CoChat
Sign Up
Cited by 40Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesVirtual Reality Applications and ImpactsDigital Mental Health Interventions

Exposure to a Standardized Catastrophic Scenario in Virtual Reality or a Personalized Scenario in Imagination for Generalized Anxiety Disorder

Open access
Guitard, Tanya, Bouchard, Stéphane, Bélanger, Claude, Berthiaume, Maxine·2019·Journal of Clinical Medicine
DOI 10.3390/jcm8030309PMC PMC6463165
Open this paper in CoChat — free accountOpen PDF

Abstract

The cognitive behavioral treatment of generalized anxiety disorder (GAD) often involves exposing patients to a catastrophic scenario depicting their most feared worry. The aim of this study was to examine whether a standardized scenario recreated in virtual reality (VR) would elicit anxiety and negative affect and how it compared to the traditional method of imagining a personalized catastrophic scenario. A sample of 28 participants were first exposed to a neutral non-catastrophic scenario and then to a personalized scenario in imagination or a standardized virtual scenario presented in a counterbalanced order. The participants completed questionnaires before and after each immersion. The results suggest that the standardized virtual scenario induced significant anxiety. No difference was found when comparing exposure to the standardized scenario in VR and exposure to the personalized scenario in imagination. These findings were specific to anxiety and not to the broader measure of negative affect. Individual differences in susceptibility to feel present in VR was a significant predictor of increase in anxiety and negative affect. Future research could use these scenarios to conduct a randomized control trial to test the efficacy and cost/benefits of using VR in the treatment of GAD.

AI snapshot

Written from the paper’s full text.

TL;DR

A within-subjects pilot study with 28 GAD patients found that a standardized catastrophic scenario in VR elicited significant anxiety compared with a neutral virtual environment, and its effect did not differ significantly from a personalized catastrophic scenario in imagination. Presence-related individual differences predicted greater anxiety and negative affect during VR exposure.

Key findings

  • Exposure to either a catastrophic scenario—standardized VR or personalized imagination—produced significantly more state anxiety than the neutral scenario: first contrast \(t(26)=3.82, p<0.001\), \(\eta^2=0.22\), large effect, power = 0.96.
  • The direct comparison between VR and imagination was not significant after correction: the first interaction contrast was non-significant \(t(26)=-0.58, p>0.05\), \(\eta^2=0.006\), very small effect, expected \(N>2000\) for power 0.80; a later interaction contrast favored personalized imagination \(t(26)=2.20, p<0.05\), partial \(\eta^2=0.09\), medium effect, but did not remain significant with Bonferroni correction.
  • Negative affect increased from neutral to first exposure \(t(26)=2.59, p<0.05\), \(\eta^2=0.11\), medium effect, but did not remain significant after Bonferroni correction; the paper reports findings were specific to anxiety rather than broader negative affect.
  • In exploratory regressions, state anxiety during VR exposure was predicted by usefulness of worrying (WW-II; \(t=2.99\), partial \(r=0.46\), \(p<0.01\)) and immersive tendency (ITQ; \(t=4.14\), partial \(r=0.63\), \(p<0.001\)), with model \(adjR^2=0.44\), \(F(3,24)=7.29\), \(p<0.01\). Negative affect during VR was predicted only by ITQ (\(t=3.54\), partial \(r=0.6\), \(p<0.01\)), with model \(adjR^2=0.32\), \(F(3,24)=4.79\), \(p<0.05\).

Methods

  • Design: within-subjects experiment; all participants first received a 5-min neutral non-catastrophic VR room, then were randomized to VR-Exp/IM-Exp (\(n=13\)) or IM-Exp/VR-Exp (\(n=15\)), with a distraction task between exposures.
  • Sample: 28 participants with primary GAD, all francophone, 24 women and 4 men, mean age 38.33 (\(SD=12.78\)); 64.3% had comorbid disorders, most frequently social anxiety (\(n=8\)). Inclusion required GAD diagnosis, age 18–65, and no prior VR experience; exclusions included other primary anxiety disorder, claustrophobia, benzodiazepine use, and specified health risks.
  • Measures/analysis: ADIS-IV diagnosis; PSWQ, CAQ, IUS, WW-II, ITQ, PQ, GPQ, SSQ; dependent variables were STAI-Y1 state anxiety and PANAS negative affect. Analyses used repeated-measures ANOVAs with a priori orthogonal within-subjects contrasts, Bonferroni corrections, and exploratory multiple regressions.

Limitations

  • The paper states the sample was relatively small, had slightly more women than typical GAD populations, and lacked physiological anxiety measures because participants were seated during imagination but standing/moving during VR.
  • The paper states the protocol was not designed to show how frightening VR could be, was not conducted with patients already in therapy and ready for exposure, and used three different VEs rather than one, which may limit direct comparison.
  • Evident from the text: several key comparisons lost significance after Bonferroni correction, and the study was underpowered for some VR-versus-imagination contrasts; no formal hypothesis or a priori power estimate was made for that comparison.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/jcm8030309

Cites

34 of 34 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 45 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Individual differences in susceptibility to feel present in VR significantly predicted increases in anxiety and negative affect.

    “Individual differences in susceptibility to feel present in VR was a significant predictor of increase in anxiety and negative affect.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The standardized virtual scenario induced significant anxiety.

    “The results suggest that the standardized virtual scenario induced significant anxiety.”
    Quote in the paperSubstantial claim
  • Findingnone given

    The findings were specific to anxiety and not to the broader measure of negative affect.

    “These findings were specific to anxiety and not to the broader measure of negative affect.”
    Quote in the paperSubstantial claim
  • Findingown data

    No difference was found between exposure to the standardized scenario in VR and exposure to the personalized scenario in imagination.

    “No difference was found when comparing exposure to the standardized scenario in VR and exposure to the personalized scenario in imagination.”
    Quote in the paperSubstantial claim
  • Findingown data

    The main regression predicting negative affect during VR exposure was significant.

    “The exploratory predictor analyses of negative affect was significant [adjR2 = 0.32, F(3, 24) = 4.79, p < 0.05]”
    Quote in the paperNot a substantial claim
  • May combine two claims. 30
  • Classified as probably not a substantial claim. 34
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    In the group first exposed to traditional cognitive exposure, negative affect decreased in the second exposure, whereas the group first exposed to VR showed an increase in negative affect when exposed to the traditional personalized scenario.

    “In the group first exposed to traditional cognitive exposure, negative affect decreased in the second exposure whereas the second group, first exposed to VR, shows an increase in negative affect when exposed to the traditional personalized scenario.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The sample (N = 28) consisted of 24 women and 4 men with a primary diagnosis of GAD.

    “The sample (N = 28) consisted of 24 women and 4 men with a primary diagnosis of GAD.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The final sample included 28 participants who all met the criteria.

    “The final sample included a total of 28 participants who all met the criteria.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The interaction contrast for the first exposure was non-significant, showing that both scenarios induced anxiety.

    “The interaction contrast was non-significant [t(26) = −0.58, p > 0.05, eta-squared = 0.006, effect-size = very small, power = 0.10, expected N to detect a significant difference with a power of 0.80 > 2000], showing that both scenarios induced anxiety.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The neutral virtual environment does not itself induce anxiety and serves as a valid baseline.

  • May combine two claims.

    Findingown data

    The interaction between scenario and time for state anxiety was non-significant, indicating that exposure to the traditional personalized scenario over time did not elicit more anxiety than exposure to the virtual scenario.

    “The interaction was non-significant, indicating that exposure to the traditional personalized scenario over time did not elicit more anxiety than exposure to the virtual scenario.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Comorbid disorders were diagnosed in 64.3% of the sample.

    “Comorbid disorders were diagnosed in 64.3% of the sample—social anxiety being the most frequent (n = 8) while others were specific phobias (n = 4), panic disorder (n = 3), obsessive-compulsive disorder (n = 1), and other diagnosis (n = 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The second a priori interaction contrast for negative affect was non-significant, although the effect size was close to significance.

    “The second a priori interaction contrast was non-significant [t(26) = 2.03, p > 0.05 eta-squared = 0.07, effect-size = medium, power = 0.60, expected N to detect a significant difference with a power of 0.80 = 120], although the effect size was close to significance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Participants were all francophone with a mean age of 38.33 (SD = 12.78).

    “They were all francophone with a mean age of 38.33 (SD = 12.78).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The interaction contrast from the first to the second exposure was significant, indicating that the traditional personalized scenario elicited more anxiety than the VR scenario.

    “However, the interaction contrast was significant [t(26) = 2.20, p < 0.05, partial eta-squared = 0.09, effect-size = medium, power = 0.65], indicating that the traditional personalized scenario elicited more anxiety than the VR scenario.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The personalized scenario in imagination is a valid representation of traditional cognitive exposure.

  • May combine two claims.

    Findingown data

    The interaction contrast for negative affect at the first exposure was non-significant, revealing a similar and only slight increase in negative affect.

    “The interaction contrast was non-significant [t(26) = 0.94, p > 0.05, eta-squared = 0.02, effect-size = small, power = 0.20, expected N to detect a significant difference with a power of 0.80 = 344], revealing a similar and only slight increase in negative affect.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    When compared to the neutral scenario, the increase in anxiety in the personalized imagination scenario versus the standardized VR scenario is associated with a small effect size, and more than 2000 participants would be required to detect a significant difference between the two exposure modalities.

    “When compared to the neutral scenario, the increase in anxiety experience in the personalized scenario in imagination versus the standardized scenario in VR is associated with a small effect size and more than 2 000 participants would be required to detect a significant difference in the two exposure modalities.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The neutral virtual environment does not itself induce anxiety and serves as a valid baseline.
    • Rests on an assumption: The personalized scenario in imagination is a valid representation of traditional cognitive exposure.

  • May combine two claims.

    Findingown data

    The impact of the exposure sessions mirrors those of the anxiety measure on the a priori contrasts, but the differences do not remain statistically significant after controlling for the number of comparisons.

    “To be more precise, the impact of the exposure sessions mirror those of the anxiety measure on the a priori contrasts, but the differences do not remain statistically significant after controlling for the number of comparisons.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The difference between exposure to standardized scenarios in VR and personalized scenarios in imagination was significant only when the sequence of exposure sessions was counterbalanced, and it did not remain significant after controlling for the number of comparisons.

    “The actual difference between exposure to standardized scenarios in VR and personalized scenarios in imagination was significant only when the sequence of exposure sessions was counterbalanced and it did not remain significant after controlling for the number of comparisons.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The personalized scenario in imagination is a valid representation of traditional cognitive exposure.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    VR immersions can elicit anxiety in people with specific phobia compared to people without an anxiety disorder.

    “Studies have demonstrated that, compared to people who do not suffer from an anxiety disorder, immersions in virtual reality (VR) can elicit anxiety in people suffering from specific phobia [5], and from obsessive-compulsive disorder characterized by fear of contamination [6] or by checking behaviors [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Robillard, 2003, 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, Cyberpsychol. Behav. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    VR is relevant and efficacious for conducting exposure in the treatment of anxiety disorders.

    “Several studies, summarized in literature reviews (e.g., [8]) and meta-analyses (e.g., [9,10,11]), have documented the relevance and efficacy of using VR to conduct exposure (also called in virtuo exposure, [12]) in the treatment of anxiety disorders.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [8] McCann, 2014, Virtual reality exposure therapy for the treatment of anxiety disorders: An evaluation of research quality, J. Anxiety Disord. source

      Not checked in the free run.

    • cites [9] Chesham, 2018, Meta-analysis of the efficacy of virtual reality exposure therapy for social anxiety, Behav. Chang. source

      Not checked in the free run.

    • cites [10] Fernández-Alvarez, J., Rozental, A., Carlbring, P., Colombo, D., Riva, G., Anderson, P.L., Baños, R.M., Benbow, A.A., Bouchard, S., and Bretón López, J.M. (2018). Deterioration rates in virtual reality exposure therapy: An individual patient data level meta-analysis. J. Anxiety Disord., in press. source

      Not checked in the free run.

    • cites [11] Morina, 2015, Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments, Behav. Res. Ther. source

      Not checked in the free run.

    • cites [12] Tisseau, J. (2008, January 2). In vivo, in vitro, in silico, in virtuo. Proceedings of the 1st Workshop on SMA in Biology at Meso or Macroscopic Scales, Paris, France.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    VR immersions can elicit anxiety in people with obsessive-compulsive disorder characterized by checking behaviors.

    “Studies have demonstrated that, compared to people who do not suffer from an anxiety disorder, immersions in virtual reality (VR) can elicit anxiety in people suffering from specific phobia [5], and from obsessive-compulsive disorder characterized by fear of contamination [6] or by checking behaviors [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Kim, 2012, Comparison of checking behavior in adults with or without checking symptoms of obsessive-compulsive disorder using a novel computer-based measure, Comput. Methods Programs Biomed. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    VR immersions can elicit anxiety in people with obsessive-compulsive disorder characterized by fear of contamination.

    “Studies have demonstrated that, compared to people who do not suffer from an anxiety disorder, immersions in virtual reality (VR) can elicit anxiety in people suffering from specific phobia [5], and from obsessive-compulsive disorder characterized by fear of contamination [6] or by checking behaviors [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Laforest, 2016, Inducing an anxiety response using a contaminated virtual environment: Validation of a therapeutic tool for obsessive-compulsive disorder, Front. ICT source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    No differences were found between the two conditions on GAD severity (ADIS-IV and PSWQ), perceived quality of the VR system (PQ), and unwanted negative side effects induced by VR immersion (SSQ).

    “No differences were found between the two conditions on the GAD severity (as assessed with the ADIS-IV and the PSWQ), on how they perceived the quality of the VR system (PQ), and in unwanted negative side effects induced by the immersion in VR (SSQ).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premiseown data

    The ITQ has a Cronbach's alpha of 0.78.

    “Cronbach’s alpha reaches 0.78.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Witmer, 1998, Measuring presence in virtual environments: A presence questionnaire, Presence source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The PQ has a Cronbach's alpha of 0.84.

    “Cronbach’s alpha reaches 0.84.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Witmer, 1998, Measuring presence in virtual environments: A presence questionnaire, Presence source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Using VR is considered more attractive than in vivo exposure for some patients.

    “Finally, using VR is considered more attractive than in vivo exposure for some patients [17].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Hoffman, 2001, Redefining therapeutic success with VR exposure therapy, Cyberpsychol. Behav. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The IUS has very good internal consistency (Cronbach's alpha of 0.91) and good convergent validity with the PSWQ.

    “This measure possesses very good internal consistency (Cronbach’s alpha of 0.91) and good convergent validity with the PSWQ.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Freeston, 1994, Why do people worry?, Personal. Individ. Differ. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The study was approved by the Ethics Committee of UQO and participants signed a free and informed consent form.

    “The project, conducted in concordance with the Declaration of Helsinki and the Canadian Tri-Council policy statement for ethical conduct for research involving humans, was approved by the Ethics Committee of UQO and participants signed a free and informed consent form.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The GPQ has a Cronbach's alpha of 0.69.

    “The GPQ has a Cronbach’s alpha of 0.69.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Laforest, 2016, Inducing an anxiety response using a contaminated virtual environment: Validation of a therapeutic tool for obsessive-compulsive disorder, Front. ICT source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The results of Guitard et al. were positive enough to warrant transposing the scenarios used in imagination into VR scenarios and testing them with people suffering from GAD.

    “In their research, Guitard and her colleagues [25] demonstrated that the effect size of exposure in imagination to the individualized scenarios was slightly higher than the standardized ones on the measure of heart rate but, nevertheless, the results were positive enough to warrant transposing the scenarios used in imagination into VR scenarios and testing them with people suffering from GAD.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Guitard, T., Bouchard, S., and Bélanger, C. (2011, January 10–13). Exposure to standardized catastrophic scenarios with patients suffering from GAD. Presented at the 45th Annual Convention of the Association for Behavioral and Cognitive Therapy (ABCT), Toronto, ON, Canada.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The CAQ has good psychometric features with a Cronbach's alpha of 0.95 for the totality of items on an adult non-clinical sample and of 0.92 on a sample of adolescents.

    “Studies have indicated good psychometric features for this scale with a Cronbach’s alpha of 0.95 for the totality of the items on an adult sample and of 0.92 on a sample of adolescents, both non-clinical samples.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Gosselin, 2001, Évaluation des inquiétudes: Validation d’une traduction française du Penn State Worry Questionnaire, L’Encéphale

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Mauchly's sphericity values were non-significant, so non-corrected values were used in the repeated measures ANOVAs.

    “All Mauchly’s (sphericity) values were non-significant, therefore the non-corrected values were used.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The regression analyses met assumptions of linearity, multicollinearity, autocorrelation, multivariate normality, and homoscedasticity.

    “Prior to performing the analyses, data were screened for linearity (by examining a scatterplot), multicollinearity (by verifying the tolerance and VIF values), autocorrelation among the residuals (by verifying the Durbin-Watson values and examining a scatterplot), multivariate normality (by examining a histogram), and homoscedasticity (by examining a scatterplot). All assumptions were met.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The French version of the STAI-Y1 has excellent psychometric values, with a Cronbach's alpha of 0.94 and 0.86 for men and women, respectively.

    “The French version of this measure has excellent psychometric values, with a Cronbach’s alpha of 0.94 and 0.86 for men and women, respectively [36].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Gauthier, 1993, Adaptation canadienne-française de la forme révisée du State-Trait Anxiety Inventory de Spielberger, Revue Canadienne des Sciences du Comportement source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The English version of the PSWQ has good internal consistency (Cronbach's alpha ranging from 0.86 to 0.95) and test-retest reliability (ranging from 0.74 to 0.93).

    “The psychometric properties of the English version are very good, with good internal consistency (Cronbach’s alpha ranging from 0.86 to 0.95) and test retest reliability (ranging from 0.74 to 0.93) [29,30].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [29] Davey, G.C.L., and Tallis, F. (1994). The Penn State Worry Questionnaire: Psychometric properties and associated characteristics. Worrying: Perspectives on Theory, Assessment and Treatment, John Wiley & Sons.

      Not checked in the free run.

    • cites [30] Gosselin, 2002, Le questionnaire d’évitement cognitif: Développement et validation auprès d’adultes et d’adolescents, Journal de thérapie comportementale et cognitive

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Results were similar if the data were not corrected for outliers.

    “Parametric analyses were then performed, with descriptive results reported in Table 2 (note that results were similar if the data is not corrected for outliers).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Bonferroni corrections were applied to control the Type-I error rate.

    “To control for Type-I error rate, Bonferroni corrections were applied.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The negative affect subscale of the PANAS has adequate internal consistency, with a Cronbach's alpha ranging from 0.80 to 0.84.

    “Internal consistency of the negative affect subscale is adequate, with a Cronbach’s alpha ranging from 0.80 to 0.84.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Watson, 1988, Development and validation of brief measures of positive and negative affect: The PANAS scales, J. Personal. Soc. Psychol. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The WW-II has good test-retest reliability (r = 0.81) and internal consistency (Cronbach's alpha of 0.93).

    “This questionnaire possesses good test-retest reliability (r = 0.81) and internal consistency (Cronbach’s alpha of 0.93) [40].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Bouvard, M. (2009). Questionnaires et échelles d’évaluation de la personnalité, Elsevier Masson. [3rd ed.].

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Participants were randomly assigned to one of two exposure orders.

    “The participants included in the study were randomly assigned to one of the two conditions: (a) exposure to a standardized scenario in VR followed by exposure to an individualized scenario in imagination (VR-Exp/IM-Exp; n = 13) or (b) exposure to an individualized scenario in imagination followed by exposure to standardized scenario in VR (IM-Exp/VR-Exp.; n = 15).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Controlling with ANCOVAs for the use of three standardized scenarios did not change the interpretation of the results.

    “Controlling with ANCOVAs for the use of three standardized scenarios did not change the interpretation of the results.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    People with GAD are afraid of uncertainty accompanied with a broad range of situations.

    “As opposed to other anxiety disorders, people suffering from GAD are not essentially afraid of specific and concrete stimuli. They are afraid of uncertainty accompanied with a broad range of situations.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [18] Dugas, 1998, Generalized anxiety disorder: A preliminary test of a conceptual model, Behav. Res. Ther. source

      Not checked in the free run.

    • cites [19] Dugas, 2000, Treatment of GAD. Targeting intolerance of uncertainty in two types of worry, Bheav. Modif. source

      Not checked in the free run.

    • cites [20] Freeston, 1994, Why do people worry?, Personal. Individ. Differ. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The results were in the same range as those in the Guitard et al. [25] study and studies using VR for other anxiety disorders.

    “Results were also in the same range than in the Guitard et al. [25] study, where participants had to imagine the scenarios instead of being exposed to them in VR, and to studies using VR for other anxiety disorders (e.g., [6,7]).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [25] Guitard, T., Bouchard, S., and Bélanger, C. (2011, January 10–13). Exposure to standardized catastrophic scenarios with patients suffering from GAD. Presented at the 45th Annual Convention of the Association for Behavioral and Cognitive Therapy (ABCT), Toronto, ON, Canada.

      Not checked in the free run.

    • cites [6] Laforest, 2016, Inducing an anxiety response using a contaminated virtual environment: Validation of a therapeutic tool for obsessive-compulsive disorder, Front. ICT source

      Not checked in the free run.

    • cites [7] Kim, 2012, Comparison of checking behavior in adults with or without checking symptoms of obsessive-compulsive disorder using a novel computer-based measure, Comput. Methods Programs Biomed. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The French version of the PSWQ has equally good validity and internal consistency.

    “The same was found for the French version (see [30]) indicate equally good validity and internal consistency.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Gosselin, 2002, Le questionnaire d’évitement cognitif: Développement et validation auprès d’adultes et d’adolescents, Journal de thérapie comportementale et cognitive

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The SSQ has a Cronbach's alpha of 0.87.

    “Cronbach’s alpha reaches 0.87.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Bouchard, 2007, Revising the factor structure of the Simulator Sickness Questionnaire, Annu. Rev. Cyberther. Telemed.

      Not checked in the free run.

  • The quote only partly states this claim.

    Interpretationown data

    Overall, personalized scenarios may be more anxiety provoking than standardized VR scenarios.

    “Overall, this suggests that personalized scenarios may be more anxiety provoking.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The personalized scenario in imagination is a valid representation of traditional cognitive exposure.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The sample is relatively small.

    “First, the sample is relatively small.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Results from Labbé et al. [42] are in line with the pioneering paper from Repetto et al. [43] on GAD, although they are the first to address the core fear of GAD.

    “Results from Labbé et al. [42] are in line with the pioneering paper from Repetto et al. [43] on GAD, although they are the first to address the core fear of GAD.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [42] Labbé Thibault, P., Côté, G., and Gosselin, P. (2017). Effet de l’exposition en réalité virtuelle sur les symptômes du trouble d’anxiété généralisée. [Ph.D. Thesis, Université de Sherbrooke].

      Not checked in the free run.

    • cites [43] Repetto, 2013, Virtual reality and mobile phones in the treatment of generalized anxiety disorders: A phase-2 clinical trial, Pers. Ubiquitous Comput. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Using three different VEs instead of one could be argued as a limitation, but using only one scenario would fail to target participants' main worry themes, which would be far more detrimental than comparing three generic scenarios to 28 individualized ones.

    “Furthermore, the choice of three different VEs instead of only one could be argued as another limitation. However, the drawback of using only one scenario would be not targeting the main worry themes of the participants. This would be far more detrimental than comparing only three slightly different generic scenarios to 28 totally different and individualized ones.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    The research protocol was not designed to show how frightening VR could be to GAD patients, but to show the potential of scenarios with a feeling of uncertainty to elicit anxiety in a population that perceives uncertainty as threatening.

    “The research protocol was not designed to show how much an experience in VR could be frightening to GAD patients, but to show the potential of scenarios with a feeling of uncertainty to elicit anxiety in a population that is known to perceive uncertainty as threatening [18].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Dugas, 1998, Generalized anxiety disorder: A preliminary test of a conceptual model, Behav. Res. Ther. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The findings were observed on the anxiety measure but not on the less specific measure of negative affect.

    “The findings are even more interesting because they were observed on the anxiety measure, but not on the less specific measure of negative affect.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The direct comparison of the two exposure modalities is associated with a medium effect size, and a lack of power explains why the difference does not remain significant after controlling for the number of comparisons.

    “However, the direct comparison of the two modalities with each other (i.e., the interaction contrast between the exposure scenarios) is associated with a medium effect size and a lack of power explains why the difference does not remain significant after controlling for the number of comparisons.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    Presenting the neutral immersion in VR to all participants at the beginning of the experiment may have protected against novelty, leaving room for other variables such as dysfunctional thoughts about the usefulness of worry to stand out in predicting state anxiety.

    “Presenting the neutral immersion in VR to all participants at the beginning of the experiment may have protected against the elements of novelty in the task [25], leaving room for other variables to stand out, such as the severity of dysfunctional thoughts about the usefulness of worry in predicting state anxiety.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Guitard, T., Bouchard, S., and Bélanger, C. (2011, January 10–13). Exposure to standardized catastrophic scenarios with patients suffering from GAD. Presented at the 45th Annual Convention of the Association for Behavioral and Cognitive Therapy (ABCT), Toronto, ON, Canada.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    This paves the way for the development of psychotherapy protocols that would integrate in virtuo exposure to test in randomized control trials.

    “This paves the way for the development of psychotherapy protocols that would integrate in virtuo exposure to test in randomized control trials.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Labbé et al. [42] found that exposure to one standardized VR scenario in GAD patients significantly improved all GAD measures post-treatment, maintained at two-month follow-up, and specific to health-related worries.

    “Results showed a significant improvement on all measures related to GAD post-treatment, including the tendency to worry, symptoms of GAD, and anxiety. Treatment gains were maintained at the two-month follow-up. In addition, the changes were specific to health-related worries”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [42] Labbé Thibault, P., Côté, G., and Gosselin, P. (2017). Effet de l’exposition en réalité virtuelle sur les symptômes du trouble d’anxiété généralisée. [Ph.D. Thesis, Université de Sherbrooke].

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The sociodemographic and clinical characteristics of the sample are typical of a study sample of GAD patients, except that there were slightly more women than in the general population, where women are usually three times more likely than men to have GAD.

    “The sociodemographic and clinical characteristics of the sample are typical of a study sample of GAD patients, with the exception of slightly more women than what is found in the general population, where women are usually three times more likely than men to have GAD [44].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Katzman, 2014, Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders, BMC Psychiatry source

      Not checked in the free run.

51 of 51

  • The paper relies on this without support.

    Inducing anxiety in a standardized VR scenario is necessary for it to be usable as an exposure strategy in GAD treatment.

    “Accordingly, the goal of the current study is to document the potential of virtual environments adapted from catastrophic scenarios to induce the anxiety necessary to eventually use VR as an exposure strategy in the treatment of GAD.”

  • The paper relies on this without support.

    In virtuo exposure provides greater standardization of exposure cues than in vivo exposure.

    “In virtuo exposure also provides greater standardization of the exposure cues, which can be useful for researchers as well as clinicians.”

  • The paper relies on this without support.

    Not all patients are good at imagining or visualizing feared situations.

    “For example, not all patients are good at imagining or visualizing feared situations, yet exposure in imagination is often used with GAD patients.”

  • The paper relies on this without support.

    It is difficult to know what patients are thinking about, if they are engaged in avoidance or neutralization behaviors while doing exposure, or if the right stimuli are included in the scenario.

    “It may be difficult to know what patients are thinking about, if they are engaged in avoidance or neutralization behaviors while doing exposure, or if the right stimuli are included in the scenario.”

  • The paper relies on this without support.

    The neutral virtual environment does not itself induce anxiety and serves as a valid baseline.

    “Exposure to a neutral scenario was used as a baseline for comparisons.”

  • The paper relies on this without support.

    The personalized scenario in imagination is a valid representation of traditional cognitive exposure.

    “The current study compared a standardized scenario in VR and a traditional personalized scenario.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The outcomes from the IM-VRCBT group are concordant to other investigations indicating that exposure and relaxation VR scenarios are similarly effective to the classical, face-to-face version of these strategies in reducing GAD symptoms.

    “Consequently, the outcomes from the IM-VRCBT group are concordant to other investigations indicating that exposure and relaxation VR scenarios are similarly effective to the classical, face-to-face version of these strategies in reducing GAD symptoms (Gorini and Riva, 2008; Meyerbröker and Emmelkamp, 2010; Guitard et al., 2019).”

    From Standard CBT versus integrative and multimodal CBT assisted by virtual-reality for generalized anxiety disorder (2022) · cites this paper as Guitard et al., 2019

    The Abstract and Discussion report that VR exposure and traditional exposure in imagination both elicited anxiety in participants with GAD, with no clear difference between them on that measure. They do not establish that the approaches are similarly effective at reducing GAD symptoms: the study did not test treatment efficacy or compare VR relaxation with face-to-face relaxation. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • A recent study found no difference in evoked anxiety between exposure to standardized catastrophic scenarios in VR and imaginal exposure with personalized scenarios, suggesting that perfect tailoring is at least not necessary.

    “One recent study compared exposure to standardized catastrophic scenarios in VR, to imaginal exposure with personalized scenarios, and found no difference in evoked anxiety (Guitard et al. 2019), suggesting that perfect tailoring is at least not necessary.”

    From Better, Virtually: the Past, Present, and Future of Virtual Reality Cognitive Behavior Therapy (2021) · cites this paper as Guitard et al. 2019

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentt(26) = 3.82reported p < .001 · recomputed p < .001

    “t(26) = 3.82, p < .001”

  • Consistentt(26) = -0.58reported p > .05 · recomputed p = .567

    “t(26) = −0.58, p > .05”

  • Consistentt(26) = 0.48reported p > .05 · recomputed p = .635

    “t(26) = 0.48, p > .05”

  • Consistentt(26) = 2.2reported p < .05 · recomputed p = .037

    “t(26) = 2.20, p < .05”

  • Consistentt(26) = 2.59reported p < .05 · recomputed p = .016

    “t(26) = 2.59, p < .05”

  • Consistentt(26) = 0.94reported p > .05 · recomputed p = .356

    “t(26) = 0.94, p > .05”

  • Consistentt(26) = 2.03reported p > .05 · recomputed p = .053

    “t(26) = 2.03, p > .05”

  • ConsistentF(3, 24) = 7.29reported p < .01 · recomputed p = .001

    “F(3, 24) = 7.29, p < .01”

  • ConsistentF(3, 24) = 4.79reported p < .05 · recomputed p = .009

    “F(3, 24) = 4.79, p < .05”

9 of 9

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Cognitive Avoidance Questionnaire citation points to the PSWQ

    Minor

    The Cognitive Avoidance Questionnaire is attributed to reference 31, whose title instead identifies it as a validation of the Penn State Worry Questionnaire.

  • PSWQ French-version citation points to a different questionnaire

    Minor

    The text cites reference 30 for the French version of the Penn State Worry Questionnaire, but reference 30 is titled as a study of the Cognitive Avoidance Questionnaire.

  • Why Worry citation points to the PSWQ

    Minor

    Reference 31 is identified as the source of the original Why Worry questionnaire, but its title identifies the Penn State Worry Questionnaire instead.

3 of 3

Cites

Flagged first, then by citations

2 of the 36 references couldn’t be matched to a known paper.

Research works printed but not linked: 9

  1. Bellack, A.S., and Herson, M. (1986). Exposure. Dictionary of Behavior Therapy Techniques, Pergamon Press.
  2. Tisseau, J. (2008, January 2). In vivo, in vitro, in silico, in virtuo. Proceedings of the 1st Workshop on SMA in Biology at Meso or Macroscopic Scales, Paris, France.
  3. Richard, D.C.S., and Lauterbach, D. (2007). Exposure for phobias. Handbook of Exposure Therapies, Academic Press.
  4. Ladouceur, 1992, Penn State Worry Questionnaire: Validity and reliability of a French translation, Can. Psychol., 33, 236
  5. Gosselin, 2001, Évaluation des inquiétudes: Validation d’une traduction française du Penn State Worry Questionnaire, L’Encéphale, 27, 475
  6. Robillard, G., Bouchard, S., Renaud, P., and Cournoyer, L.G. (2002, January 1–3). Validation canadienne-française de deux mesures importantes en réalité virtuelle: l’Immersive Tendencies Questionnaire et le Presence Questionnaire. Proceedings of the 25ième congrès de la Société Québécoise pour la Recherche en Psychologie (SQRP), Trois-Rivières, QC, Canada.
  7. Bouchard, 2007, Revising the factor structure of the Simulator Sickness Questionnaire, Annu. Rev. Cyberther. Telemed., 5, 117
  8. Spielberger, C.D., Gorsuch, R.L., Lushene, R., Vagg, P.R., and Jacobs, G.A. (1983). Manual for the State-Trait Anxiety Inventory, Consulting Psychologists Press.
  9. Bouvard, M. (2009). Questionnaires et échelles d’évaluation de la personnalité, Elsevier Masson. [3rd ed.].

Cited by

Sorted by citations

Related

Authors
Guitard, T., Bouchard, S., Bélanger, C., & Berthiaume, M.
Affiliations
  • Université du Québec à Montréal (CA)
  • University of Ottawa (CA)
Corresponding author
Bouchard, Stéphane
ORCID
Venue
Journal of Clinical Medicine
Publisher
MDPI AG
Published
2019-03-05
Volume
8
Issue
3
Pages
309
ISSN
2077-0383 (ISSN-L)
DOI
10.3390/jcm8030309
PMC
PMC6463165
OpenAlex
W2918739891
Cited by
40
References
36
Citations by year
2026: 3 · 2025: 5 · 2024: 4 · 2023: 3 · 2022: 8 · 2021: 8 · 2020: 5 · 2019: 4
FWCI
7.37
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Clinical Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
Canada Research Chairs (950-205582)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
generalized anxiety disorder, virtual reality exposure therapy, catastrophic scenarios, cognitive behavioral therapy, anxiety induction, negative affect, individual differences

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review