Sensory Interactive Table (SIT)-Development of a Measurement Instrument to Support Healthy Eating in a Social Dining Setting.

This paper presents the Sensory Interactive Table (SIT): an instrumented, interactive dining table. Through the use of load cells and LEDs that are embedded in the table surface, SIT allows us to study: (1) the eating behaviors of people in a social setting, (2) the social interactions around the eating behaviors of people in a social setting, and (3) the continuous cycle of feedback through LEDs on people's eating behavior and their response to this feedback in real time, to ultimately create an effective dietary support system. This paper presents the hard- and software specifications of the system, and it shows the potential of the system to capture mass-related dimensions in real time and with high accuracy and spatial resolution.

AMAB: automated measurement and analysis of body motion.

Technologies that measure human nonverbal behavior have existed for some time, and their use in the analysis of social behavior has become more popular following the development of sensor technologies that record full-body movement. However, a standardized methodology to efficiently represent and analyze full-body motion is absent. In this article, we present automated measurement and analysis of body motion (AMAB), a methodology for examining individual and interpersonal nonverbal behavior from the output of full-body motion tracking systems. We address the recording, screening, and normalization of the data, providing methods for standardizing the data across recording condition and across subject body sizes. We then propose a series of dependent measures to operationalize common research questions in psychological research. We present practical examples from several application areas to demonstrate the efficacy of our proposed method for full-body measurements and comparisons across time, space, body parts, and subjects.

Development of an Alcohol Refusal Training in Immersive Virtual Reality for Patients With Mild to Borderline Intellectual Disability and Alcohol Use Disorder: Cocreation With Experts in Addiction Care.

BACKGROUND: People with mild to borderline intellectual disability (MBID; IQ=50-85) are at risk for developing an alcohol use disorder (AUD). One factor contributing to this risk is sensitivity to peer pressure. Hence, tailored trainings are needed to practice alcohol refusal in impacted patients. Immersive virtual reality (IVR) appears promising to engage patients in dialogs with virtual humans, allowing to practice alcohol refusal realistically. However, requirements for such an IVR have not been studied for MBID/AUD. OBJECTIVE: This study aims to develop an IVR alcohol refusal training for patients with MBID and AUD. In this work, we cocreated our peer pressure simulation with experienced experts in addiction care. METHODS: We followed the Persuasive System Design (PSD) model to develop our IVR alcohol refusal training. With 5 experts from a Dutch addiction clinic for patients with MBID, we held 3 focus groups to design the virtual environment, persuasive virtual human(s), and persuasive dialog. Subsequently, we developed our initial IVR prototype and conducted another focus group to evaluate IVR and procedures for clinical usage, resulting in our final peer pressure simulation. RESULTS: Our experts described visiting a friend at home with multiple friends as the most relevant peer pressure situation in the clinical setting. Based on the identified requirements, we developed a social-housing apartment with multiple virtual friends present. Moreover, we embedded a virtual man with generic appearance to exert peer pressure using a persuasive dialog. Patients can respond to persuasive attempts by selecting (refusal) responses with varying degrees of risk for relapse in alcohol use. Our evaluation showed that experts value a realistic and interactable IVR. However, experts identified lacking persuasive design elements, such as paralanguage, for our virtual human. For clinical usage, a user-centered customization is needed to prevent adverse effects. Further, interventions should be therapist delivered to avoid try-and-error in patients with MBID. Lastly, we identified factors for immersion, as well as facilitators and barriers for IVR accessibility. CONCLUSIONS: Our work establishes an initial PSD for IVR for alcohol refusal trainings in patients with MBID and AUD. With this, scholars can create comparable simulations by performing an analogous cocreation, replicate findings, and identify active PSD elements. For peer pressure, conveying emotional information in a virtual human's voice (eg, paralanguage) seems vital. However, previous rapport building may be needed to ensure that virtual humans are perceived as cognitively capable entities. Future work should validate our PSD with patients and start developing IVR treatment protocols using interdisciplinary teams.

Developing an eMental health monitoring module for older mourners using fuzzy cognitive maps.

Objective: Effective internet interventions often combine online self-help with regular professional guidance. In the absence of regularly scheduled contact with a professional, the internet intervention should refer users to professional human care if their condition deteriorates. The current article presents a monitoring module to recommend proactively seeking offline support in an eMental health service to aid older mourners. Method: The module consists of two components: a user profile that collects relevant information about the user from the application, enabling the second component, a fuzzy cognitive map (FCM) decision-making algorithm that detects risk situations and to recommend the user to seek offline support, whenever advisable. In this article, we show how we configured the FCM with the help of eight clinical psychologists and we investigate the utility of the resulting decision tool using four fictitious scenarios. Results: The current FCM algorithm succeeds in detecting unambiguous risk situations, as well as unambiguously safe situations, but it has more difficulty classifying borderline cases correctly. Based on recommendations from the participants and an analysis of the algorithm's erroneous classifications, we propose how the current FCM algorithm can be further improved. Conclusion: The configuration of FCMs does not necessarily demand large amounts of privacy-sensitive data and their decisions are scrutable. Thus, they hold great potential for automatic decision-making algorithms in mental eHealth. Nevertheless, we conclude that there is a need for clear guidelines and best practices for developing FCMs, specifically for eMental health.

Analyzing nonverbal listener responses using parallel recordings of multiple listeners.

In this paper, we study nonverbal listener responses on a corpus with multiple parallel recorded listeners. These listeners were meant to believe that they were the sole listener, while in fact there were three persons listening to the same speaker. The speaker could only see one of the listeners. We analyze the impact of the particular setup of the corpus on the behavior and perception of the two types of listeners: the listeners that could be seen by the speaker and the listeners that could not be seen. Furthermore, we compare the nonverbal listening behaviors of these three listeners to each other with regard to timing and form. We correlate these behaviors with behaviors of the speaker, like pauses and whether the speaker is looking at the listeners or not.

Immersive Virtual Reality Avatars for Embodiment Illusions in People With Mild to Borderline Intellectual Disability: User-Centered Development and Feasibility Study.

BACKGROUND: Immersive virtual reality (IVR) has been investigated as a tool for treating psychiatric conditions. In particular, the practical nature of IVR, by offering a doing instead of talking approach, could support people who do not benefit from existing treatments. Hence, people with mild to borderline intellectual disability (MBID; IQ=50-85) might profit particularly from IVR therapies, for instance, to circumvent issues in understanding relevant concepts and interrelations. In this context, immersing the user into a virtual body (ie, avatar) appears promising for enhancing learning (eg, by changing perspectives) and usability (eg, natural interactions). However, design requirements, immersion procedures, and proof of concept of such embodiment illusion (ie, substituting the real body with a virtual one) have not been explored in this group. OBJECTIVE: Our study aimed to establish design guidelines for IVR embodiment illusions in people with MBID. We explored 3 factors to induce the illusion, by testing the avatar's appearance, locomotion using IVR controllers, and virtual object manipulation. Furthermore, we report on the feasibility to induce the embodiment illusion and provide procedural guidance. METHODS: We conducted a user-centered study with 29 end users in care facilities, to investigate the avatar's appearance, controller-based locomotion (ie, teleport, joystick, or hybrid), and object manipulation. Overall, 3 iterations were conducted using semistructured interviews to explore design factors to induce embodiment illusions in our group. To further understand the influence of interactions on the illusion, we measured the sense of embodiment (SoE) during 5 interaction tasks. RESULTS: IVR embodiment illusions can be induced in adults with MBID. To induce the illusion, having a high degree of control over the body outweighed avatar customization, despite the participants' desire to replicate their own body image. Similarly, the highest SoE was measured during object manipulation tasks, which required a combination of (virtual) locomotion and object manipulation behavior. Notably, interactions that are implausible (eg, teleport and occlusions when grabbing) showed a negative influence on SoE. In contrast, implementing artificial interaction aids into the IVR avatar's hands (ie, for user interfaces) did not diminish the illusion, presuming that the control was unimpaired. Nonetheless, embodiment illusions showed a tedious and complex need for (control) habituation (eg, motion sickness), possibly hindering uptake in practice. CONCLUSIONS: Balancing the embodiment immersion by focusing on interaction habituation (eg, controller-based locomotion) and lowering customization effort seems crucial to achieve both high SoE and usability for people with MBID. Hence, future studies should investigate the requirements for natural IVR avatar interactions by using multisensory integrations for the virtual body (eg, animations, physics-based collision, and touch) and other interaction techniques (eg, hand tracking and redirected walking). In addition, procedures and use for learning should be explored for tailored mental health therapies in people with MBID.

Consulting the Oracle: A Delphi study for determining parameters for a mental health user profile and personalization strategy for an online service to aid grieving older adults.

While much effort has been devoted to the development of mental e-health interventions, the tailoring of these applications to user characteristics and needs is a comparatively novel field of research. The premise of personalizing mental e-health interventions is that personalization increases user motivation and (thereby) mitigates intervention dropout and enhances clinical effectiveness. In this study, we selected user profile parameters for personalizing a mental e-health intervention for older adults who lost their spouse. We conducted a three-round Delphi study involving an international and interdisciplinary expert panel (N = 16) with two objectives. The first aim was to elicit adaptation strategies that can be used to dynamically readjust the intervention to the user's needs. The second aim was to identify a set of meaningful indicators for monitoring the user from within the grief intervention to escalate from self-help to blended care, whenever advisable. This Delphi study used as starting point an evaluated, text-based grief intervention composed of ten modules, including psychoeducation about grief and cognitive-behavioral exercises to support the user in adjusting their lives after bereavement. Every user follows this grief intervention in a linear fashion from beginning to end. The resulting conceptual adaptation model encompasses dynamic adjustments, as well as one-time adjustments performed at the initialization of the service. On the level of the application structure, the adaptations affect when which topic module is presented to the user. The adaptations further provide strategies for adjusting the text-based content of individual intervention modules dependent on user characteristics and for selecting appropriate reactions to user input. Eighteen monitoring parameters were elicited and grouped into four categories: clinical, behavioral/emotional, interactive, and external. Parameters that were perceived as most urgent to attend to for escalation were Suicidality, Self-destructive behavior, Client-initiated escalation, Unresponsiveness and (Complicated) Grief symptoms.

Who Makes Your Heart Beat? What Makes You Sweat? Social Conflict in Virtual Reality for Educators.

Though educators often deal with stressful social conflicts, many face them ad hoc without much training. We studied if and how virtual agents can help University staff manage student-teacher conflicts. We explored educators' verbal, behavioral, and physiological reactions to a virtual agent that brought up a student-teacher conflict and held exit-interviews. Our qualitative analysis revealed that virtual agents for conflict training were positively received, but not for conflict mediation with cross-cultural differences. Those with non-Western backgrounds felt that an agent could help "save face," whereas Westerners preferred to resolve conflicts in person. In line with this, participants with a Western background rated the virtual agent to be less competent compared to those with non-Western backgrounds. While physiological measures only allow for limited conclusions, we found that participants who believed that the agent was controlled by a human had higher normalized hear rate variability (for the entire conversation in total) than people who thought that the agent was autonomous. We discuss implications for implementing virtual agents for training purposes, the impact of physiological signals, and the need to consider cultural and individual differences.

Clinical Relevance of Immersive Virtual Reality in the Assessment and Treatment of Addictive Disorders: A Systematic Review and Future Perspective.

(1) Background: Virtual reality (VR) has been investigated in a variety of psychiatric disorders, including addictive disorders (ADs); (2) Objective: This systematic review evaluates the current evidence of immersive VR (using head-mounted displays) in the clinical assessment and treatment of ADs; (3) Method: PubMed and PsycINFO were queried for publications up to November 2020; (4) Results: We screened 4519 titles, 114 abstracts and 85 full-texts, and analyzed 36 articles regarding the clinical assessment (i.e., diagnostic and prognostic value; n = 19) and treatment (i.e., interventions; n = 17) of ADs. Though most VR assessment studies (n = 15/19) showed associations between VR-induced cue-reactivity and clinical parameters, only two studies specified diagnostic value. VR treatment studies based on exposure therapy showed no or negative effects. However, other VR interventions like embodied and aversive learning paradigms demonstrated positive findings. The overall study quality was rather poor; (5) Conclusion: Though VR in ADs provides ecologically valid environments to induce cue-reactivity and provide new treatment paradigms, the added clinical value in assessment and therapy remains to be elucidated before VR can be applied in clinical care. Therefore, future work should investigate VR efficacy in randomized clinical trials using well-defined clinical endpoints.

Differences in Spontaneous Interactions of Autistic Children in an Interaction With an Adult and Humanoid Robot.

Robots are promising tools for promoting engagement of autistic children in interventions and thereby increasing the amount of learning opportunities. However, designing deliberate robot behavior aimed at engaging autistic children remains challenging. Our current understanding of what interactions with a robot, or facilitated by a robot, are particularly motivating to autistic children is limited to qualitative reports with small sample sizes. Translating insights from these reports to design is difficult due to the large individual differences among autistic children in their needs, interests, and abilities. To address these issues, we conducted a descriptive study and report on an analysis of how 31 autistic children spontaneously interacted with a humanoid robot and an adult within the context of a robot-assisted intervention, as well as which individual characteristics were associated with the observed interactions. For this analysis, we used video recordings of autistic children engaged in a robot-assisted intervention that were recorded as part of the DE-ENIGMA database. The results showed that the autistic children frequently engaged in exploratory and functional interactions with the robot spontaneously, as well as in interactions with the adult that were elicited by the robot. In particular, we observed autistic children frequently initiating interactions aimed at making the robot do a certain action. Autistic children with stronger language ability, social functioning, and fewer autism spectrum-related symptoms, initiated more functional interactions with the robot and more robot-elicited interactions with the adult. We conclude that the children's individual characteristics, in particular the child's language ability, can be indicative of which types of interaction they are more likely to find interesting. Taking these into account for the design of deliberate robot behavior, coupled with providing more autonomy over the robot's behavior to the autistic children, appears promising for promoting engagement and facilitating more learning opportunities.

Content validity and internal consistency of the Dutch translation of the Safety Attitudes Questionnaire: an observational study.

BACKGROUND: Patient safety is fundamental to healthcare quality. Attention has recently focused on the patient safety culture of an organisation and its impact on patient outcomes. A strong safety climate appears to be an essential condition for safe patient care in the hospital. A number of instruments are used to measure this patient safety climate or culture. The Safety Attitudes Questionnaire is a validated, widely used instrument to investigate multiple dimensions of safety climate at the clinical level in a variety of inpatient and outpatient settings. OBJECTIVES: The purpose of this study is to explore the face- and content validity and the internal consistency of the Safety Attitudes Questionnaire in a large Belgian academic medical center. METHOD: The translation into Dutch was done by three researchers. A panel of fifteen Dutch speaking experts evaluated the translation and its content validity. Content validity was quantified by the content validity index (CVI) and a modified kappa index. Face validity was evaluated by two nurses and two physicians who assessed the Dutch version of the SAQ. A cross-sectional design was used to test internal consistency of the SAQ items by calculating Cronbach's alpha and corrected item-total correlations. RESULTS: Twenty-three of the 33 SAQ items showed excellent and seven items showed good content validity. One item had a fair kappa value (item 20) and two items had a low content validity index (items 15 and 16). The average CVI of the total scale was 0.83 and ranged from 0.55 to 0.97 for the six subscales. The face-validity was good with no fundamental remarks given. The SAQ's overall Cronbach's alpha was 0.9 and changed minimally when removing items. The item-total correlations ranged from 0.10 to 0.63, no single items were strongly correlated with the sum of the other items. CONCLUSION: We conclude that in this study the Dutch version of the Safety Attitudes Questionnaire showed acceptable to good psychometric properties. In line with previous evidence, this instrument seems to be an acceptable to adequate tool to evaluate the safety climate.

Accuracy of head orientation perception in triadic situations: experiment in a virtual environment.

Research has revealed high accuracy in the perception of gaze in dyadic (sender- receiver) situations. Triadic situations differ from these in that an observer has to report where a sender is looking, not relative to himself. This is more difficult owing to the less favourable position of the observer. The effect of the position of the observer on the accuracy of the identification of the sender's looking direction is relatively unexplored. Here, we investigate this, focusing exclusively on head orientation. We used a virtual environment to ensure good stimulus control. We found a mean angular error close to 5 degrees. A higher observer viewpoint results in more accurate identification. Similarly, a viewpoint with a smaller angle to the sender's midsagittal plane leads to an improvement in identification performance. Also, we found an effect of underestimation of the error in horizontal direction, similar to findings for dyadic situations.