A Smartphone-Gamified Virtual Reality Exposure Therapy Augmented With Biofeedback for Ailurophobia: Development and Evaluation Study.

BACKGROUND: To the best of our knowledge, no specialized research has been conducted to address ailurophobia (fear of cats) in Iran or globally. This has driven our project, along with the prevalence of ailurophobia and the absence of a gamified virtual reality exposure therapy (VRET) that incorporates affordable and easily accessible biofeedback (BF) tools. We hypothesize that a gamified VRET augmented with BF will yield more positive effects than a similar device lacking BF. OBJECTIVE: This study primarily focuses on the development and preliminary evaluation of a smartphone-gamified VRET integrated with BF, targeting animal phobia, with a specific case study on ailurophobia. The secondary objectives are using affordable and readily available BF found in devices such as smart bands and smartwatches and creating a mobile virtual reality gamified app to improve patients' adherence to treatments while simultaneously enhancing the app's accessibility, scalability, and outreach. METHODS: Evaluations encompassed 3 methods. First, we identified the tool's potential positive effects on phobia interventions, exploring 4 effects: intrinsic motivation, simulation of fearful situations, management of stressful circumstances without therapists' presence and mitigation of catastrophic thoughts, and preliminary effects on ailurophobia treatment. Participants were divided into BF and non-BF groups. Second, we gathered user preferences and opinions about the treatment. Third, we conducted heuristic evaluations using 44 heuristics from existing system usability scales assessing user interfaces, virtual reality platforms, and video games' playability. To interpret the data, mean scores; ANOVA, single factor; and ANOVA, 2-factor with replication were used. A total of 29 individuals were identified, of which 10 met the eligibility criteria or were accessible. RESULTS: The smartphone-gamified VRET augmented with BF exhibited better results on the identified effects compared with the non-BF version and contributed to normalizing encounters with cats. Moreover, 41 of the 44 heuristics achieved a percentage above 62%, indicating its potential as a therapeutic product and its ability to enhance patient adherence to treatments. Patient preferences on the treatment and its strengths and weaknesses were provided for further improvement. CONCLUSIONS: The tool has the potential to evolve into a comprehensive solution by incorporating various types of cats and their behaviors, simulating environments in which they are commonly found, and enhancing its appeal through an increased sense of adventure without inducing unrealistic fears. By adapting fear elements, the game can be tailored to treat various animal phobias. Phobia-focused games should avoid action and combat scenarios to prevent reinforcement of fear responses. After rigorous evaluation, further exploration is required to provide remote use beyond clinical settings.

Comparison of the Effect of Four Transcranial Direct Current Stimulation Configurations on Picture-Naming Improvement in Non-Fluent Aphasia: A Randomized Clinical Trial.

Background: Anomia is a language disorder that negatively affects communication abilities in people with aphasia (PWA). We aimed to compare the effect of transcranial direct current stimulation (tDCS) over the left and right inferior frontal gyrus (IFG) and superior temporal gyrus (STG) on the picture-naming accuracy and reaction time in PWA. Methods: A randomized, single-blind, sham-controlled crossover trial was conducted in 2021 at Mobasher Kashani Clinic, Hamadan, Iran. Sixteen patients received both five days of real-tDCS (1 mA for 20 minutes) and five days of sham-tDCS with a seven-day washout period in between. Using the Persian aphasia naming test, picture-naming accuracy and reaction time on 50 images were assessed at baseline, real-tDCS, and sham-tDCS stages. The data were analyzed using STATA software, version 11.0. P<0.05 was considered statistically significant. Results: Sixteen non-fluent PWA participated in the study. Of all patients, 64% benefited from tDCS over the STG and 18% over the IFG. The results showed that real-tDCS had a significant effect on the picture-naming accuracy (P=0.003) and the Persian-Western aphasia battery-one score (P=0.01), whereas sham-tDCS had no noticeable effects. Both the real- and sham-tDCS had no significant effect on the reaction time (P=0.28). Conclusion: Five sessions of individualized tDCS protocol (1 mA for 20 minutes) were adequate to improve picture-naming accuracy in patients with chronic aphasia.

Executive functions in Persian-speaking preschool children with speech sound disorders and comparison with their typically developing peers.

This study aimed to compare working memory, inhibitory control, and cognitive flexibility, the core components of executive functions, among two prevalent subtypes of preschool children with speech sound disorder, i.e., phonological delay (n = 16) and consistent phonological disorder (n = 15), and a group of typically developing children (n = 18). The correlation between executive function components and the accuracy of speech sound production were also investigated. Nonword repetition task and syllable repetition task were used to evaluate the phonological loop of working memory. Backward digit span was administered to examine the central executive of working memory. Cognitive flexibility was assessed using the second selection of the flexible item selection task and inhibitory control using Stroop-like and Go/No-Go tasks. The percentage consonants correct was applied to calculate the accuracy of speech sound production. Results of a one-way multivariate analysis of covariance revealed statistically significant differences between groups in the combined dependent variables after controlling for age (F(14, 80) = 17.289, p < .001, Pillai's trace = 1.503, partial ηƞ2 = .752). Typically developing children outperformed in all measurements of executive functions than both speech sound disorder subgroups. Moreover, children with phonological delay performed better in nonword repetition and corrected responses of Stroop-like than consistent phonological disorder group. All executive function measurements also correlated with speech sound production. The results of the present study highlight the importance of including domain-general cognitive skills in current assessment protocols for children with phonological delay and consistent phonological disorders.

Normative Data and Reliability of the Moving Shapes Paradigm.

Objective: Moving Shapes paradigm is a test that evaluates intentionality as a theory of mind (ToM) component. This study aimed to assess the normative data and reliability of this test in a community sample of 9-11-year-old children. Method : A total of 398 children aged between 9 and 11 years were recruited from mainstream elementary schools through a random cluster sampling. All participants were evaluated using the Moving Shapes paradigm. To evaluate test-retest reliability, the test was administered again after 2-4 weeks. Results: The intentionality mean score was 29.70 (+5.88) out of 60. There was no significant difference between girls and boys in test scores. Age was not significantly related to the paradigm variables scores. Ten percent of the participants achieved the scores below 22, and 10% above 37. Cronbach's Alfa was 0.40 for the intentionality score. The test-retest reliability was fair to good (0.43 - 0.79) for different groups of animations. The inter-rater agreement was 80%. Conclusion: The study found that the Moving shapes paradigm is a reliable instrument to evaluate intentionality in normal school-aged children.

A new semi-nonverbal task glance, moderate role of cognitive flexibility in ADHD children's theory of mind.

Introduction: Studies have documented both executive functions (EF) impairment in children with Attention Deficit / Hyperactivity Disorders (ADHD) and Theory of Mind (ToM), yielding mixed results, possibly because of a variety of tasks used, all requiring different levels of language skills.Aim: To investigate the relationship between ToM and EF with non-language-based tasks.Methods: Thirty ADHD (7-9 years old) were compared to thirty controls (age and IQ matched). Participants' ToM was assessed using the Animated Triangles task and two EF tasks, namely spatial control test, the Stockings Of Cambridge (SOC) and rule and acquisition test, the Intra-Extra Dimensional set shift (IED)-from the neuropsychological battery of the Cambridge Neuropsychological Test Automated Battery (CANTAB).Results: ADHD group had a significant ToM and EF impairment relative to the control group. ToM was not significantly correlated with EF; however, the performance on IED tasks affected the performance on ToM tasks.Discussion: The study provides evidence for a link between the abilities to attribute correct mental states to others, planning and shifting attention in ADHD children, suggesting the ability to rely on cognitive flexibility in the face of a changing environment plays a role in explaining the association between ToM and EF.

Normative data and psychometric properties of a farsi translation of the strange stories test.

BACKGROUND AND OBJECTIVE: The Strange Stories test is one of the most commonly used tests to evaluate advanced "theory of mind," i.e. attribution of mental states. Normative data and psychometric properties of a new Farsi translation of this test were evaluated in a large community-based sample of Iranian school-aged children. METHODS: Through randomized cluster sampling, 398 children aged 9-11 years studying at 20 elementary schools were recruited from 4 central regions of Tehran, Iran. The mean age of the students was 9.96 years (SD = 0.92), and 51% were girls (n = 202). The Child Behavior Checklist (CBCL) was completed by parents. The Strange Stories test was completed by all children and repeated for 20% of them after 2-4 weeks to assess the test-retest reliability. FINDINGS: Students in upper grades had higher scores (P < .01); age predicted 2% of variance on the mental state score. Girls had significantly higher mentalizing scores than boys (P = .003). The split-half internal reliability coefficient was good (0.73). The test-retest reliability was fair to good. Item-scale score correlations were all significant (P < .01). CONCLUSION: This new translation of the Strange Stories test is a reliable and valid instrument to evaluate higher level theory of mind abilities in community samples of Farsi speaking children. Autism Res 2017, 10: 1960-1967. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: "Mentalizing" or "theory of mind," the ability to recognize others' mental states, is a key aspect of social understanding. Mentalizing problems are characteristic of some clinical conditions such as autism. The Strange Stories is a test evaluating mentalizing in every day social situations. It was translated into Farsi language and administered to a group of Iranian school-aged children. The instrument was useful in assessing children's mind reading. Older children and girls were better in mentalizing ability.

Chronic Pain and Selective Attention to Pain Arousing Daily Activity Pictures: Evidence From an Eye Tracking Study.

INTRODUCTION: According to the pain research literature, attentional bias for pain is the mechanism responsible for the development and maintenance of fear of pain in patients with chronic pain. However, there is still some debate about the exact mechanism and the role of faster engagement versus difficulty in disengagement in the development of attentional bias. METHODS: To investigate attentional bias in patients with chronic pain, we used an eye-tracker with the pictures of pain-provoking activities and compared the results with an age- and gender-matched group of pain-free participants. In addition, other measures of pain-related cognition and pain severity ratings were included to assess their contribution to the attentional bias toward pain-related information. RESULTS: Calculating the frequency of the first fixations showed that both groups fixated initially on pain-provoking pictures compared to neutral one. Calculating the speed of fixations showed that control participants were faster in fixating on neutral stimuli, but patients with pain were faster in fixating on pain-provoking pictures, indicating a relative vigilance for the pain-related stimuli among them. These patients reported that the intensity of pain in the previous week was positively correlated with the speed of their fixation on the painful stimuli. CONCLUSION: Although these results did not provide unequivocal support for the vigilance-avoidance hypothesis, they are generally consistent with the results of studies using eye tracking technology. Furthermore, our findings put a question over characterization of attentional biases in patients with chronic pain by simply relating that to difficulty in disengaging from pain-related stimuli.