Self-report psychopathy-III facet scores predict sexual crimes, sexual preferences, and sexual deviance index validity more precisely than total scores.

Understanding the profiles of sexual offenders, such as the presence of psychopathic traits, is key to preventing future sexual crimes. The self-report psychopathy-III (SRP-III) is a tool used to assess the characteristics of psychopathy, but improvements on its interpretation are required to maximize its precision. The SRP-III can be interpreted by examining the scores on each of the four facets (interpersonal manipulation, callous affect, erratic lifestyle, antisocial behavior), on each of two factors (factor 1, factor 2), or by examining the total score. Here, we investigate the interpretation of the results from the SRP-III using these three approaches of analysis of the data for predicting types of sexual crimes, sexually deviant preferences (measured via PPG), and the validity of the sexual deviance results. Logistic regressions were carried out using either the four facets, two factors, or the total score of the SRP-III. Data were previously obtained from 198 Canadian men who were convicted of, or who admitted to committing, at least one sexual crime, or who reported experiencing sexually deviant fantasies. We also examined the point-biserial correlations between each of the methods of interpreting the SRP-III results and each of the dependent variables. We find that SRP-III facet scores most precisely predict types of sexual crimes, sexually deviant preferences, and sexual deviance index validity, followed by SRP-III factor scores, and lastly SRP-III total scores. Additionally, significant correlations are only found between SRP-III scores and one dependent variable. Potential reasons for this are discussed. Based on these findings, we recommend that future studies consider facet and factor scores in addition to the standard practice of examining total scores.

Arguing in Favor of Revising the Simulator Sickness Questionnaire Factor Structure When Assessing Side Effects Induced by Immersions in Virtual Reality.

Two issues are increasingly of interest in the scientific literature regarding unwanted virtual reality (VR) induced side effects: (1) whether the latent structure of the Simulator Sickness Questionnaire (SSQ) is comprised of two or three factors, and (2) if the SSQ measures symptoms of anxiety that can be misattributed to unwanted negative side effects induced by immersions in VR. Study 1 was conducted with a sample of 876 participants. A confirmatory factor analysis clearly supported a two-factor model composed of nausea and oculomotor symptoms instead of the 3-factor structure observed in simulators. To tease-out symptoms of anxiety from unwanted negative side effects induced by immersions in VR, Study 2 was conducted with 88 participants who were administered the Trier Stress Social Test in groups without being immersed in VR. A Spearman correlation showed that 11 out of 16 side effects correlated significantly with anxiety. A factor analysis revealed that items measuring general discomfort, difficulty concentrating, sweating, nausea, and vertigo loaded significantly on the anxiety factor comprised of items from the State-Trait Anxiety Inventory. Finally, a multiple regression indicated that the items measuring general discomfort and difficulty concentrating significantly predicted increases in anxiety. The overall results support the notion that side effects associated with immersions in VR consist mostly of a nausea and an oculomotor latent structure and that a few items are confounding anxiety and cybersickness. The data support the suggestion to revise the scoring procedures of the Simulator Sickness Questionnaire when using this instrument with immersions in VR.

Videoconferencing Psychotherapy for Panic Disorder and Agoraphobia: Outcome and Treatment Processes From a Non-randomized Non-inferiority Trial.

BACKGROUND: In the context of the COVID-19 pandemic, legislations are being modified around the world to allow patients to receive mental health services through telehealth. Unfortunately, there are no large clinical trial available to reliably document the efficacy of delivering videoconferencing psychotherapy (VCP) for people with panic disorder and agoraphobia (PDA) and whether basic psychotherapeutic processes are altered. METHODS: This 2-arm intent-to-treat non-inferiority study reports on a clinical trial on VCP and documents how therapeutic working alliance and motivation toward psychotherapy are associated to treatment outcome. We hypothesized that VCP would not be inferior to standard face-to-face (FF) cognitive behavior therapy for PDA. No specific hypothesis was stated to address working alliance and treatment mechanisms. VCP was compared to a gold-standard psychotherapy treatment for PDA, which was delivered either in person or in videoconference, with a strict tolerance criterion of about 2 points on the primary outcome measure. Seventy one adult patients were recruited. Measures of working alliance were collected after the first, fifth, and last session. Motivation toward therapy at pre-treatment and working alliance after the fifth therapy session were used as predictors of treatment outcome and compared with change in dysfunctional beliefs toward bodily sensations. RESULTS: Panic disorder, agoraphobia, fear of sensations and depressed mood all showed significant improvements and large effect-sizes from pre to post-treatment. Gains were maintained at follow-up. No significant differences were found between VCP and FF, and effect sizes were trivial for three of the four outcome measures. Non-inferiority tests confirmed that VCP was no less effective than FF therapy on the primary outcome measure and two of the three secondary outcome measures. Working alliance was very strong in VCP and did not statistically differ from FF. Working alliance and motivation did not predict treatment outcome, which was significantly predicted by the reduction in dysfunctional beliefs. The strength of the therapeutic bond was correlated with change in dysfunctional beliefs. CONCLUSION: Mental health professionals can use VCP to provide services to patients with PDA. Building and maintaining a sound working alliance should not be a source concern. Practical recommendations are formulated. ISRCTN TRIAL REGISTRATION NUMBER: ISRCTN76456442.

Virtual Reality and Sex Therapy: Future Directions for Clinical Research.

Rapidly growing new technologies are revolutionizing the field of mental health, in terms of both understanding and treating mental disorders. Among these, virtual reality (VR) is a powerful tool providing clients with new learning experiences benefiting their psychological well-being. This article offers an overview of the current literature on VR in psychotherapy, highlighting its relevance to sexual dysfunction (SD) treatment.A literature review of PubMed and Google Scholar databases was used to provide a description of the theoretical frameworks and clinical indications associated with VR use in psychotherapy and SD treatment. The effectiveness of VR exposure-based therapy has been empirically validated for several mental disorders, notably anxiety disorders. The emerging combined use of VR and mindfulness tends to focus on chronic pain treatment. Experimental research examining the use of immersive technologies in the treatment of SDs is lacking.Given the shortcomings of conventional SD treatments, exploring and developing specialized VR interventions may prove beneficial. VR offers promising avenues in sex therapy, particularly for the treatment of genital pain disorders or SDs in which anxiety plays a significant etiological role.

Suppression of Sensorimotor Alpha Power Associated With Pain Expressed by an Avatar: A Preliminary EEG Study.

Several studies using functional magnetic resonance imaging (fMRI) showed that empathic capabilities are associated with the activation (and deactivation) of relatively specific neural circuits. A growing number of electroencephalography studies also suggest that it might be useful to assess empathy. The main goal of this study was to use quantitative electroencephalography (qEEG) to test whether observation of pain expressed by an avatar (virtual reality) induces a suppression of alpha waves over sensorimotor cortical areas, as it is observed with human stimuli. Not only was it the case, but also the magnitude of alpha suppression was correlated with perspective-taking capacity of participants. Both empathy levels and magnitude of sensorimotor alpha suppression (SAS) were significantly higher in women than men. Interestingly, a significant interaction emerged between levels of individual empathy and specificity of experimental instructions, where SAS in participants with good perspective-taking was higher during passive observation of the distressed avatar, while the opposite was true during an active (trying to understand) condition. These results suggest that: (1) synthetic characters are able to elicit SAS; (2) SAS is indeed associated with perspective-taking capacities; (3) Persons with poorer perspective-taking capacities can show significant SAS when proper instructions are provided. Therefore, qEEG represents a low-cost objective approach to measure perspective-taking abilities.

Virtual reality therapy for refractory auditory verbal hallucinations in schizophrenia: A pilot clinical trial.

Schizophrenia is a chronic and severe mental illness that poses significant challenges. While many pharmacological and psychosocial interventions are available, many treatment-resistant schizophrenia patients continue to suffer from persistent psychotic symptoms, notably auditory verbal hallucinations (AVH), which are highly disabling. This unmet clinical need requires new innovative treatment options. Recently, a psychological therapy using computerized technology has shown large therapeutic effects on AVH severity by enabling patients to engage in a dialogue with a computerized representation of their voices. These very promising results have been extended by our team using immersive virtual reality (VR). Our study was a 7-week phase-II, randomized, partial cross-over trial. Nineteen schizophrenia patients with refractory AVH were recruited and randomly allocated to either VR-assisted therapy (VRT) or treatment-as-usual (TAU). The group allocated to TAU consisted of antipsychotic treatment and usual meetings with clinicians. The TAU group then received a delayed 7weeks of VRT. A follow-up was ensured 3months after the last VRT therapy session. Changes in psychiatric symptoms, before and after TAU or VRT, were assessed using a linear mixed-effects model. Our findings showed that VRT produced significant improvements in AVH severity, depressive symptoms and quality of life that lasted at the 3-month follow-up period. Consistent with previous research, our results suggest that VRT might be efficacious in reducing AVH related distress. The therapeutic effects of VRT on the distress associated with the voices were particularly prominent (d=1.2). VRT is a highly novel and promising intervention for refractory AVH in schizophrenia.

Increasing Valid Profiles in Phallometric Assessment of Sex Offenders with Child Victims: Combining the Strengths of Audio Stimuli and Synthetic Characters.

Penile plethysmography (PPG) is a measure of sexual interests that relies heavily on the stimuli it uses to generate valid results. Ethical considerations surrounding the use of real images in PPG have further limited the content admissible for these stimuli. To palliate this limitation, the current study aimed to combine audio and visual stimuli by incorporating computer-generated characters to create new stimuli capable of accurately classifying sex offenders with child victims, while also increasing the number of valid profiles. Three modalities (audio, visual, and audiovisual) were compared using two groups (15 sex offenders with child victims and 15 non-offenders). Both the new visual and audiovisual stimuli resulted in a 13% increase in the number of valid profiles at 2.5 mm, when compared to the standard audio stimuli. Furthermore, the new audiovisual stimuli generated a 34% increase in penile responses. All three modalities were able to discriminate between the two groups by their responses to the adult and child stimuli. Lastly, sexual interest indices for all three modalities could accurately classify participants in their appropriate groups, as demonstrated by ROC curve analysis (i.e., audio AUC = .81, 95% CI [.60, 1.00]; visual AUC = .84, 95% CI [.66, 1.00], and audiovisual AUC = .83, 95% CI [.63, 1.00]). Results suggest that computer-generated characters allow accurate discrimination of sex offenders with child victims and can be added to already validated stimuli to increase the number of valid profiles. The implications of audiovisual stimuli using computer-generated characters and their possible use in PPG evaluations are also discussed.

How Ego Depletion Affects Sexual Self-Regulation: Is It More Than Resource Depletion?

Rational thinking and decision making are impacted when in a state of sexual arousal. The inability to self-regulate arousal can be linked to numerous problems, like sexual risk taking, infidelity, and sexual coercion. Studies have shown that most men are able to exert voluntary control over their sexual excitation with various levels of success. Both situational and dispositional factors can influence self-regulation achievement. The goal of this research was to investigate how ego depletion, a state of low self-control capacity, interacts with personality traits-propensities for sexual excitation and inhibition-and cognitive absorption, to cause sexual self-regulation failure. The sexual responses of 36 heterosexual males were assessed using penile plethysmography. They were asked to control their sexual arousal in two conditions, with and without ego depletion. Results suggest that ego depletion has opposite effects based on the trait sexual inhibition, as individuals moderately inhibited showed an increase in performance while highly inhibited ones showed a decrease. These results challenge the limited resource model of self-regulation and point to the importance of considering how people adapt to acute and high challenging conditions.

Virtual faces expressing emotions: an initial concomitant and construct validity study.

BACKGROUND: Facial expressions of emotions represent classic stimuli for the study of social cognition. Developing virtual dynamic facial expressions of emotions, however, would open-up possibilities, both for fundamental and clinical research. For instance, virtual faces allow real-time Human-Computer retroactions between physiological measures and the virtual agent. OBJECTIVES: The goal of this study was to initially assess concomitants and construct validity of a newly developed set of virtual faces expressing six fundamental emotions (happiness, surprise, anger, sadness, fear, and disgust). Recognition rates, facial electromyography (zygomatic major and corrugator supercilii muscles), and regional gaze fixation latencies (eyes and mouth regions) were compared in 41 adult volunteers (20 ♂, 21 ♀) during the presentation of video clips depicting real vs. virtual adults expressing emotions. RESULTS: Emotions expressed by each set of stimuli were similarly recognized, both by men and women. Accordingly, both sets of stimuli elicited similar activation of facial muscles and similar ocular fixation times in eye regions from man and woman participants. CONCLUSION: Further validation studies can be performed with these virtual faces among clinical populations known to present social cognition difficulties. Brain-Computer Interface studies with feedback-feedforward interactions based on facial emotion expressions can also be conducted with these stimuli.

Sexual self-regulation and cognitive absorption as factors of sexual response toward virtual characters.

The eye movements and penile responses of 20 male participants were recorded while they were immersed with virtual sexual stimuli. These participants were divided into two groups according to their capacity to focus their attention in immersion (high and low focus). In order to understand sexual self-regulation better, we subjected participants to three experimental conditions: (a) immersion with a preferred sexual stimulus, without sexual inhibition; (b) immersion with a preferred sexual stimulus, with sexual inhibition; and (c) immersion with a neutral stimulus. A significant difference was observed between the effects of each condition on erectile response and scanpath. The groups differed on self-regulation of their erectile responses and on their scanpath patterns. High focus participants had more difficulties than low focus participants with inhibiting their sexual responses and displayed less scattered eye movement trajectories over the critical areas of the virtual sexual stimuli. Results are interpreted in terms of sexual self-regulation and cognitive absorption in virtual immersion. In addition, the use of validated virtual sexual stimuli is presented as a methodological improvement over static and moving pictures, since it paves the way for the study of the role of social interaction in an ecologically valid and well-controlled way.

Using eye tracking to identify faking attempts during penile plethysmography assessment.

Penile plethysmography (PPG) is considered the most rigorous method for sexual interest assessment. Nevertheless, it is subject to faking attempts by participants, which compromises the internal validity of the instrument. To date, various attempts have been made to limit voluntary control of sexual response during PPG assessments, without satisfactory results. This exploratory research examined eye-tracking technologies' ability to identify the presence of cognitive strategies responsible for erectile inhibition during PPG assessment. Eye movements and penile responses for 20 subjects were recorded while exploring animated human-like computer-generated stimuli in a virtual environment under three distinct viewing conditions: (a) the free visual exploration of a preferred sexual stimulus without erectile inhibition; (b) the viewing of a preferred sexual stimulus with erectile inhibition; and (c) the free visual exploration of a non-preferred sexual stimulus. Results suggest that attempts to control erectile responses generate specific eye-movement variations, characterized by a general deceleration of the exploration process and limited exploration of the erogenous zone. Findings indicate that recording eye movements can provide significant information on the presence of competing covert processes responsible for erectile inhibition. The use of eye-tracking technologies during PPG could therefore lead to improved internal validity of the plethysmographic procedure.

Empathy toward virtual humans depicting a known or unknown person expressing pain.

This study is about pain expressed by virtual humans and empathy in users immersed in virtual reality. It focuses on whether people feel more empathy toward the pain of a virtual human when the virtual human is a realistic representation of a known individual, as opposed to an unknown person, and if social presence is related to users' empathy toward a virtual human's pain. The 42 participants were immersed in virtual reality using a large immersive cube with images retro projected on all six faces (CAVE-Like system) where they can interact in real time with virtual characters. The first immersion (baseline/control) was with a virtual animal, followed by immersions involving discussions with a known virtual human (i.e., the avatar of a person they were familiar with) or an unknown virtual human. During the verbal exchanges in virtual reality, the virtual humans expressed acute and very strong pain. The pain reactions were identical in terms of facial expressions, and verbal and nonverbal behaviors. The Conditions by Time interactions in the repeated measures analyses of variance revealed that participants were empathic toward both virtual humans, yet more empathic toward the known virtual human. Multivariate regression analyses revealed that participants' feeling of social presence--impression that the known virtual character is really there, with them--was a significant predictor of empathy.

Real-time functional magnetic imaging-brain-computer interface and virtual reality promising tools for the treatment of pedophilia.

This chapter proposes a prospective view on using a real-time functional magnetic imaging (rt-fMRI) brain-computer interface (BCI) application as a new treatment for pedophilia. Neurofeedback mediated by interactive virtual stimuli is presented as the key process in this new BCI application. Results on the diagnostic discriminant power of virtual characters depicting sexual stimuli relevant to pedophilia are given. Finally, practical and ethical implications are briefly addressed.

Sexual affordances, perceptual-motor invariance extraction and intentional nonlinear dynamics: sexually deviant and non-deviant patterns in male subjects.

Sexual arousal and gaze behavior dynamics are used to characterize deviant sexual interests in male subjects. Pedophile patients and non-deviant subjects are immersed with virtual characters depicting relevant sexual features. Gaze behavior dynamics as indexed from correlation dimensions (D2) appears to be fractal in nature and significantly different from colored noise (surrogate data tests and recurrence plot analyses were performed). This perceptual-motor fractal dynamics parallels sexual arousal and differs from pedophiles to non-deviant subjects when critical sexual information is processed. Results are interpreted in terms of sexual affordance, perceptual invariance extraction and intentional nonlinear dynamics.

Presence as determined by fractal perceptual-motor dynamics.

This paper presents a tentative model of the role of perceptual-motor dynamics in the emergence of the feeling of presence. A new method allowing the measure of how gaze probes three-dimensional space in immersion is used to support this model. Fractal computations of gaze behavior are shown to be more effective than standard computations of eye movements in predicting presence.

Effectiveness of virtual reality exposure in the treatment of arachnophobia using 3D games.

Buying or creating a virtual reality (VR) software is very costly. A less expensive alternative could be to modify already existing 3D computer games. The goal of this study is to assess the effectiveness of in virtuo exposure in the treatment of arachnophobia using modified 3D games. Participants were 10 women and 1 man. Virtual worlds were created using the game editor of a 3D computer game (Half-Life), modified to offer graduals hierarchies of fearful stimuli (spiders). Analyses revealed significant improvement between pre and post results on the behavioral avoidance test, the Spider Beliefs Questionnaire, and perceived self-efficacy. These promising results suggest that therapy using virtual reality exposure via a modified computer game is useful in the treatment of arachnophobia.

Scene perception, gaze behavior, and perceptual learning in virtual environments.

More and more immersive environments are developed to provide support for learning or training purposes. Ecological validity of such environments is usually based on learning performance comparisons between virtual environments and their genuine counterparts. Little is known about learning processes occurring in immersive environments. A new technique is proposed for testing perceptual learning during virtual immersion. This methodology relies upon eye-tracking technologies to analyze gaze behavior recorded in relation to virtual objects' features and tasks' requirements. It is proposed that perceptual learning mechanisms engaged could be detected through eye movements. In this study, nine subjects performed perceptual learning tasks in virtual immersion. Results obtained indicated that perceptual learning influences gaze behavior dynamics. More precisely, analysis revealed that fixation number and variability in fixation duration varied with perceptual learning level. Such findings could contribute in shedding light on learning mechanisms as well as providing additional support for validating virtual learning environments.

Delivering cognitive-behavior therapy for panic disorder with agoraphobia in videoconference.

Delivering psychotherapy by videoconference could significantly increase the accessibility of empirically validated treatments. The aim of this study was to compare the effectiveness of cognitive-behavior therapy (CBT) for panic disorder with agoraphobia (PDA) when the therapy is delivered either face-to-face or by videoconference. A sample of 21 participants was treated either face-to-face or by videoconference. Results showed that CBT delivered by videoconference was as effective as CBT delivered face-to-face. There was a statistically significant reduction in all measures, and the number of panic-free participants among those receiving CBT by videoconference was 81% at post-treatment and 91% at the 6-month follow-up. None of the comparisons with face-to-face psychotherapy suggested that CBT delivered by videoconference was less effective. These results were confirmed by analyses of effect size. The participants reported the development of an excellent therapeutic alliance in videoconference as early as the first therapy session. The importance of these results for treatment accessibility is discussed. Hypotheses are proposed to explain the rapid creation of strong therapeutic alliances in videoconferencing.

Anxiety and presence during VR immersion: a comparative study of the reactions of phobic and non-phobic participants in therapeutic virtual environments derived from computer games.

Virtual reality can be used to provide phobic clients with therapeutic exposure to phobogenic stimuli. However, purpose-built therapeutic VR hardware and software can be expensive and difficult to adapt to individual client needs. In this study, inexpensive and readily adaptable PC computer games were used to provide exposure therapy to 13 phobic participants and 13 non-phobic control participants. It was found that anxiety could be induced in phobic participants by exposing them to phobogenic stimuli in therapeutic virtual environments derived from computer games (TVEDG). Assessments were made of the impact of simulator sickness and of sense of presence on the phobogenic effectiveness of TVEDGs. Participants reported low levels of simulator sickness, and the results indicate that simulator sickness had no significant impact on either anxiety or sense of presence. Group differences, correlations, and regression analyses indicate a synergistic relationship between presence and anxiety. These results do not support Slater's contention that presence and emotion are orthogonal.

Eye-tracking in immersive environments: a general methodology to analyze affordance-based interactions from oculomotor dynamics.

This paper aims at presenting a new methodology to study how perceptual and motor processes organized themselves in order to achieve invariant visual information picking-up in virtual immersions. From a head-mounted display, head and eye movements were recorded using tracking devices (magnetic and infrared) that render the six degrees-of-freedom associated with the position and orientation of head movements, and two degrees-of-freedom from one eye. We measured the continuous line of sight's deviation from a pre-selected area on a virtual stimulus. Some preliminary analyses of the dynamical properties of the emergent perceptual and motor patterns are presented as they are considered to be representative of the process of affordance extraction.