Virtual Reality for Distraction and Relaxation in a Pediatric Hospital Setting: An Interventional Study With a Mixed-Methods Design

Accumulating evidence supports the use of virtual reality (VR) as an effective pain and anxiety management tool for pediatric patients during specific medical procedures in dedicated patient groups. However, VR is still not widely adopted in everyday clinical practice. Feasibility and acceptability measures of clinicians' experiences are often missing in studies, thereby omitting an important stakeholder in VR use in a clinical setting. Therefore, the aim of this mixed-methods study was to investigate the feasibility, acceptability, tolerability (primary outcomes), and preliminary effectiveness (secondary outcome) of Relaxation-VR in both pediatric patients aged 4–16 years and clinicians. Relaxation-VR is a VR application prototype aimed to provide distraction and relaxation for a variety of patient populations and procedures and is used to reduce anxiety, stress (tension) and pain for children in hospital. Multiple measures of acceptability, feasibility and tolerability, and pre-to-post changes in measures of pain, anxiety, stress and happiness were assessed in pediatric patients. At the end of the study, acceptability and feasibility of VR use was assessed in clinicians. Results indicate that VR use (in particular, the Relaxation-VR prototype) for both distraction and relaxation is acceptable, feasible and tolerable for a variety of pediatric patients aged 4–16 years, as assessed in both patients and clinicians, and can reduce anxiety, pain and tension (stress), and increase happiness in a hospital setting.

The Effect of Outcome Probability on Generalization in Predictive Learning

Abstract. People apply what they learn from experience not only to the experienced stimuli, but also to novel stimuli. But what determines how widely people generalize what they have learned? Using a predictive learning paradigm, we examined the hypothesis that a low (vs. high) probability of an outcome following a predicting stimulus would widen generalization. In three experiments, participants learned which stimulus predicted an outcome (S+) and which stimulus did not (S−) and then indicated how much they expected the outcome after each of eight novel stimuli ranging in perceptual similarity to S+ and S−. The stimuli were rings of different sizes and the outcome was a picture of a lightning bolt. As hypothesized, a lower probability of the outcome widened generalization. That is, novel stimuli that were similar to S+ (but not to S−) produced expectations for the outcome that were as high as those associated with S+.

A mind cleared by walnut oil: The effects of polyunsaturated and saturated fat on extinction learning

The treatment of anxiety-based psychopathology often hinges upon extinction learning. Research in nutritional neuroscience has observed that the regular consumption of perilla oil (50% alpha-linolenic acid (ALA)) facilitates extinction learning in rats (Yamamoto et al., 1988). However, acute facilitation of extinction learning by oils rich in ALA has not been reported for rats or humans, though the acute consumption of rapeseed oil (10% ALA) has been observed to improve cognitive processing speed in humans (Jones, Sünram-Lea, & Wesnes, 2012). For this reason, the present laboratory work examined the effects of adding walnut oil (12% ALA) to a chocolate milkshake on the acquisition, generalization, and extinction of a fear-based prediction in young adults. It compared performance between subjects. The other participants consumed a similar milkshake with either an equicaloric amount of cream (saturated fat), or with no added fat (control). Acquisition and generalization of the fear-based prediction were similar for all groups. However, those who consumed walnut oil extinguished most rapidly and profoundly. Implications for extinction learning are discussed.

Perceptual discrimination in fear generalization: Mechanistic and clinical implications

For almost a century, Pavlovian conditioning is the imperative experimental paradigm to investigate the development and generalization of fear. However, despite the rich research tradition, the conceptualization of fear generalization has remained somewhat ambiguous. In this selective review, we focus explicitly on some challenges with the current operationalization of fear generalization and their impact on the ability to make inferences on its clinical potential and underlying processes. The main conclusion is that, despite the strong evidence that learning influences perception, current research has largely neglected the role of perceptual discriminability and its plasticity in fear generalization. We propose an alternative operationalization of generalization, where the essence is that Pavlovian conditioning itself influences the breadth of fear generalization via learning-related changes in perceptual discriminability. Hence a conceptualization of fear generalization is incomplete without an in-depth analysis of processes of perceptual discriminability. Furthermore, this highlights perceptual learning and discriminability as important future targets for pre-clinical and clinical research.

Increasing predictive estimations without further learning: the peak-shift effect

The peak of learned responding normally occurs at the learning stimulus itself, but can shift to a different stimulus after discriminative learning. This provides important information about the nature of the generalization mechanism, and reveals alternative pathways through which learned responses can increase. Over two experiments, we established the peak-shift effect in a human predictive learning paradigm. Participants were asked to predict the occurrence of a neutral outcome (drawing of a lightning bolt) based on preceding geometrical figures (rings of different sizes). During learning, the middle-sized ring was sometimes followed by the outcome, whereas a larger ring was never followed by the outcome. At test, we presented larger and smaller rings (Experiment 1), or only a slightly smaller ring (Experiment 2). We consistently observed highest prediction of the outcome to the slightly smaller ring. Predictive estimations in humans can reach their height to stimuli that have never actually participated in the learning experiences. We argue that the results are most in line with an associative learning account, rather than an adaptation-level or a rule-learning account.

[Theater and psychiatry]

It is the look which creates theater, for the spectator as well as for the comedian. When this look does not exist anymore, the game disappears and the theater dies. In our work with patients, we have emphasized the representation, the look and the game. This is true for psychotic and neurotic patients, the working methods being however different. The director is there as guarantee of ethics of "well playing". He forces a door, but what lies behind does not concern him. To talk about his perception, his fantasies, has no room in the repetition. We think it is important that theater remains theater, respecting its own laws, and that it can only become therapeutic at this price. This work is dedicated to Claude Etienne who helped us to make our first steps in the theater.