[Breaking the silence: The emergency to improve access to healthcare for deaf patients]. / Rompre le silence : l'urgence d'améliorer l'accès aux soins pour les patients sourds.

Until this day, deafness (and hearing loss) is still a major public health concern in our society. In Switzerland, congenital hearing loss affects about 0,1% of the population. Through a literature review, this article aims to highlight the health inequalities affecting the deaf population. It also reveals the shortcomings of a healthcare system made of practitioners who have limited knowledge about the deaf population and its specific needs, and whose care, particularly in the emergency department, still remains inappropriate. Lastly, we attempt to propose concrete measures that would bridge the communication gap in practice, with the goal of improving the quality of care and reducing mutual frustrations.

La problématique de la surdité et de la difficulté d'accès aux soins qui en découle constitue encore de nos jours un important enjeu de santé publique. En Suisse, la surdité congénitale concerne environ 0,1 % de la population. À travers une revue de littérature, cet article a pour but de faire un état des lieux des inégalités en santé dont est victime la population sourde. Il révèle également la défaillance d'un système de santé fait de professionnels qui méconnaissent largement cette population et ses besoins spécifiques, et dont la prise en charge aux urgences reste particulièrement inadaptée. Nous tentons enfin de proposer des aides concrètes qui permettraient de réduire le fossé communicationnel sur le terrain, dans le but d'améliorer la qualité des soins et de diminuer les frustrations réciproques.

Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: a three-arm randomised controlled trial.

BackgroundPeople with social anxiety disorder (SAD) fear social interactions and may be reluctant to seek treatments involving exposure to social situations. Social exposure conducted in virtual reality (VR), embedded in individual cognitive-behavioural therapy (CBT), could be an answer.AimsTo show that conducting VR exposure in CBT for SAD is effective and is more practical for therapists than conducting exposure in vivoMethodParticipants were randomly assigned to either VR exposure (n = 17), in vivo exposure (n = 22) or waiting list (n = 20). Participants in the active arms received individual CBT for 14 weekly sessions and outcome was assessed with questionnaires and a behaviour avoidance test. (Trial registration number ISRCTN99747069)ResultsImprovements were found on the primary (Liebowitz Social Anxiety Scale) and all five secondary outcome measures in both CBT groups compared with the waiting list. Conducting exposure in VR was more effective at post-treatment than in vivo on the primary outcome measure and on one secondary measure. Improvements were maintained at the 6-month follow-up. VR was significantly more practical for therapists than in vivo exposure.ConclusionsUsing VR can be advantageous over standard CBT as a potential solution for treatment avoidance and as an efficient, cost-effective and practical medium of exposure.

The development of the SWEAT questionnaire: a scale measuring costs and efforts inherent to conducting exposure sessions.

For decades, empirical studies have shown the effectiveness of exposure techniques when used in cognitive-behavioral therapy (CBT) treatment for anxiety disorders. A few studies are now suggesting that using Virtual Reality (VR) may be an effective way to conduct exposure and overcome some of the limitations of in vivo exposure. The aim of this study is to validate the Specific Work for Exposure Applied in Therapy (SWEAT) questionnaire that measures costs and efforts required to conduct in vivo and in virtuo exposure. A total of 265 exposure sessions (in vivo = 140; in virtuo = 125) were rated by experienced psychologists. Reliability analysis revealed three main factors in the construct of the SWEAT questionnaire. Results also showed that conducting exposure in VR is less of a burden and more readily adapted to the patients' needs than in vivo.

Telepresence experienced in videoconference varies according to emotions involved in videoconference sessions.

Previous studies have linked telepresence to the strength of the therapeutic relationship experienced during telepsychotherapy. This finding comes as a surprise for many people who have been involved in a teleconference meeting, where telepresence is often considered weak. The aim of this study is to (re)evaluate the impact of emotional engagement on telepresence. Participants were randomly assigned to one of the two conditions: (a) emotionally charged verbal exchange first (followed by a more neutral verbal exchange), or (b) emotionally neutral verbal exchange first (followed by an emotionally charged verbal exchange). A distraction task was performed between the two verbal exchanges in videoconference. Results showed that verbal exchanges involving stronger emotions increase telepresence. These results may explain why telepresence is so high in telepsychotherapy.

Are Cognitive Load and Focus of Attention Differentially Involved in Pain Management: An Experimental Study Using a Cold Pressor Test and Virtual Reality.

OBJECTIVE: The aim of this study is to assess whether distraction (lack of attentional focus) and attention (cognitive load) are differentially involved in the analgesic effect of virtual reality (VR) immersions during a cold pressor test (CPT). METHODS: Thirty-one participants were randomly assigned to four experimental conditions (high and low cognitive load, attention with or without a reminder of the pain stimuli) and performed three CPTs. Pain was assessed based on the duration of the CPT (pain tolerance), a visual analog rating scale of perceived pain intensity during the CPT and the subjective pain scale of the Short form McGill Pain Questionnaire (SF-MPQ). RESULTS: The statistical analyses revealed that VR immersions were associated with less pain compared to the baseline (all p <0.001), but for the experimental manipulations, only the conditions where there was an increase in cognitive load (ie, from low cognitive load at Immersion 1 to high cognitive load at Immersion 2) were effective for increasing pain tolerance (significant Time X Conditions interaction). The interactions were not significant for pain intensity assessed with the VAS or the SF-MPQ. CONCLUSION: The results suggest that increases in cognitive load play an important role in the analgesic effect of VR immersion, although the combination of attentional focus and cognitive load may be important. Suggestions are given for designing a replication study.

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.

A Randomized Controlled Trial on the Use of Virtual Reality for Needle-Related Procedures in Children and Adolescents in the Emergency Department.

Objective: A large number of children report fear and distress when undergoing blood work and intravenous placement. In pediatric departments, Child Life interventions are considered to be the gold standard in nonmedical pain management techniques. Virtual reality (VR) has also been identified as an effective tool for pain distraction in children undergoing painful medical procedures. The aim of this study was to document the efficacy of VR as a mode of distraction during a medical procedure compared with two comparison conditions: watching television (TV, minimal control condition) and distraction provided by the Child Life (CL, gold standard control condition) program. Materials and Methods: A total of 59 children aged 8-17 years (35% female) were recruited through the emergency department (ED) of the Children's Hospital of Eastern Ontario and randomly assigned to one of the three conditions. The key outcome measures were visual analog scale ratings of pain intensity and fear of pain, administrated before and right after the procedure. Patient satisfaction was also measured after the intervention. Results: A significant reduction in fear of pain and pain intensity was reported in all three conditions. A larger and statistically significant reduction in fear of pain was observed among children who used VR distraction compared with the CL and TV conditions, but this effect was not observed for pain intensity. The children's satisfaction with the VR procedure was significantly higher than for TV and comparable to CL. Discussion: The advantages of using VR in the ED to manage pain in children are discussed.

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.