Albert Rizzo | University of Southern California (original) (raw)

Papers by Albert Rizzo

There has been a recent resurgence of Vietnam-era Veterans seeking Veteran Affairs (VA) services ... more There has been a recent resurgence of Vietnam-era Veterans seeking Veteran Affairs (VA) services for post-traumatic stress disorder (PTSD). Multiple studies have reported positive outcomes using Virtual Reality Exposure Therapy (VRET) with Iraq/Afghanistan Veteran PTSD patients, but there have been fewer investigations into the acceptability and feasibility of VRET with older Veterans. We have extended an established VRET system, BRAVEMIND, to include Vietnam relevant content following a user-centered iterative design methodology. This paper will present the BRAVEMIND Vietnam VRET system, including setup, content, and technical architecture along with the findings of an initial focus group with Vietnam Veterans. These Veterans rated this system to be acceptable as a treatment tool for combat-related PTSD and provided valuable first-person accounts of their time in Vietnam to help guide the evolution of the VR content.

Psychological Inquiry, Oct 2, 2019

We present a versatile system for training job interviewing skills that focuses specifically on s... more We present a versatile system for training job interviewing skills that focuses specifically on segments of the population facing increased challenges during the job application process. In particular, we target those with Autism Spectrum Disorder (ADS), veterans transitioning to civilian life, and former convicts integrating back into society. The system itself follows the SAIBA framework and contains several interviewer characters, who each represent a different type of vocational field, (e.g. service industry, retail, office, etc.) Each interviewer can be set to one of three conversational modes, which not only affects what they say and how they say it, but also their supporting body language. This approach offers varying difficulties, allowing users to start practicing with interviewers who are more encouraging and accommodating before moving on to personalities that are more direct and indifferent. Finally, the user can place the interviewers in different environmental settings (e.g. conference room, restaurant, executive office, etc.), allowing for many different combinations in which to practice.

Routledge eBooks, Feb 11, 2013

This demo introduces a novel mHealth application with an agentbased interface designed to collect... more This demo introduces a novel mHealth application with an agentbased interface designed to collect multimodal data with passive sensors native to popular wearables (e.g., Apple Watch, FitBit, and Garmin) as well as through user self-report. This mHealth application delivers personalized and adaptive multimedia content via smartphone application specifically tailored to the user in the interdependent domains of physical, cognitive, and emotional health via novel adaptive logic-based algorithms while employing behavior change techniques (e.g., goal-setting, barrier identification, etc.). A virtual human coach leads all interactions to improve adherence.

Scientific Reports, Feb 6, 2019

slow-wave sleep (sWs) is known to contribute to memory consolidation, likely through the reactiva... more slow-wave sleep (sWs) is known to contribute to memory consolidation, likely through the reactivation of previously encoded waking experiences. Contemporary studies demonstrate that when auditory or olfactory stimulation is administered during memory encoding and then reapplied during sWs, memory consolidation can be enhanced, an effect that is believed to rely on targeted memory reactivation (TMR) induced by the sensory stimulation. Here, we show that transcranial current stimulations (tCs) during sleep can also be used to induce tMR, resulting in the facilitation of high-level cognitive processes. Participants were exposed to repeating sequences in a realistic 3D immersive environment while being stimulated with particular tCs patterns. A subset of these tCs patterns was then reapplied during sleep stages N2 and SWS coupled to slow oscillations in a closed-loop manner. We found that in contrast to our initial hypothesis, performance for the sequences corresponding to the reapplied tCs patterns was no better than for other sequences that received stimulations only during wake or not at all. In contrast, we found that the more stimulations participants received overnight, the more likely they were to detect temporal regularities governing the learned sequences the following morning, with tCs-induced beta power modulations during sleep mediating this effect. Sleep plays an important role in consolidating recently encoded memories and facilitating a variety of cognitive skills 1. The consolidation process for declarative memories is thought to involve the coordinated transfer of memory traces from short-term fast-learning storage in the hippocampus to long-term slow-learning storage across the neocortex, occurring mostly during slow-wave sleep (SWS). Evidence from multi-site in vivo recordings in rodents during SWS 2,3 and fMRI recordings in humans during waking periods of rest 4,5 shows that the fidelity of the consolidation process, as manifested in stronger subsequent recall of the learned stimuli, may be related to the reactivations, or replay, of the spatiotemporal brain activity patterns that were elicited during learning at wake. Specifically, coordinated replay across the hippocampus and neocortex-as indexed by enhanced slow-wave (SW) oscillations 6 , increased spindle-SW phase-amplitude coupling 7,8 , and enhanced functional connectivity between hippocampal and cortical voxels 4,9 , among others-may allow for the consolidation of waking experiences in the neocortex 10 and result in the facilitation of subsequent memory recall performance during waking 11,12. Accordingly, over the last decade and a half, researchers have developed non-invasive methods to modulate both memory consolidation during sleep and its manifestations in brain oscillations using either sensory or electric

Communications in computer and information science, 2020

The overall goal of VRN is to develop a novel technology solution at Children’s Hospital Los Ange... more The overall goal of VRN is to develop a novel technology solution at Children’s Hospital Los Angeles (CHLA) to overcome barriers that prevent the recruitment of diverse patient populations to clinical trials by providing both caregivers and children with an interactive educational experience. This system consists of 1) an intelligent agent called Zippy that users interact with by keyboard or voice input, 2) a series of videos covering topics including Privacy, Consent and Benefits, and 3) a UI that guides users through all available content. Pre- and post-questionnaires assessed willingness to participate in clinical research and found participants either increased or maintained their level of willingness to participate in research studies. Additionally, qualitative analysis of interview data revealed participants rated the overall interaction favorably and believed Zippy to be more fun, less judgmental and less threatening than interacting with a human. Future iterations are in-progress based on the user-feedback.

Springer eBooks, 2015

ABSTRACT War is one of the most challenging environments that a human can experience. The cogniti... more ABSTRACT War is one of the most challenging environments that a human can experience. The cognitive, emotional, and physical demands of a combat environment place enormous stress on even the best-prepared military personnel. The OEF-OIF (Operation Enduring Freedom-Operation Iraqi Freedom) combat theatre, with its ubiquitous battlefronts, ambiguous enemy identification, and repeated extended deployments, was anticipated to produce significant numbers of military personnel with post-traumatic stress disorder (PTSD) and other mental disorders. Recent studies are now confirming this expectation. Among the many approaches that have been used to treat PTSD, exposure therapy appears to have the best-documented therapeutic efficacy. Such treatment typically involves the graded and repeated imaginal reliving of the traumatic event within the therapeutic setting and is believed to provide a low-threat context in which the patient can begin to therapeutically process trauma-relevant emotions as well as decondition the learning cycle of the disorder via a habituation/extinction process. While the efficacy of imaginal exposure has been established in multiple studies with diverse trauma populations, many patients are unwilling or unable to effectively visualize the traumatic event. To address this problem, researchers have recently turned to the use of virtual reality (VR) to deliver exposure therapy by immersing patients in simulations of trauma-relevant environments that allow for precise control of stimulus conditions. This chapter presents an overview of PTSD exposure therapy, a description of VR, and the rationale for how this technology has been applied as a tool to deliver exposure therapy along with a brief review of current research. We then provide a description of the current Virtual Iraq exposure therapy system and treatment protocol and present initial results from an open clinical trial with active duty military personnel and a brief case study. The chapter concludes with a summary of future directions in which VR technology can be further applied to more comprehensively address a range of PTSD-relevant issues. KeywordsClinical interface–exposure therapy–extinction–habituation–PTSD–virtual reality

Contemporary Clinical Trials, Dec 1, 2019

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Depression and Anxiety, May 7, 2018

Background: The majority of studies comparing active psychological treatments for posttraumatic s... more Background: The majority of studies comparing active psychological treatments for posttraumatic stress disorder (PTSD) do not find significant differences at posttreatment. This was the case in a recent trial examining prolonged exposure (PE) and virtual reality exposure (VRE) among active-duty soldiers with combat-related PTSD. Matching individual patients to specific treatments provides a potential avenue to improve significantly the public health impact of effective treatments for PTSD. A composite moderator approach was used to identify profiles of patients who would see superior PTSD symptom reduction in VRE or PE to inform future treatment matching. Methods: Active duty U.S. army soldiers (N = 108) were enrolled in a randomized clinical trial comparing VRE and PE in the treatment of PTSD stemming from deployments to Iraq or Afghanistan. Eighteen baseline variables were examined to identify treatment response heterogeneity in two patient groups: those with a superior response to PE and those with a superior response to VRE. The final composite moderator comprised four of 18 baseline variables. Results: Results revealed that patients who were predicted to see greater PTSD symptom reduction in VRE were likely to be younger, not taking antidepressant medication, had greater PTSD hyperarousal symptoms, and were more likely to have greater than minimal suicide risk. Conclusions: Results suggest that treatment matching based on patient profiles could meaningfully improve treatment efficacy for combat-related PTSD. Future research can build on these results to improve our understanding of how to improve treatment matching for PTSD.

Biological Psychiatry, May 1, 2023

Background: Virtual reality exposure therapy (VRET) has been used to treat a variety of fears and... more Background: Virtual reality exposure therapy (VRET) has been used to treat a variety of fears and phobias. Aim: To determine the feasibility (i.e. safety and efficacy) of using VRET to treat dental phobia. Method: Safety was evaluated by determining any adverse events or symptom exacerbation. Efficacy of VRET was evaluated by comparing the reduction in dental anxiety scores (measured 16 times within a 14-week study period, and at 6-month follow-up), and its behavioural effects with that of an informational pamphlet (IP) on ten randomized patients with dental phobia using a controlled multiple baseline design. Participants' heart rate response during VRET, and their experience post-VRET, were indexed. Results: No personal adverse events or symptom exacerbation occurred. Visual analysis and post-hoc intention-totreat analysis showed a significantly greater decrease in dental anxiety scores [higher PND (percentage of non-overlap data) scores of 100% and lower POD (percentage of overlap data) of 0%, Modified Dental Anxiety Scale, F (1,8) = 8.

AHFE international, 2023

Addressing the significant mental and physical healthcare needs of Veterans requires innovative s... more Addressing the significant mental and physical healthcare needs of Veterans requires innovative strategies to enhance access to evidence-based care. The integration of Virtual Human (VH) agents into Mobile Health (mHealth) applications presents a promising opportunity to overcome barriers associated with suicide prevention and connect with Veterans. The Battle Buddy (BB) project was conceived as a mobile wellness and suicide prevention application, empowering Veterans with an always-available resource concierged by an engaging and supportive conversational VH agent. Human-centered design is essential in the development of all interactions focused on the persuasive strategies of (1) personalization, (2) self-monitoring, (3) tunneling, (4) suggestion, and (5) expertise. Veterans can interact with the BB VH during daily check-ins, learn about mental health and wellness strategies, participate in interactive activities, increase self-awareness of their current status, and build and work safety plans in times of suicidal crisis. BB is designed to provide the Veteran with easy access to a suicide prevention ecosystem in which a wealth of evidenced-based interventions will be delivered in a non-stigmatizing fashion by a computer-based dialogue system with virtual embodiment, utilizing various multi-modal language cues such as text, speech, animated facial expressions, and gestures to interact with users. This paper explores our human-centered design process for the BB feature set to target the negative effects of social isolation and loneliness, conditions that challenge Veteran healthcare and suicide prevention.

PubMed, 2012

The incidence of posttraumatic stress disorder (PTSD) in returning OEF/OIF military personnel is ... more The incidence of posttraumatic stress disorder (PTSD) in returning OEF/OIF military personnel is creating a significant healthcare challenge. This has served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. One emerging form of treatment for combat-related PTSD that has shown promise involves the delivery of exposure therapy using immersive Virtual Reality (VR). Initial outcomes from open clinical trials have been positive and fully randomized controlled trials are currently in progress to further validate this approach. Based on our research group's initial positive outcomes using VR to emotionally engage and successfully treat persons undergoing exposure therapy for PTSD, we have begun development in a similar VR-based approach to deliver stress resilience training with military service members prior to their initial deployment. The Stress Resilience In Virtual Environments (STRIVE) project aims to create a set of combat simulations (derived from our existing Virtual Iraq/Afghanistan exposure therapy system) that are part of a multi-episode narrative experience. Users can be immersed within challenging combat contexts and interact with virtual characters within these episodes as part of an experiential learning approach for training a range of psychoeducational and cognitive-behavioral emotional coping strategies believed to enhance stress resilience. The STRIVE project aims to present this approach to service members prior to deployment as part of a program designed to better prepare military personnel for the types of emotional challenges that are inherent in the combat environment. During these virtual training experiences users are monitored physiologically as part of a larger investigation into the biomarkers of the stress response. One such construct, Allostatic Load, is being directly investigated via physiological and neuro-hormonal analysis from specimen collections taken immediately before and after engagement in the STRIVE virtual experience.

The number of mobile health (mHealth) apps has steadily increased in recent years, however little... more The number of mobile health (mHealth) apps has steadily increased in recent years, however little work has been done to define a rigorous and standardized process for the design of this technology. This case study presents our novel user-centered design model for mHealth applications through our experiences developing Battle Buddy, an mHealth app designed to support mental, physical and emotional well-being of US service members and their families. Our approach combines an Information Systems Research (ISR) framework with the qualitative methodology of Rapid Assessment Process (RAP) to 1) guide app development and 2) include end-users into the design process in a meaningful way. The ISR framework is known in the HCI community but is rarely applied to the domain of mHealth applications, while RAP is a fast, cost-effective process for gaining insight into a situation from an insider's perspective. This case study mainly focuses on our team's experience with RAP to explore the mHealth needs and design preferences of members of the military community through a series of end-user interviews conducted by a community "insider". Findings from our work support the use of combining the ISR framework with RAP as a process for designing future mHealth apps and understanding the unique needs and design preferences of groups of specific end-users. CCS Concepts: • Human-centered computing → Ubiquitous and mobile computing design and evaluation methods; HCI design and evaluation methods; User centered design; • Applied computing → Military; • Computing methodologies → Intelligent agents.

Proceedings of the AAAI Conference on Artificial Intelligence

We present the SimSensei system, a fully automatic virtual agent that conducts interviews to asse... more We present the SimSensei system, a fully automatic virtual agent that conducts interviews to assess indicators of psychological distress. We emphasize on the perception part of the system, a multimodal framework which captures and analyzes user state for both behavioral understanding and interactional purposes.

Military Medicine, 2019

Introduction Resilience is the ability to maintain or quickly return to a stable physical and psy... more Introduction Resilience is the ability to maintain or quickly return to a stable physical and psychological equilibrium despite experiencing stressful events. Flexibility of the autonomic nervous system is particularly important for adaptive stress responses and may contribute to individual differences in resilience. Power spectrum analysis of heart rate variability (HRV) allows measurement of sympathovagal balance, which helps to evaluate autonomic flexibility. The present study investigated HRV as a broad index of resilience. Materials and Methods Twenty-four male participants from the Army National Guard Special Forces completed psychological measures known to relate to resilience and had HRV measured while undergoing stressful virtual environment scenarios. Pearson product-moment correlations were used to explore the relationships between HRV and resilience factors. All research was conducted with the oversight of the Human Subjects Review Committee of Fuller Theological Seminar...