in-depth analysis of one specific clinical area that clearly illustrates how VR has been successfully applied and is supported by an encouraging and evolving scientific literature.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{lineberry_learner-adaptive_2018,

title = {Learner-Adaptive Educational Technology for Simulation in Healthcare: Foundations and Opportunities},

author = {Matthew Lineberry and Parvati Dev and H. Chad Lane and Thomas B. Talbot},

url = {https://ovidsp.tx.ovid.com/sp-3.32.0a/ovidweb.cgi?QS2=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},

doi = {10.1097/SIH.0000000000000274},

issn = {1559-2332},

year  = {2018},

date = {2018-06-01},

journal = {Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare},

pages = {1},

abstract = {Despite evidence that learners vary greatly in their learning needs, practical constraints tend to favor ’’one-size-fits-all’’ educational approaches, in simulation-based education as elsewhere. Adaptive educational technologies - devices and/or software applications that capture and analyze relevant data about learners to select and present individually tailored learning stimuli - are a promising aid in learners’ and educators’ efforts to provide learning experiences that meet individual needs. In this article, we summarize and build upon the 2017 Society for Simulation in Healthcare Research Summit panel discussion on adaptive learning. First, we consider the role of adaptivity in learning broadly. We then outline the basic functions that adaptive learning technologies must implement and the unique affordances and challenges of technology-based approaches for those functions, sharing an illustrative example from healthcare simulation. Finally, we consider future directions for accelerating research, development, and deployment of effective adaptive educational technology and techniques in healthcare simulation.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{loucks_you_2018,

title = {You can do that⁈: Feasibility of virtual reality exposure therapy in the treatment of PTSD due to military sexual trauma},

author = {Laura Loucks and Carly Yasinski and Seth D. Norrholm and Jessica Maples-Keller and Loren Post and Liza Zwiebach and Devika Fiorillo and Megan Goodlin and Tanja Jovanovic and Albert A. Rizzo and Barbara O. Rothbaum},

url = {https://linkinghub.elsevier.com/retrieve/pii/S0887618517304991},

doi = {10.1016/j.janxdis.2018.06.004},

issn = {08876185},

year  = {2018},

date = {2018-06-01},

journal = {Journal of Anxiety Disorders},

abstract = {This initial feasibility study examined the use of virtual reality exposure therapy (VRE) in the treatment of MSTrelated PTSD, with newly developed content tailored to MST. Participants included 15 veterans (26% male) with MST-related PTSD. Assessment of PTSD, depression, and psychophysiological indicators of distress occurred at pre-treatment, post-treatment, and 3-month follow-up. Treatment included 6–12 VRE sessions. There were significant reductions in pre- to post-treatment PTSD (CAPS severity: t(10) = 3.69},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{norr_virtual_2018,

title = {Virtual reality exposure versus prolonged exposure for PTSD: Which treatment for whom?},

author = {Aaron M. Norr and Derek J. Smolenski and Andrea C. Katz and Albert A. Rizzo and Barbara O. Rothbaum and JoAnn Difede and Patricia Koenen-Woods and Mark A. Reger and Greg M. Reger},

url = {http://doi.wiley.com/10.1002/da.22751},

doi = {10.1002/da.22751},

issn = {10914269},

year  = {2018},

date = {2018-06-01},

journal = {Depression and Anxiety},

volume = {35},

number = {6},

pages = {523–529},

abstract = {1 Background The majority of studies comparing active psychological treatments for posttraumatic stress disorder (PTSD) do not find significant differences at posttreatment. This was the case in a recent trial examining prolonged exposure (PE) and virtual reality exposure (VRE) among active‐duty soldiers with combat‐related PTSD. Matching individual patients to specific treatments provides a potential avenue to improve significantly the public health impact of effective treatments for PTSD. A composite moderator approach was used to identify profiles of patients who would see superior PTSD symptom reduction in VRE or PE to inform future treatment matching. 2 Methods Active duty U.S. army soldiers (N = 108) were enrolled in a randomized clinical trial comparing VRE and PE in the treatment of PTSD stemming from deployments to Iraq or Afghanistan. Eighteen baseline variables were examined to identify treatment response heterogeneity in two patient groups: those with a superior response to PE and those with a superior response to VRE. The final composite moderator comprised four of 18 baseline variables. 3 Results Results revealed that patients who were predicted to see greater PTSD symptom reduction in VRE were likely to be younger, not taking antidepressant medication, had greater PTSD hyperarousal symptoms, and were more likely to have greater than minimal suicide risk. 4 Conclusions Results suggest that treatment matching based on patient profiles could meaningfully improve treatment efficacy for combat‐related PTSD. Future research can build on these results to improve our understanding of how to improve treatment matching for PTSD.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{bioulac_virtual_2018,

title = {Virtual Remediation Versus Methylphenidate to Improve Distractibility in Children With ADHD: A Controlled Randomized Clinical Trial Study},

author = {Stéphanie Bioulac and Jean-Arthur Micoulaud-Franchi and Jenna Maire and Manuel P. Bouvard and Albert A. Rizzo and Patricia Sagaspe and Pierre Philip},

url = {http://journals.sagepub.com/doi/abs/10.1177/1087054718759751},

doi = {10.1177/1087054718759751},

year  = {2018},

date = {2018-03-01},

journal = {Journal of attention disorders},

abstract = {Objective: Virtual environments have been used to assess children with ADHD but have never been tested as therapeutic tools. We tested a new virtual classroom cognitive remediation program to improve symptoms in children with ADHD. Method: In this randomized clinical trial, 51 children with ADHD (7-11 years) were assigned to a virtual cognitive remediation group, a methylphenidate group, or a psychotherapy group. All children were evaluated before and after therapy with an ADHD Rating Scale, a Continuous Performance Test (CPT), and a virtual classroom task. Results: After therapy by virtual remediation, children exhibited significantly higher numbers of correct hits on the virtual classroom and CPT. These improvements were equivalent to those observed with methylphenidate treatment. Conclusion: Our study demonstrates for the first time that a cognitive remediation program delivered in a virtual classroom reduces distractibility in children with ADHD and could replace methylphenidate treatment in specific cases.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{rizzo_skip_will_2018,

title = {Will healthcare be where the killer VR apps will emerge?},

author = {Skip Rizzo},

url = {https://www.virtualreality-news.net/news/2018/feb/13/will-healthcare-be-where-killer-vr-apps-will-emerge/},

year  = {2018},

date = {2018-02-01},

journal = {VR 360},

abstract = {Virtual reality (VR) technology offers new opportunities for clinical research, assessment, and intervention. Since the mid-1990s, VR-based testing, training, teaching, and treatment approaches have been developed by clinicians and researchers that would be difficult, if not impossible, to deliver using traditional methods},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{rizzo_clinical_2018,

title = {Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD},

author = {Albert ‘Skip’ Rizzo and Russell Shilling},

url = {https://www.tandfonline.com/doi/full/10.1080/20008198.2017.1414560},

doi = {10.1080/20008198.2017.1414560},

issn = {2000-8198, 2000-8066},

year  = {2018},

date = {2018-01-01},

journal = {European Journal of Psychotraumatology},

volume = {8},

number = {sup5},

abstract = {Numerous reports indicate that the incidence of posttraumatic stress disorder (PTSD) in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/ OND) military personnel has created a significant behavioural healthcare challenge. These findings have served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. The current article presents the use of Virtual Reality (VR) as a clinical tool to address the assessment, prevention, and treatment of PTSD, based on the VR projects that were evolved at the University of Southern California Institute for Creative Technologies since 2004. A brief discussion of the definition and rationale for the clinical use of VR is followed by a description of a VR application designed for the delivery of prolonged exposure (PE) for treating Service Members (SMs) and Veterans with combat- and sexual assault-related PTSD. The expansion of the virtual treatment simulations of Iraq and Afghanistan for PTSD assessment and prevention is then presented. This is followed by a forward-looking discussion that details early efforts to develop virtual human agent systems that serve the role of virtual patients for training the next generation of clinical providers, as healthcare guides that can be used to support anonymous access to trauma-relevant behavioural healthcare information, and as clinical interviewers capable of automated behaviour analysis of users to infer psychological state. The paper will conclude with a discussion of VR as a tool for breaking down barriers to care in addition to its direct application in assessment and intervention.},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{rizzo_is_2017,

title = {Is clinical virtual reality ready for primetime?},

author = {Albert “Skip” Rizzo and Sebastian Thomas Koenig},

url = {https://www.researchgate.net/publication/319165844_Is_Clinical_Virtual_Reality_Ready_for_Primetime},

doi = {10.1037/neu0000405},

issn = {1931-1559, 0894-4105},

year  = {2017},

date = {2017-10-01},

journal = {Neuropsychology},

volume = {31},

number = {8},

pages = {877–899},

abstract = {Objective: Since the mid-1990s, a significant scientific literature has evolved regarding the outcomes from the use of what we now refer to as Clinical Virtual Reality (VR). This use of VR simulation technology has produced encouraging results when applied to address cognitive, psychological, motor, and functional impairments across a wide range of clinical health conditions. This article addresses the question, “Is Clinical VR Ready for Primetime?” Method: After a brief description of the various forms of VR technology, we discuss the trajectory of Clinical VR over the last 20 years and summarize the basic assets that VR offers for creating clinical applications. The discussion then addresses the question of readiness in terms of the theoretical basis for Clinical VR assets, the research to date, the pragmatic factors regarding availability, usability, and costs of Clinical VR content/systems, and the ethical issues for the safe use of VR with clinical populations. Results: Our review of the theoretical underpinnings and research findings to date leads to the prediction that Clinical VR will have a significant impact on future research and practice. Pragmatic issues that can influence adoption across many areas of psychology also appear favorable, but professional guidelines will be needed to promote its safe and ethical use. Conclusions: While there is still much research needed to advance the science in this area, we strongly believe that Clinical VR applications will become indispensable tools in the toolbox of psychological researchers and practitioners and will only grow in relevance and popularity in the future. Keywords: Clinical Virtual Reality, Psychology, Rehabilitation, Neuropsychology},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{schnurr_what_2017,

title = {What I have changed my mind about and why: public health and technology perspectives in the field of trauma studies},

author = {Paula P. Schnurr and Richard Bryant and Lucy Berliner and Dean G. Kilpatrick and Albert Rizzo and Josef I. Ruzek},

url = {https://www.tandfonline.com/doi/full/10.1080/20008198.2017.1372007},

doi = {10.1080/20008198.2017.1372007},

issn = {2000-8198, 2000-8066},

year  = {2017},

date = {2017-09-01},

journal = {European Journal of Psychotraumatology},

volume = {8},

number = {sup5},

abstract = {Background: This paper is based on a panel discussion at the 32nd annual meeting of the International Society for Traumatic Stress Studies in Dallas, Texas, in November 2016. Objective: Paula Schnurr convened a panel of experts in the fields of public health and technology to address the topic: ‘What I have changed my mind about and why.’ Method: The panel included Richard Bryant, Lucy Berliner, Dean Kilpatrick, Albert (‘Skip’) Rizzo, and Josef Ruzek. Results: Panellists discussed innovative strategies for the dissemination of scientific knowledge and evidence-based treatment. Conclusions: Although there are effective treatments, there is a need to enhance the effectiveness of these treatments. There also is a need to develop simpler, low-cost strategies to disseminate effective treatments. However, technology approaches also offer pathways to increased dissemination. Researchers must communicate scientific findings more effectively to impact public opinion and public policy.},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{kang_social_2017,

title = {Social influence of humor in virtual human counselor's self-disclosure},

author = {Sin-Hwa Kang and David M. Krum and Peter Khooshabeh and Thai Phan and Chien-Yen Chang and Ori Amir and Rebecca Lin},

url = {http://doi.wiley.com/10.1002/cav.1763},

doi = {10.1002/cav.1763},

issn = {15464261},

year  = {2017},

date = {2017-04-01},

journal = {Computer Animation and Virtual Worlds},

volume = {28},

number = {3-4},

abstract = {We explored the social influence of humor in a virtual human counselor's selfdisclosure while also varying the ethnicity of the virtual counselor. In a 2 × 3 experiment (humor and ethnicity of the virtual human counselor), participants experienced counseling interview interactions via Skype on a smartphone. We measured user responses to and perceptions of the virtual human counselor. The results demonstrate that humor positively affects user responses to and perceptions of a virtual counselor. The results further suggest that matching styles of humor with a virtual counselor's ethnicity influences user responses and perceptions. The results offer insight into the effective design and development of realistic and believable virtual human counselors. Furthermore, they illuminate the potential use of humor to enhance self‐disclosure in human–agent interactions.},

keywords = {ARL, DoD, MedVR, MxR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{rizzo_ultimate_2017,

title = {The Ultimate Skinner Box: Clinical Virtual Reality 1990-2016},

author = {Albert "Skip" Rizzo},

url = {https://www.engadget.com/2017/01/10/the-ultimate-skinner-box-clinical-virtual-reality-1990-2016/},

year  = {2017},

date = {2017-01-01},

journal = {Engadget},

abstract = {The last decade has given rise to a dramatic increase in the global adoption of innovative digital technologies. This can be seen in the rapid acceptance and growing demand for mobile devices, high speed network access, smart televisions, social media, hyper-realistic digital games, behavioral sensing devices, and now the 2nd coming of Virtual Reality! Such consumer driven technologies that were considered to be visionary just 10 years ago have now become common and increasingly essential fixtures in the current digital landscape},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{shefer_eini_camera-tracking_2017,

title = {Camera-tracking gaming control device for evaluation of active wrist flexion and extension},

author = {Dalit Shefer Eini and Navah Z. Ratzon and Albert A. Rizzo and Shih-Ching Yeh and Belinda Lange and Batia Yaffe and Alexander Daich and Patrice L. Weiss and Rachel Kizony},

url = {http://linkinghub.elsevier.com/retrieve/pii/S0894113016301132},

doi = {10.1016/j.jht.2016.07.002},

issn = {08941130},

year  = {2017},

date = {2017-01-01},

journal = {Journal of Hand Therapy},

volume = {30},

number = {1},

pages = {89–96},

abstract = {Study Design: Cross sectional. Introduction: Measuring wrist range of motion (ROM) is an essential procedure in hand therapy clinics. Purpose of the Study: To test the reliability and validity of a dynamic ROM assessment, the Camera WristTracker (CWT). Methods: Wrist flexion and extension ROM of 15 patients with distal radius fractures and 15 matchedcontrols were assessed with the CWT and with a universal goniometer. Results: One-way model intraclass correlation coefficient analysis indicated high test-retest reliability for extension (ICC ¼ 0.92) and moderate reliability for flexion (ICC ¼ 0.49). Standard error for extension was 2.45 and for flexion was 4.07 . Repeated-measures analysis revealed a significant main effect for group; ROM was greater in the control group (F[1, 28] ¼ 47.35; P textbackslashtextbackslashtextbackslashtextless.001). The concurrent validity of the CWT was partially supported. Conclusion: The results indicate that the CWT may provide highly reliable scores for dynamic wrist extension ROM, and moderately reliable scores for flexion, in people recovering from a distal radius fracture. Level of Evidence: N/A.},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}

@article{rizzo_detection_2016,

title = {Detection and computational analysis of psychological signals using a virtual human interviewing agent},

author = {Albert Rizzo and Scherer Scherer and David DeVault and Jonathan Gratch and Ronald Artstein and Arno Hartholt and Gale Lucas and Stacy Marsella and Fabrizio Morbini and Angela Nazarian and Giota Stratou and David Traum and Rachel Wood and Jill Boberg and Louis Philippe Morency},

url = {http://www.icdvrat.org/2014/papers/ICDVRAT2014_S03N3_Rizzo_etal.pdf},

issn = {1939-5914},

year  = {2016},

date = {2016-11-01},

journal = {Journal of Pain Management},

pages = {311–321},

abstract = {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. 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 real-time audiovisual behavioral signals from users interacting with the system. It is specifically designed for health care support and leverages years of virtual human research and development at USC-ICT. The platform enables an engaging face-to-face interaction where the virtual human automatically reacts to the state and inferred intent of the user through analysis of behavioral signals gleaned from facial expressions, body gestures and vocal parameters. Akin to how non-verbal behavioral signals have an impact on human to human interaction and communication, SimSensei aims to capture and infer from user non-verbal communication to improve engagement between a VH and a user. The system can also quantify and interpret sensed behavioral signals longitudinally that can be used to inform diagnostic assessment within a clinical context.},

keywords = {MedVR, UARC, Virtual Humans},

pubstate = {published},

tppubtype = {article}

}

@article{galen_buckwalter_allostatic_2016,

title = {Allostatic Load as a Complex Clinical Construct: A Case-Based Computational Modeling Approach},

author = {J. Galen Buckwalter and Brian Castellani and Bruce Mcewen and Arun S. Karlamangla and Albert A. Rizzo and Bruce John and Kyle O'donnell and Teresa Seeman},

url = {http://doi.wiley.com/10.1002/cplx.21743},

doi = {10.1002/cplx.21743},

issn = {10762787},

year  = {2016},

date = {2016-09-01},

journal = {Complexity},

volume = {21},

number = {S1},

pages = {291–306},

abstract = {Allostatic load (AL) is a complex clinical construct, providing a unique window into the cumulative impact of stress. However, due to its inherent complexity, AL presents two major measurement challenges to conventional statistical modeling (the field’s dominant methodology): it is comprised of a complex causal network of bioallostatic systems, represented by an even larger set of dynamic biomarkers; and, it is situated within a web of antecedent socioecological systems, linking AL to differences in health outcomes and disparities. To address these challenges, we employed casebased computational modeling (CBM), which allowed us to make four advances: (1) we developed a multisystem, 7-factor (20 biomarker) model of AL’s network of allostatic systems; (2) used it to create a catalog of nine different clinical AL profiles (causal pathways); (3) linked each clinical profile to a typology of 23 health outcomes; and (4) explored our results (post hoc) as a function of gender, a key socioecological factor. In terms of highlights, (a) the Healthy clinical profile had few health risks; (b) the pro-inflammatory profile linked to high blood pressure and diabetes; (c) Low Stress Hormones linked to heart disease, TIA/Stroke, diabetes, and circulation problems; and (d) high stress hormones linked to heart disease and high blood pressure. Post hoc analyses also found that males were overrepresented on the High Blood Pressure (61.2%), Metabolic Syndrome (63.2%), High Stress Hormones (66.4%), and High Blood Sugar (57.1%); while females were overrepresented on the Healthy (81.9%), Low Stress Hormones (66.3%), and Low Stress Antagonists (stress buffers) (95.4%) profiles.},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{reger_randomized_2016,

title = {Randomized Controlled Trial of Prolonged Exposure Using Imaginal Exposure vs. Virtual Reality Exposure in Active Duty Soldiers With Deployment-Related Posttraumatic Stress Disorder (PTSD).},

author = {Greg M. Reger and Patricia Koenen-Woods and Kimberlee Zetocha and Derek J. Smolenski and Kevin M. Holloway and Barbara O. Rothbaum and JoAnn Difede and Albert A. Rizzo and Amanda Edwards-Stewart and Nancy A. Skopp and Matthew Mishkind and Mark A. Reger and Gregory A. Gahm},

url = {https://www.researchgate.net/profile/Amanda_Edwards-Stewart/publication/307950241_Randomized_Controlled_Trial_of_Prolonged_Exposure_Using_Imaginal_Exposure_vs_Virtual_Reality_Exposure_in_Active_Duty_Soldiers_With_Deployment-Related_Posttraumatic_Stress_Disorder_PTSD/links/57d6f13f08ae601b39ac25d9.pdf},

doi = {10.1037/ccp0000134},

issn = {1939-2117, 0022-006X},

year  = {2016},

date = {2016-09-01},

journal = {Journal of Consulting and Clinical Psychology},

abstract = {Prolonged exposure (PE) is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD) but there is limited research with active-duty military populations. Virtual reality exposure (VRE) has shown promise but randomized trials are needed to evaluate efficacy relative to existing standards of care. This study evaluated the efficacy of VRE and PE for active duty soldiers with PTSD from deployments to Iraq and Afghanistan. Active-duty soldiers ( = 162) were randomized to 10-sessions of PE, VRE, or a minimal attention waitlist (WL). Blinded assessors evaluated symptoms at baseline, halfway through treatment, at posttreatment, and at 3- and 6-month follow-ups using the Clinician Administered PTSD Scale (CAPS). Intent-to-treat analyses found that both PE and VRE resulted in significant reductions in PTSD symptoms relative to those in the WL. The majority of patients demonstrated reliable change in PTSD symptoms. There was no difference between PE and VRE regarding treatment drop out before completing 10 sessions (44 and 41% for VRE and PE, respectively). Contrary to hypotheses, analyses at posttreatment did not show that VRE was superior to PE. Post hoc analyses found that PE resulted in significantly greater symptom reductions than VRE at 3- and 6-month follow-up. Both treatments significantly reduced self-reported stigma. PE is an efficacious treatment for active-duty Army soldiers with PTSD from deployments to Iraq or Afghanistan. Results extend previous evidence supporting the efficacy of PE to active-duty military personnel and raise important questions for future research on VRE},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{freed_irb_2016,

title = {IRB and Research Regulatory Delays Within the Military Health System: Do They Really Matter? And If So, Why and for Whom?},

author = {Michael C. Freed and Laura A. Novak and William D. S. Killgore and Sheila A. M. Rauch and Tracey P. Koehlmoos and J. P. Ginsberg and Janice L. Krupnick and Albert "Skip" Rizzo and Anne Andrews and Charles C. Engel},

url = {http://www.tandfonline.com/doi/full/10.1080/15265161.2016.1187212},

doi = {10.1080/15265161.2016.1187212},

issn = {1526-5161, 1536-0075},

year  = {2016},

date = {2016-08-01},

journal = {The American Journal of Bioethics},

volume = {16},

number = {8},

pages = {30–37},

abstract = {Institutional review board (IRB) delays may hinder the successful completion of federally funded research in the U.S. military. When this happens, time-sensitive, mission-relevant questions go unanswered. Research participants face unnecessary burdens and risks if delays squeeze recruitment timelines, resulting in inadequate sample sizes for definitive analyses. More broadly, military members are exposed to untested or undertested interventions, implemented by well-intentioned leaders who bypass the research process altogether. To illustrate, we offer two case examples. We posit that IRB delays often appear in the service of managing institutional risk, rather than protecting research participants. Regulators may see more risk associated with moving quickly than risk related to delay, choosing to err on the side of bureaucracy. The authors of this article, all of whom are military-funded researchers, government stakeholders, and/or human subject protection experts, offer feasible recommendations to improve the IRB system and, ultimately, research within military, veteran, and civilian populations.},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{washburn_pilot_2016,

title = {A pilot feasibility study of virtual patient simulation to enhance social work students’ brief mental health assessment skills},

author = {Micki Washburn and Patrick Bordnick and Albert “Skip” Rizzo},

url = {https://www.tandfonline.com/doi/full/10.1080/00981389.2016.1210715},

doi = {10.1080/00981389.2016.1210715},

issn = {0098-1389, 1541-034X},

year  = {2016},

date = {2016-08-01},

journal = {Social Work in Health Care},

pages = {1–19},

abstract = {This study presents preliminary feasibility and acceptability data on the use of virtual patient (VP) simulations to develop brief assessment skills within an interdisciplinary care setting. Results support the acceptability of technology-enhanced simulations and offer preliminary evidence for an association between engagement in VP practice simulations and improvements in diagnostic accuracy and clinical interviewing skills. Recommendations and next steps for research on technologyenhanced simulations within social work are discussed.},

keywords = {MedVR, UARC},

pubstate = {published},

tppubtype = {article}

}

@article{norrholm_baseline_2016,

title = {Baseline psychophysiological and cortisol reactivity as a predictor of PTSD treatment outcome in virtual reality exposure therapy},

author = {Seth Davin Norrholm and Tanja Jovanovic and Maryrose Gerardi and Kathryn G. Breazeale and Matthew Price and Michael Davis and Erica Duncan and Kerry J. Ressler and Bekh Bradley and Albert Rizzo and Peter W. Tuerk and Barbara O. Rothbaum},

url = {http://linkinghub.elsevier.com/retrieve/pii/S0005796716300663},

doi = {10.1016/j.brat.2016.05.002},

issn = {00057967},

year  = {2016},

date = {2016-07-01},

journal = {Behaviour Research and Therapy},

volume = {82},

pages = {28–37},

abstract = {Baseline cue-dependent physiological reactivity may serve as an objective measure of posttraumatic stress disorder (PTSD) symptoms. Additionally, prior animal model and psychological studies would suggest that subjects with greatest symptoms at baseline may have the greatest violation of expectancy to danger when undergoing exposure based psychotherapy; thus treatment approaches which enhanced the learning under these conditions would be optimal for those with maximal baseline cue-dependent reactivity. However methods to study this hypothesis objectively are lacking. Virtual reality (VR) methodologies have been successfully employed as an enhanced form of imaginal prolonged exposure therapy for the treatment of PTSD. Our goal was to examine the predictive nature of initial psychophysiological (e.g., startle, skin conductance, heart rate) and stress hormone responses (e.g., cortisol) during presentation of VR-based combat-related stimuli on PTSD treatment outcome. Combat veterans with PTSD underwent 6 weeks of VR exposure therapy combined with either D-cycloserine (DCS), alprazolam (ALP), or placebo (PBO). In the DCS group, startle response to VR scenes prior to initiation of treatment accounted for 76% of the variance in CAPS change scores, p textbackslashtextbackslashtextbackslashtextless 0.001, in that higher responses predicted greater changes in symptom severity over time. Additionally, baseline cortisol reactivity was inversely associated with treatment response in the ALP group},

keywords = {MedVR},

pubstate = {published},

tppubtype = {article}

}