In the context of Cognitive and Behavioural Therapies, the use of immersion technologies to replace classical exposure could improve the therapeutic process. As it is necessary to validate the efficiency of such a technique, both therapists and VR specialists need tools to monitor the impact of Virtual Reality Exposure on the patients. According to previous observations and experiments, it appears that an automatic evaluation of the Arousal and Valence components of affective reactions can provide significant information. The present study investigates a possible solution of Arousal and Valence computation from physiological measurements. Results show that the dimensional reduction is not statistically meaningful, but the correlations found encourage the investigation of this approach as a complement to cognitive and behavioural study of the patient.

Abstract:In this paper, we present a study, conducted over eight social phobic subjects, whose aim is to evaluate the efficiency and flexibility of virtual reality as a therapeutic tool in the confines of a social phobia behavioral therapeutic program. Our research protocol, accepted by the ethical commission of the cantonal hospices' psychiatry service, is identical in content and structure for each patient. This study's second goal is to use virtual exposure to evaluate objectively a specific parameter present in social phobia, namely eye contact avoidance, by using an eyetracking system. Analysis of our results shows a tendency to improvement in the subjects' feedback to specific assessment scales, which is correlated to the decrease of eye contact avoidance. The results show that the presented virtual reality exposure therapy protocol could be successfully applied to social therapy.

Exposure is considered to be an essential ingredient of cognitive-behavioral therapy treatment of social phobia and of most anxiety disorders. To assess the impact of the amount of exposure on outcome, 30 social phobic patients were randomly allocated to 1 of 2 group treatments of 8 weekly sessions: Self-Focused Exposure Therapy which is based essentially on prolonged exposure to public speaking combined with positive feedback or a more standard cognitive and behavioral method encompassing psychoeducation, cognitive work, working through exposure hierarchies of feared situations for exposure within and outside the group. The results show that the 2 methods led to significant and equivalent symptomatic improvements which were maintained at 1-year follow-up. There was a more rapid and initially more pronounced decrease in negative cognitions with the Self-Focused Exposure Therapy, which included no formal cognitive work, than with the more standard approach in which approximately a third of the content was cognitive. In contrast, decrease in social avoidance was more persistent with standard cognitive-behavior therapy which involved less exposure. The results indicate that positive cognitive change can be achieved more rapidly with non cognitive methods while avoidance decreases more reliably with a standard approach rather than an approach with an exclusive focus on exposure.

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Sir:We previously reported using ephedrine to successfully treat clozapine-induced urinary incontinence in a population of patients with treatment-refractory schizophrenia and schizoaffective disorder (DSM-IV).1 It was postulated that the anti-α-adrenergic effects of clozapine were involved and that an α-adrenergic agonist (ephedrine) would reduce urinary inconti-