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Summary Background Virtual reality (VR)-based biofeedback is a relatively new intervention and is increasingly being used for the treatment of anxiety disorders. This is the first research synthesis regarding effects and efficacy of this novel mode of treatment. Method We conducted a systematic review and meta-analysis of the VR biofeedback literature on treating anxiety symptoms. The MEDLINE/PubMed, Scopus and Web of Science databases were searched for eligible pre-post comparisons and randomized controlled trials (RCTs). We used self-reported anxiety, heart rate (HR), and heart rate variability (HRV) as primary outcome measures. Results A total of 7 studies with 191 participants reported VR biofeedback interventions. Of these studies 5 were RCTs, with 103 participants receiving VR biofeedback and 99 control participants (either 2D biofeedback or waiting list controls). We found that VR biofeedback significantly lowers self-reported anxiety (g = −0.28) and HR (g = −0.45), but not HRV. Furthermore, there were no significant differences in outcomes between VR biofeedback and 2D biofeedback but a significant reduction in HR in the VR biofeedback group compared with the waiting list (g = −0.52). Conclusion While the first findings are optimistic, more controlled studies with a wider variety of samples are needed to bring this field forward. Particularly, children and adolescents may profit from the combination of gamification elements, VR, and biofeedback.

In 2019, the global Coronavirus (COVID-19) pandemic and associated prevention measures affected the mental health and psychological well-being of young people with and without a migratory background. The present study aimed to compare the mental health and psychological well-being of migrant and non-migrant young people before and after the COVID-19 vaccination campaign period in two countries which had different policies to deal with the pandemic. The “Psychological General Well-being” of young people and their experiences during the pandemic were investigated using an anonymous online survey during two pandemic waves before the vaccination campaign and 6 months after its start. A majority of the 6154 participants (aged between 15 and 25 years in all study groups) reported a decrease of mental health from the time period before the vaccination (BV) to after the vaccination (AV) campaign (b = 0.27, p b = 0.04, p = 0.008) and in youth with financial problems (b = 0.13, p 17 years (59% to 67%). Contrary to expectation, vulnerable groups such as the economically disadvantaged, younger, and female participants did not experience a significant easing of the pandemic’s psychological burden AV. Vaccination campaigns should continue emphasizing the beneficial effects of COVID-19 vaccination on general well-being, but with an acknowledgement that the road to recovery is still a long one. Concurrently, free access to psychological treatment and financial support should be offered, especially for vulnerable groups.

As a global health crisis, COVID-19 has led to a rise in overall stress levels. Concurrently, conspiracy beliefs regarding the origin and spread of the disease have become widespread. Engaging in such beliefs can be explained as a form of coping in order to deal with elevated levels of stress. The present study investigated the indirect effects of coping strategies in the association between perceived chronic stress and COVID-related conspiracy beliefs. We report data from an online survey (N = 1,354 individuals: 807 female; 508 male; 8 diverse; 6 not specified; mean age 39.14 years) in German-speaking countries collected between January and March 2021. Our results indicate that people who felt more stressed were more prone to conspiracy beliefs. Coping via acceptance and self-blame was associated with decreased tendencies towards COVID-related conspiracy beliefs, while people who used denial as a strategy were more prone to these beliefs. These findings emphasize the need for stress management interventions and effective coping strategies during times of crisis in order to reduce chronic perceived stress, promote adaptive coping, and ultimately reduce conspiracy beliefs.

BackgroundGiven the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate treatments that reduce both self-harm and suicidal ideation in the context of broader adolescent psychopathology is critical.MethodsWe conducted a systematic review and meta-analysis of the Dialectical Behaviour Therapy for Adolescents (DBT-A) literature on treating self-injury in adolescents (12–19 years). We searched for eligible trials and treatment evaluations published prior to July 2020 in MEDLINE/PubMed, Scopus, Google Scholar, EMBASE, and the Cochrane Library databases for clinical trials. Twenty-one studies were identified [five randomized-controlled trials (RCTs), three controlled clinical trials (CCTs), and 13 pre-post evaluations]. We extracted data for predefined primary (self-harm, suicidal ideation) and secondary outcomes (borderline personality symptoms; BPD) and calculated treatment effects for RCTs/CCTs and pre-post evaluations. This meta-analysis was pre-registered with OSF: osf.io/v83e7.ResultsOverall, the studies comprised 1673 adolescents. Compared to control groups, DBT-A showed small to moderate effects for reducing self-harm (g = −0.44; 95% CI −0.81 to −0.07) and suicidal ideation (g = −0.31, 95% CI −0.52 to −0.09). Pre-post evaluations suggested large effects for all outcomes (self-harm: g = −0.98, 95% CI −1.15 to −0.81; suicidal ideation: g = −1.16, 95% CI −1.51 to −0.80; BPD symptoms: g = −0.97, 95% CI −1.31 to −0.63).ConclusionsDBT-A appears to be a valuable treatment in reducing both adolescent self-harm and suicidal ideation. However, evidence that DBT-A reduces BPD symptoms was only found in pre-post evaluations.

Highlights: Conspiracy beliefs are spread via social media platforms and may have a negative impact on preventive health measures Preventive measures against fear and misinformation need to consider the differential effects of different forms of conspiracy theories on behavior Fostering awareness in society about COVID-19 misinformation in social media is crucial.

Ethnic discrimination negatively affects the health of ethnic minorities. The dysregulation of psychobiological stress systems, such as the autonomic nervous system (ANS) or the hypothalamic-pituitary-adrenal (HPA) axis, might be an intermediary in this association and chronicity of ethnic discrimination may matter. We studied stress responses to a standardized discriminatory event in Turkish immigrants living in Austria.Seventy-two male Turkish immigrants were recruited; n = 35 had experienced high levels of ethnic discrimination (high), n = 37 infrequent ethnic discrimination (low). During a two-hour laboratory appointment, they underwent a previously validated 10-minute ethnic discrimination paradigm, i.e., a simulated physician's consultation with verbal and non-verbal discriminatory cues. Perceived stress, perceived discrimination, salivary cortisol, and alpha-amylase were assessed seven times, and ANS measures (heart rate, heart rate variability, and electrodermal activity) were measured continuously. In addition, hair cortisol concentrations were determined.The ethnic discrimination paradigm elicited stress responses across all outcomes in both groups. Compared to the low group, the high group reported higher levels of perceived stress and discrimination, exhibited a less steep increase in cortisol in response to the paradigm, and showed higher hair cortisol concentrations. No group differences were found regarding ANS measures.The combination of high subjective stress, flattened cortisol responses, and relatively high hair cortisol concentrations may indicate a dysregulation of the HPA axis in chronic ethnic discrimination. A better understanding of the psychobiological effects of chronic ethnic discrimination is crucial given that alterations in stress response systems may, over time, lead to illness and ultimately to substantial health inequities in ethnic minorities.

(1) Background: Many studies have used a well-known social exclusion task, namely Cyberball, to assess the psychophysiological reactions to ostracism in laboratory settings. However, this task has been recently criticized for its lack of realism. Instant messaging communication platforms are currently central communication channels where adolescents conduct their social life. These should be considered when recreating the emotional experiences that fuel the development of negative emotions. To overcome this limitation, a new ostracism task, namely SOLO (Simulated On-Line Ostracism), recreating hostile interactions (i.e., exclusion and rejection) over WhatsApp was developed. The aim of this manuscript is to compare adolescents’ self-reported negative and positive affect, as well as physiological reactivity (i.e., heat rate, HR; heart rate variability, HRV) exhibited during SOLO to Cyberball. (2) Method: A total of 35 participants (Mage = 15.16; SD = 1.48; 24 females) took part in the study. The first group (n = 23; transdiagnostic group), recruited at an inpatient and outpatient unit of a clinic for children and adolescent psychiatry, psychotherapy, and psychosomatic therapy in Baden-Württemberg (Germany), reported clinical diagnoses linked with emotional dysregulation (e.g., self-injury and depression). The second group (n = 12; control group), recruited in the district of Bavaria and Baden-Württemberg, had no pre-existing clinical diagnoses. (3) Results: The transdiagnostic group showed higher HR (b = 4.62, p < 0.05) and lower HRV (b = 10.20, p < 0.01) in SOLO than in Cyberball. They also reported increased negative affect (interaction b = −0.5, p < 0.01) after SOLO but not after Cyberball. In the control group, no differences in either HR (p = 0.34) or HRV (p = 0.08) between tasks were found. In addition, no difference in negative affect after either task (p = 0.83) was found. (4) Conclusion: SOLO could be an ecologically valid alternative to Cyberball when assessing reactions to ostracism in adolescents with emotional dysregulation.

Background Although the Trier Social Stress Test (TSST) constitutes a valid paradigm for social stress induction, less is known about the effects of a virtual reality (VR) TSST on short- and long-term hypothalamic-pituitary-adrenal (HPA) axis and sympathetic-adreno-medullar (SAM) axis responses. Hence, this study set out to evaluate reactivity and habituation of self-reported stress and HPA and SAM reactivity in a real TSST and VR-TSST when compared to a placebo TSST. Method Sixty-eight healthy young adults (50% female) were randomly assigned to either a real TSST, a VR-TSST, or a placebo TSST, all of which were conducted three times (one day and one week post initial exposure). Social presence, self-reported stress, salivary cortisol, heart rate (HR), and heart rate variability (HRV) were analyzed using ANOVAs and multilevel models. Findings On the first exposure, both the real and VR-TSST showed significantly stronger cortisol and cardiovascular responses than the placebo. On the second visit, the cortisol response was still significantly high—and the HRV response low—for the real and VR-TSST. The third visit resulted in HR, HRV, and cortisol responses comparable to the placebo group. Furthermore, the real TSST induced more self-reported stress than the placebo on all three visits, the VR-TSST only on the first two visits. Social presence was stable across conditions and had no association with stress markers. Conclusion These findings imply that the replicability of stress exposures at shorter intervals seems problematic for the traditional TSST, and for the VR-TSST.

Research on participatory medical decision making in children is still scarce. At the same time, there is broad consensus that involving young patients in decision making processes increases their adherence to medical procedures and reduces anxiety. Thus, this cross-sectional study’s objective was to assess mothers’, fathers’, and children’s evaluation of the child’s decisional competence in the context of psychosomatic and psychiatric care and test for possible predictors of competence such as illness perception, health-related quality of life (HrQoL), socioeconomic status, gender, and age. Fifty-four families (mother, father, child triads; total N = 143) completed self-report questionnaires. Age of the children ranged from 6–16 (M = 11.68, SD = 2.74; 43% female), and the majority had a diagnosis of hyperkinetic, depressive or pervasive developmental disorders. 80% of children were German native speakers, and 27–37% of parents had a university degree. Findings show that parents rate the consequences of the child’s illness as more severe and report to understand it better than the child. Also, children indicate the proposed age for autonomous decision making as lower (13.55 years) than their parents (15.63, 16.58). Furthermore, age of child, mother, and father, HrQoL, illness coherence, and emotional illness representation emerged as significant predictors of the decisional competence subscales understanding, autonomy, decision making, and attitudes. This study demonstrates the importance of considering all parties in shared decision making. Future research is challenged to more comprehensively evaluate contributing factors to achieve a more valid picture of children’s decisional competence.

IntroductionChronic ethnic discrimination is associated with negative mental and physical health outcomes in ethnic minority groups. It is assumed that suffering from repeated discriminatory events leads, over time, to psychological consequences such as higher perceived stress, higher negative affect and lower positive affect. Higher stress reactivity to non-discriminatory stressors, such as daily hassles, as well as anticipation and avoidance behaviour regarding discriminatory events, may further contribute to the overall burden for affected individuals. Studies investigating chronic ethnic discrimination and its psychological consequences in the daily lives of affected persons are lacking. Here, we present a study protocol to investigate the impact of chronic ethnic discrimination and acute discriminatory events in the daily lives of Turkish immigrants living in Austria, using an ambulatory assessment design. The feasibility of our study design was tested and confirmed in a pilot study (n=10).Methods and analysisNinety male Turkish immigrants will complete daily questionnaires for 30 days. Participants will indicate stress, perceived discrimination, negative and positive affect, daily hassles, anticipation and avoidance behaviour, as well as rumination with regard to discriminatory events on a daily basis. Furthermore, they will use preprogrammed iPods to assess acute discriminatory events in real time. Our hypotheses will be tested using multilevel analyses.Ethics and disseminationThis study has been approved by the institutional review board of the University of Vienna (reference number 00358). Results will be presented at conferences and submitted for publication in a peer-reviewed journal.

This systematic review and meta-analysis aimed to investigate the association of neonatal exposure to pain, stress, opiate administration alone, as well as opiate administration prior to a painful procedure on neuronal cell death, motor, and behavioral outcomes in rodents. In total, 36 studies investigating the effect of pain (n = 18), stress (n = 15), opiate administration (n = 13), as well as opiate administration prior to a painful event (n = 7) in rodents were included in our meta-analysis. The results showed a large effect of pain (g = 1.37, 95% CI 1.00-1.74, p .001) on neuronal cell death. Moreover, higher number of neonatal pain events were significantly associated with increased neuronal cell death, increased anxiety (b = -1.18, SE = 0.43, p = .006), and depressant-like behavior (b = 1.74, SE = 0.51, p = .027) in rodents. Both opiates and pain had no impact on motor function (g = 0.26, 95% CI 0.18-0.70, p = .248).

Background Post-traumatic stress disorder (PTSD) is a debilitating disorder that is often accompanied by alterations in the hypothalamic-pituitary (HPA) axis. While there is abundant evidence for the efficacy of psychological therapies in reducing post-traumatic stress symptoms, barely anything is known about pharmacological interventions. Given the role of the HPA axis in the pathophysiology of PTSD, the aim of this study was to provide the first meta-analysis of Hydrocortisone as a potential treatment for this condition. Method A systematic review of randomized-controlled trials (RCTs) was conducted to investigate the efficacy of hydrocortisone in the prevention and curative treatment of post-traumatic stress symptoms. This study was pre-registered with the OSF (doi:10.17605/OSF.IO/GJAZF). Findings Eight studies (9 effect sizes) covering 362 participants met our inclusion criteria. We found that Hydrocortisone as compared to placebo significantly reduced PTSD symptoms (d = 0.96, 95% Cl 0.22–1.69 p = 0.011) and PTSD incidence (logRR = 0.85, 95% CI 1.12–1.59, p = 0.023). Subgroup analyses revealed a significant effect of Hydrocortisone when it was administered in a preventative context (d = 1.50; 95%CI 0.30–2.69, p = 0.014), but not when it was administered in a curative context (d = 0.28; 95%CI −0.11 to 0.66, p = 0.161). Conclusion Hydrocortisone appears to be a promising and efficient low-cost medication for the prevention of PTSD. However, the small number of included studies and their limited methodological quality emphasize the need for further rigorous studies in this field.

While ostracism constitutes a social stressor with negative effects on physical and mental health, social inclusion seems to increase resilience. This may be true not only for face-to-face settings, but also for computer-mediated interactions. Hence, this study examined the differences between ostracism and social inclusion in real-life or Virtual Reality (VR) regarding self-reported stress, neuroendocrine and cardiovascular reactivity in a subsequent real-life socio-evaluative task. 84 females were randomly assigned to a 3 (agency: face-to-face/human controlled VR-avatar/computer VR-agent) x 2 (inclusion status: inclusion/exclusion) between-subject design using a Cyberball paradigm. Subsequently, they were exposed to a real-life Trier Social Stress Test (TSST). Results indicate that the experience of ostracism constitutes a threat to fundamental social needs independent of agency. Excluded participants showed cardiovascular reactivity during TSST; also face-to-face and avatar excluded individuals had elevated salivary cortisol levels. Included participants reported more perceived social support during Cyberball and showed a blunted cortisol response to the TSST. These results suggest that face-to-face and avatar-related ostracism provokes responses in the hypothalamic–pituitary–adrenal (HPA) axis and the sympathetic nervous system (SNS). Furthermore, they reveal that social inclusion may act as a stress-protector as it alters HPA- and SNS-related stress responsiveness to subsequent stressors.

BackgroundParental beliefs about the cause of their child’s illness are thought to affect parents’ help-seeking behaviors, treatment decisions, and the child’s health outcomes. Yet, research on parental beliefs about disease causation is still scarce. While a small number of studies assesses parental cause attributions for singular disorders (e.g., neurodevelopmental disorders), no study has compared disorders with differing physical versus mental conditions or with mixed comorbidities in children and adolescents or their caregivers. Furthermore, most pediatric research suffers from a lack of data on fathers.ObjectiveHence, the objective of the current study was to test for possible differences in mothers’ and fathers’ perceptions about the etiology of their child’s illness.MethodsForty-two parent couples (overall N = 84) whose child had been diagnosed either with Attention Deficit Hyperactivity-Disorder (ADHD) or Autism Spectrum Disorder (ASD) (category “neurodevelopmental disorder”) or with a primary physical illness and a comorbid mental disorder, e.g. depression (category “psychosomatic disorder”) were asked to rate possible causes of their child’s illness using a modified version of the revised Illness Perception Questionnaire (IPQ) Cause scale.ResultsA two-way ANOVA showed that psychosomatic disorders were significantly more strongly attributed to be caused by medical and environmental stressors than neurodevelopmental disorders. A significant parent × illness category interaction revealed that this effect was more pronounced in fathers.ConclusionsBy providing first insights into parental beliefs about the etiology of their children’s neurodevelopmental versus psychosomatic disorders, this study paves ground for future research and tailored counseling of affected families.

Background Self-harm is a clinically relevant and prevalent behaviour which peaks in adolescence. Given the high prevalence of self-harm, the high levels of psychiatric comorbidity, and its role as a risk factor for suicide, delivering evidence-based care is critical. Methods We conducted a systematic review and meta-analysis of the literature on treating self-harm in adolescents (12–19 years) published in the last 20 years, identifying 25 randomised controlled trials. We calculated the effect of treatment interventions relative to active control conditions in reducing self-harm, suicidal ideation and depressive symptoms. Results Overall, treatment interventions fared slightly better than active controls in decreasing self-harm (d = 0.13, 95% CI 0.04–0.22, p = .004), suicidal ideation (d = 0.31, 95% CI 0.12–0.50, p = .001) and depressive symptoms (d = 0.22, 95% CI 0.07–0.38, p = .006). Subgroup analysis of specific therapies revealed moderate effects of DBT-A in reducing self-harm (d = 0.51, 95% CI 0.18–0.85, p = .002) and suicidal ideation (d = 0.48, 95% CI 0.17–0.80, p = .003), as well as moderate effects of family-centred therapy in the treating suicidal ideation (d = 0.58, 95% CI 0.01–1.15, p = .049). Conclusions The findings of our meta-analysis indicate that, overall, currently available treatments are effective in treating self-harm, suicidal ideation, and depressive symptoms in adolescence. Although the treatment intervention conditions showed only small to moderate effects in comparison to active controls, these differences were statistically significant and are clinically important. Further research is needed to understand the reduction in self-harm within active controls, which may arise due to the natural course of self-harm, or the potential efficacy of treatment as usual and enhanced usual care. Given the significant reduction of self-harm in active control conditions, delivering effective care to a large number of adolescents with self-harm may require developing stepped-care models in clinical practice. Expensive and poorly available treatments should be targeted at young people who most need them.

Little is known about the impact of the COVID-19 pandemic on the mental health and psychological well-being of young people. The aim of this study is to investigate the psychological well-being and changes in the mental-health state of young people living in Austria and Turkey. By using an anonymous online survey, we recruited 1240 people aged 15&ndash, 25 years from these two countries. We used the &ldquo, Psychological General Well-being&rdquo, and a self-created questionnaire to capture individual experiences during the COVID-19 pandemic and quarantine period. The native Turks indicated higher &ldquo, anxiety&rdquo, (ps &lt, 0.010), lower &ldquo, vitality&rdquo, 0.011), and lower &ldquo, general health&rdquo, 0.011) than native Austrians or Austrian migrants and increased &ldquo, depression&rdquo, (p = 0.005) and lower &ldquo, self-control&rdquo, (p = 0.022), than Austrian migrants. Moreover, 50.9% of native Turks reported a decrease in their mental health status, compared to 31.1% of native Austrians and 23.7% of Austrian migrants. Participants with financial problems (OR = 1.68) and prior mental health problems (i.e., already in treatment by the time of COVID-19, OR = 5.83) reported a higher probability for a worsening in their mental health status. Our results show that the COVID-19 pandemic impaired the psychological well-being and mental health of young people. Especially people in Turkey were most affected, probably due to the stringent policies to fight COVID-19.

Contrary to specific phobias, for which Virtual Reality Exposure Therapy (VRET) constitutes an effective treatment, uncertainty still exists regarding the usefulness of VRET for posttraumatic stress disorder (PTSD). Therefore, this meta-analysis investigated the efficacy of VRET for PTSD as compared to waitlist and active comparators. A literature search yielded nine controlled studies encompassing 296 participants (124 VRET, 172 controls). The differences between conditions regarding the primary outcome of PTSD symptom severity and the secondary outcome of depressive and anxiety symptoms post-treatment were calculated using Hedges'Al contrario de las fobias específicas, para las cuales la Terapia de Exposición de Realidad Virtual (VRET en sus siglas en inglés) constituye un tratamiento efectivo, existe todavía incertidumbre con respecto a la utilidad de la VRET para el trastorno de estrés postraumático (TEPT). Por lo tanto, este meta-análisis investigó la efectividad de la VRET para el TEPT en comparación con la lista de espera y los comparadores activos. Una búsqueda de literatura arrojó nueve estudios controlados involucrando a 296 participantes (124 VRET, 172 controles). Las diferencias entre las condiciones con respecto al resultado principal de la severidad de los síntomas del TEPT y el resultado secundario de los síntomas depresivos y ansiosos luego del tratamiento, fueron calculados usando la g de Hedges. En comparación a los controles de lista de espera, la VRET mostró un resultado significativamente mejor para los síntomas del TEPT (g=0.62, p=.017) y los síntomas depresivos (g=0.50, p=.008). No hubo diferencias significativas entre la VRET y los comparadores activos con respecto a los síntomas del TEPT (g=0.25, p=.356) y los síntomas depresivos (g=0.24, p=.340) luego del tratamiento. No surgieron efectos significativos para los síntomas ansiosos. Estos hallazgos sugieren que la VRET podría ser tan efectiva como los comparadores activos para los pacientes con TEPT. Sin embargo, los resultados deben ser interpretados con cautela debido al número limitado de ensayos y el sustancial número de miembros del servicio militar –predominantemente hombres- estudiados. Ensayos controlados adicionales, que consideren un rango más amplio de tipos de trauma y balanceados en género, son requeridos para fortalecer la evidencia.虚拟现实暴露疗法（VRET）可有效治疗特定恐惧症，与之相比，VRET对创伤后应激障碍（PTSD）的可用性仍不确定。因此，这项元分析研究了VRET对创伤后应激障碍的疗效，及其与与等候名单和有效对照疗法的比较。文献检索产生了9项对照研究，包括296名参与者（124名VRET，172名对照组）。使用Hedges’g计算关于接受不同治疗后PTSD症状严重程度的差异，以及抑郁和焦虑症状的差异。与等候名单对照组相比，VRET显示出PTSD症状（g = 0.62，p = .017）和抑郁症状（g = 0.50，p = .008）的显著更好的结果。 VRET和有效对照疗法之间在治疗后PTSD症状（g = 0.25，p = .356）和抑郁症状（g = 0.24，p = .340）上没有显著差异。对焦虑症状没有显著效果。这些发现表明，VRET可能与PTSD患者的有效对照疗法一样有效。但是，因为纳入试验数量有限，并且研究了大量以男性为主的军事服务人员，必须谨慎解释研究结果。需要进一步的对照试验以加强证据，未来的研究需要考虑更广泛的创伤类型和对参与者性别进行平衡。.

Background Psychotic-like experiences (PLE) are reported in the general population, characterizing a non-clinical psychosis phenotype. Although those who report PLE have a higher probability of transitioning to psychosis, PLE are usually a transitory state, and most individuals will not transition to psychosis. However, PLE samples may experience symptoms such as social withdrawal, social anxiety, or social anhedonia. These symptoms may lead individuals with PLE to choose online gaming as a preferred means of social interaction. Objective This study aims to examine the relation between PLE and problematic online gaming. Methods An online questionnaire was posted in online game forums, on online fan-pages with German-speaking domains and in social media groups. Data from adolescents and young adults (14 to 30 years old; 55.4% males) from Austria and Germany (N=280) was analyzed. Measures: PLE were assessed with the Early Recognition Inventory based on the Interview for the Retrospective Assessment of the Onset of Schizophrenia (ERIraos); problematic gaming behavior was assessed with the Compulsive Internet Use Scale (CIUS) adapted for online gaming; social anxiety was assessed with the Mini-Social Phobia Inventory (Mini-SPIN); preference for online social interactions was assessed with the Preference for Online Social Interaction scale (POSI). Analyses: Problematic gaming behavior was divided into two groups based on the suggested cut-off point of ≥18 on the CIUS (i.e., ≥18 gaming disorder vs. ˂18 no gaming disorder). Multivariable logistic regression analyses were performed and adjusted for sex, age, gaming hours, POSI, and social anxiety. Results A total of 63 individuals reached the cutoff for a gaming disorder, while 217 did not reach the cutoff. The majority of subjects in the gaming disorder group were males, young adults (19–24 years old, M=23.1, SD=3.7), single, or had less than high school diploma. Individuals who experienced an increased amount of PLE had a higher probability of reaching the cut-off for a gaming disorder (AOR=1.35 [95% CI 1.19–1.53]). Males were three times as likely as females to have a gaming disorder. Discussion Results implicate a close relation between the phenomena of PLE and continued problematic gaming behavior.

While virtual humans are increasingly used to benefit the elderly, considerably little is still known about older adults' virtual experiences. However, due to age-related changes, older adults' perceptions of virtual environments (VEs) may be unique. Hence, our objective was to examine possible gender differences in immersion, flow, and emotional states as well as physical and social presence in elderly males and females interacting either with a computer-controlled agent or a human-controlled avatar. Seventy-eight German-speaking older adults were randomly assigned to an avatar or an agent condition and were exposed to a brief social encounter in a virtual café. Results indicate no overall gender differences, but a significant effect of agency on social presence, physical presence, immersion, and flow. Participants in the avatar condition reported higher levels in all measures, except for involvement. Furthermore, significant gender × agency interactions were found, with females showing more social presence, spatial presence, and flow when interacting with a human-controlled avatar and more realism when conversing with an agent. Also, all participants showed significant changes in their affect post exposure. In sum, older adults' virtual experiences seem to follow unique patterns, yet, they do not preclude the elderly from successfully participating in VEs.

Background and objectives Face-to-face and text-based social support have been shown to attenuate stress responses in past studies. Yet as social interactions increasingly take place online by means of virtual humans, our objective was to examine whether different forms of social support (virtual vs. real) prior to the Trier Social Stress Test (TSST) would also decrease stress. Additionally, the effect on subsequent real-life social behaviors (helping and approach) was evaluated while controlling for affective states and social presence. Methods 56 participants were either supported by an avatar, an agent, a real human or received no support before completing the TSST and two subsequent social behavior tasks (pen task and seating task). Results Results show no difference in agency regarding social presence. Yet, participants with agent support and no support had significantly higher heart rates during the TSST and reported to be more worried. Also, they were more irritated and showed significantly slower helping reactions (picking up pens). Limitations A limitation to this study is that only emotional verbal and non-verbal support were provided by a stranger. Different forms of support as well as a different source (i.e., a friend) may have a more pronounced effect on stress buffering. Conclusions Virtual social support is as effective as face-to-face support in terms of stress buffering, as long as the recipient has the impression that it is provided by another human (via an avatar). This has wide ranging implications not only for health-related application in prevention and treatment but also for further research.