Visualization, Self-Efficacy, and Locus of Control in a Virtual Reality Biofeedback Video Game for Anxiety Regulation.

The current study aimed to identify specific feedback mechanics and psychological processes that may contribute to positive outcomes in biofeedback applications for anxiety regulation. Specifically, using a dismantling study design, the unique impact of visualizations that directly mirror users' breathing was examined in relation to anxiety regulation as well as locus of control and self-efficacy. Following an anxiety induction, participants (N = 67) were randomly assigned to play one of two variations of a biofeedback video game. In both versions, players' in-game movement was contingent on their breathing; however, the experimental condition additionally included visualizations that directly mirrored players' breathing. Changes in self-reported state anxiety and physiological arousal were measured as well as the level of internal control and self-efficacy participants experienced while playing the game. Results showed that all participants were able to effectively reduce their anxiety and arousal, but no condition differences were found. Implementing mirroring visualizations did not contribute to individuals' ability to self-regulate nor their self-efficacy or locus of control above and beyond receiving feedback based on their in-game movement. Overall, individuals who experienced higher self-efficacy and a stronger internal locus of control were better able to regulate their anxiety, but no clear links were found with changes in self-reported physiological arousal. In light of these results, we recommend the continued exploration of the role of specific design choices and intervention components as well as underlying mechanisms of change in biofeedback interventions, especially pertaining to how individuals perceive themselves and their ability to change.

Deep-Breathing Biofeedback Trainability in a Virtual-Reality Action Game: A Single-Case Design Study With Police Trainers.

It is widely recognized that police performance may be hindered by psychophysiological state changes during acute stress. To address the need for awareness and control of these physiological changes, police academies in many countries have implemented Heart-Rate Variability (HRV) biofeedback training. Despite these trainings now being widely delivered in classroom setups, they typically lack the arousing action context needed for successful transfer to the operational field, where officers must apply learned skills, particularly when stress levels rise. The study presented here aimed to address this gap by training physiological control skills in an arousing decision-making context. We developed a Virtual-Reality (VR) breathing-based biofeedback training in which police officers perform deep and slow diaphragmatic breathing in an engaging game-like action context. This VR game consisted of a selective shoot/don't shoot game designed to assess response inhibition, an impaired capacity in high arousal situations. Biofeedback was provided based on adherence to a slow breathing pace: the slower and deeper the breathing, the less constrained peripheral vision became, facilitating accurate responses to the in-game demands. A total of nine male police trainers completed 10 sessions over a 4-week period as part of a single-case experimental ABAB study-design (i.e., alternating sessions with and without biofeedback). Results showed that eight out of nine participants showed improved breathing control in action, with a positive effect on breathing-induced low frequency HRV, while also improving their in-game behavioral performance. Critically, the breathing-based skill learning transferred to subsequent sessions in which biofeedback was not presented. Importantly, all participants remained highly engaged throughout the training. Altogether, our study showed that our VR environment can be used to train breathing regulation in an arousing and active decision-making context.

Breathing Biofeedback for Police Officers in a Stressful Virtual Environment: Challenges and Opportunities.

As part of the Dutch national science program "Professional Games for Professional Skills" we developed a stress-exposure biofeedback training in virtual reality (VR) for the Dutch police. We aim to reduce the acute negative impact of stress on performance, as well as long-term consequences for mental health by facilitating physiological stress regulation during a demanding decision task. Conventional biofeedback applications mainly train physiological regulation at rest. This might limit the transfer of the regulation skills to stressful situations. In contrast, we provide the user with the opportunity to practice breathing regulation while they carry out a complex task in VR. This setting poses challenges from a technical - (real-time processing of noisy biosignals) as well as from a user-experience perspective (multi-tasking). We illustrate how we approach these challenges in our training and hope to contribute a useful reference for researchers and developers in academia or industry who are interested in using biosignals to control elements in a dynamic virtual environment.

Efficacy of a Virtual Reality Biofeedback Game (DEEP) to Reduce Anxiety and Disruptive Classroom Behavior: Single-Case Study.

BACKGROUND: Many adolescents in special education are affected by anxiety in addition to their behavioral problems. Anxiety leads to substantial long-term problems and may underlie disruptive behaviors in the classroom as a result of the individual's inability to tolerate anxiety-provoking situations. Thus, interventions in special needs schools that help adolescents cope with anxiety and, in turn, diminish disruptive classroom behaviors are needed. OBJECTIVE: This study aimed to evaluate the effect of a virtual reality biofeedback game, DEEP, on daily levels of state-anxiety and disruptive classroom behavior in a clinical sample. In addition, the study also aimed to examine the duration of the calm or relaxed state after playing DEEP. METHODS: A total of 8 adolescents attending a special secondary school for students with behavioral and psychiatric problems participated in a single-case experimental ABAB study. Over a 4-week period, participants completed 6 DEEP sessions. In addition, momentary assessments (ie, 3 times a day) of self-reported state-anxiety and teacher-reported classroom behavior were collected throughout all A and B phases. RESULTS: From analyzing the individual profiles, it was found that 6 participants showed reductions in anxiety, and 5 participants showed reductions in disruptive classroom behaviors after the introduction of DEEP. On a group level, results showed a small but significant reduction of anxiety (d=-0.29) and a small, nonsignificant reduction of disruptive classroom behavior (d=-0.16) on days when participants played DEEP. Moreover, it was found that the calm or relaxed state of participants after playing DEEP lasted for about 2 hours on average. CONCLUSIONS: This study demonstrates the potential of the game, DEEP, as an intervention for anxiety and disruptive classroom behavior in a special school setting. Future research is needed to fully optimize and personalize DEEP as an intervention for the heterogeneous special school population.

A Stimulated Recall Method for the Improved Assessment of Quantity and Quality of Social Media Use.

BACKGROUND: Social media are as popular as ever, and concerns regarding the effects of social media use on adolescent well-being and mental health have sparked many scientific studies into use effects. Social media research is currently at an important crossroads: conflicting results on social media use's effects on well-being are abundant, and recent work in the field suggests that a new approach is required. The field is in need of an approach involving objective data regarding use where necessary and attention to different kinds of detail such as the why and how of social media use. OBJECTIVE: We present a novel paradigm implementing a principle from educational sciences called stimulated recall and demonstrate how it can be applied to social media use research. Our stimulated recall paradigm implements a number of elements that can fill the gaps currently present in social media and well-being research. METHODS: Objective data are collected regarding users' social media behaviors through video footage and in-phone data and used for a structured stimulated recall interview to facilitate detailed and context-sensitive processing of these objective data. In this interview, objective data are reviewed with the participant in an act of co-research, in which details such as the reasons for their use (eg, boredom) and processes surrounding their use (eg, with whom) are discussed and visualized in a stimulated recall chart. RESULTS: Our ongoing study (N=53) implementing this paradigm suggests this method is experienced as pleasant by participants in spite of its personal and intensive nature. CONCLUSIONS: The stimulated recall paradigm offers interesting and necessary avenues for approaching social media use research from new angles, addressing aspects of use that have thus far remained underexposed. The answers to questions such as "Why do adolescents use social media?" "In what ways exactly do they use social media?" and "How does social media use make them feel in the moment?" are now within reach, an important step forward in the field of social media use and well-being research.

Are changes in children's communication patterns predictive of treatment outcomes for children with anxiety?

Anxiety is the most prevalent childhood psychopathology. Cognitive behavioural therapy is considered the most effective treatment, but outcomes remain variable. This study investigated children's communication patterns in child-therapist conversations and whether changes in these patterns, from rigid to more flexible, were associated with better treatment outcomes. Fifty-three children (31% boys), with a mean age in years of M = 9.68 (SD = 1.85), completed a 12-week cognitive behavioural therapy program. Maternal as well as children's reports of children's anxiety were assessed pretreatment and posttreatment. Additionally, 15-min segments of two therapy sessions were audiotaped and children's conversational turns were coded for properties of response and initiative. The structure of children's communication patterns was further quantified using recurrence quantification analysis. As expected children entering treatment were characterised by rigid and inhibited conversational behaviour. Children who became less repetitive and deterministic over time had better maternal-rated treatment outcomes. These findings did not generalize to child reports. Last, the hypothesis that the positive relation between the breaking of rigid communication patterns and treatment outcome would be mediated by increases in proactive conversational behaviours of the child was only partly supported. These study findings contribute to the emergent literature on processes of change in childhood anxiety treatment by providing initial support for the hypothesis that breaking rigid (communication) patterns may be a prerequisite of clinical change.

Dyslexic and skilled reading dynamics are self-similar.

The shape of a word pronunciation time distribution supplies information about the dynamic interactions that support reading performance. Speeded word-naming pronunciation and response time distributions were collected from 20 sixth grade Dutch students with dyslexia and 23 age-matched controls. The participants' pronunciation times were modeled and contrasted with a lognormal inverse power-law mixture distribution. Identical contrasts were also conducted on the same participants' response time distributions derived from flanker, color-naming, and arithmetic tasks. Results indicated that children with dyslexia yield slower, broader, and more variable pronunciation time distributions than their age-matched counterparts. This difference approximated a self-similar rescaling between the two group's aggregate pronunciation time distributions. Moreover, children with dyslexia produced similar, but less prominent trends toward slower and more variable performance across the three non-reading tasks. The outcomes support a proportional continuum rather than a localized deficit account of dyslexia. The mixture distribution's success at describing the participants' pronunciation and response time distributions suggests that differences in proportional contingencies among low-level neurophysiological, perceptual, and cognitive processes likely play a prominent role in the etiology of dyslexia.

A fractal approach to dynamic inference and distribution analysis.

Event-distributions inform scientists about the variability and dispersion of repeated measurements. This dispersion can be understood from a complex systems perspective, and quantified in terms of fractal geometry. The key premise is that a distribution's shape reveals information about the governing dynamics of the system that gave rise to the distribution. Two categories of characteristic dynamics are distinguished: additive systems governed by component-dominant dynamics and multiplicative or interdependent systems governed by interaction-dominant dynamics. A logic by which systems governed by interaction-dominant dynamics are expected to yield mixtures of lognormal and inverse power-law samples is discussed. These mixtures are described by a so-called cocktail model of response times derived from human cognitive performances. The overarching goals of this article are twofold: First, to offer readers an introduction to this theoretical perspective and second, to offer an overview of the related statistical methods.