The embodiment of sexualized virtual selves: The Proteus effect and experiences of self-objectification via avatars

Virtually simulated interpersonal touch negatively affects perceived closeness and social affiliation to an avatar partner

Interpersonal touch is an essential component of human non-verbal communication, facilitating social affiliation and bonding. With the widespread use of digital interfaces and online platforms in all realms of human interactions, there are fewer opportunities for communicating through touch. Popular online platforms that virtually simulate human interactions rely primarily on visual and auditory modalities, providing limited or no capacity for the exchange of tactile cues. Previous studies of virtual interactions have explored the simulation of social touch using haptic devices, but little is known about how the visual representation of interpersonal touch is perceived and integrated into a virtual social experience. In two studies we examined how the exchange of virtual touch mediated by simulated 3-dimensional human characters, or avatars, within an online virtual environment influenced affiliation towards an unfamiliar interaction partner. Surprisingly, the exchange of virtual touch negatively affected the perceived closeness and affiliation to the partner and the social evaluation of the interaction but did not affect the level of physiological arousal during the interaction. These results indicate that the visual representation of social touch is sufficient to virtually communicate touch-related cues that impact social affiliation, but the influence of touch may be dependent on the interaction context.

Examining the Impact of Digital Human Gaze Expressions on Engagement Induction

With advancements in technology, digital humans are becoming increasingly sophisticated, with their application scope widening to include interactions with real people. However, research on expressions that facilitate natural engagement in interactions between real people and digital humans is scarce. With this study, we aimed to examine the differences in user engagement as measured by subjective evaluations, eye tracking, and electroencephalogram (EEG) responses relative to different gaze expressions in various conversational contexts. Conversational situations were categorized as face-to-face, face-to-video, and digital human interactions, with gaze expressions segmented into eye contact and gaze avoidance. Story stimuli incorporating twelve sentences verified to elicit positive and negative emotional responses were employed in the experiments after validation. A total of 45 participants (31 females and 14 males) underwent stimulation through positive and negative stories while exhibiting eye contact or gaze avoidance under each of the three conversational conditions. Engagement was assessed using subjective evaluation metrics in conjunction with measures of the subjects' gaze and brainwave activity. The findings revealed engagement disparities between the face-to-face and digital-human conversation conditions. Notably, only positive stimuli elicited variations in engagement based on gaze expression across different conversation conditions. Gaze analysis corroborated the engagement differences, aligning with prior research on social sensitivity, but only in response to positive stimuli. This research departs from traditional studies of un-natural interactions with digital humans, focusing instead on interactions with digital humans designed to mimic the appearance of real humans. This study demonstrates the potential for gaze expression to induce engagement, regardless of the human or digital nature of the conversational dyads.

Beyond my Real Body: Characterization, Impacts, Applications and Perspectives of "Dissimilar" Avatars in Virtual Reality

In virtual reality, the avatar - the user's digital representation - is an important element which can drastically influence the immersive experience. In this paper, we especially focus on the use of "dissimilar" avatars i.e., avatars diverging from the real appearance of the user, whether they preserve an anthropomorphic aspect or not. Previous studies reported that dissimilar avatars can positively impact the user experience, in terms for example of interaction, perception or behaviour. However, given the sparsity and multi-disciplinary character of research related to dissimilar avatars, it tends to lack common understanding and methodology, hampering the establishment of novel knowledge on this topic. In this paper, we propose to address these limitations by discussing: (i) a methodology for dissimilar avatars characterization, (ii) their impacts on the user experience, (iii) their different fields of application, and finally, (iv) future research direction on this topic. Taken together, we believe that this paper can support future research related to dissimilar avatars, and help designers of VR applications to leverage dissimilar avatars appropriately.

Gender and Media Representations: A Review of the Literature on Gender Stereotypes, Objectification and Sexualization

Media representations play an important role in producing sociocultural pressures. Despite social and legal progress in civil rights, restrictive gender-based representations appear to be still very pervasive in some contexts. The article explores scientific research on the relationship between media representations and gender stereotypes, objectification and sexualization, focusing on their presence in the cultural context. Results show how stereotyping, objectifying and sexualizing representations appear to be still very common across a number of contexts. Exposure to stereotyping representations appears to strengthen beliefs in gender stereotypes and endorsement of gender role norms, as well as fostering sexism, harassment and violence in men and stifling career-related ambitions in women. Exposure to objectifying and sexualizing representations appears to be associated with the internalization of cultural ideals of appearance, endorsement of sexist attitudes and tolerance of abuse and body shame. In turn, factors associated with exposure to these representations have been linked to detrimental effects on physical and psychological well-being, such as eating disorder symptomatology, increased body surveillance and poorer body image quality of life. However, specificities in the pathways from exposure to detrimental effects on well-being are involved for certain populations that warrant further research.

Combatting ageism through virtual embodiment? Using explicit and implicit measures

OBJECTIVES

Ageism is defined as stereotypes, prejudice, and discrimination towards people because of their age. Although ageism can be directed towards people of any age group, most research has focused on ageism towards older people. Ageism towards older people is known to have a significant impact on their health and wellbeing and to even result in higher healthcare costs. The present study evaluated the use of virtual embodiment (VE) to reduce self- and other-directed ageism.

DESIGN, SETTING, AND PARTICIPANTS

We randomized 80 individuals between the ages of 18 and 35 years to one of two conditions: VE as an older or a younger avatar.

RESULTS

No differences were found on explicit measures of ageism. Once multiple comparisons were accounted for, a nonsignificant reduction in implicit age bias following exposure to the older avatar (Cohen's d = .75, p = .02) also was found.

CONCLUSIONS

Past research has established the effectiveness of VE in relation to implicit measures. However, once both explicit and implicit measures are included and multiple comparisons are accounted for, neither explicit nor implicit measures of ageism show a significant effect. Given the multidimensional nature of ageism, further research is needed to establish the effectiveness of VE once multiple measures of ageism are considered.

Embodying the avatar of an omnipotent agent modulates the perception of one's own abilities and enhances feelings of invulnerability

Immersive virtual reality can give people the illusion of owning artificial bodies (i.e., avatars) and controlling their actions. Tellingly, people appear to adhere to the newly embodied entities not just on the basis of physical traits but also behaving accordingly with the hallmarks of the represented characters. In two studies we pushed the limits of this process by testing if one's own sense of power could be affected by embodying the anthropomorphic representation of the Christian God, that is considered an omnipotent entity. A human Muscled and a Normotype avatar were used as controls. Results showed that participants embodying the God-avatar: (i) reacted to a threatening event compromising their physical safety by exhibiting a lower skin conductance response and heart rate deceleration compared to the Normotype-control avatar (Study 1); (ii) estimated they had more physical abilities compared to both the Normotype-control and the Muscled-control avatars (Study 2). Taken together, our findings suggest that embodying an omnipotent agent may exert an influence on people's perception of their own limits and capabilities, nourishing feelings of physical invulnerability and strength. Our study indicates that effectively embodying virtual role models may boost achievements and have translational implications in the field of empowerment.

Disrupting the “empathy machine”: The power and perils of virtual reality in addressing social issues

This article looks through a critical media lens at mediated effects and ethical concerns of virtual reality (VR) applications that explore personal and social issues through embodiment and storytelling. In recent years, the press, immersive media practitioners and researchers have promoted the potential of virtual reality storytelling to foster empathy. This research offers an interdisciplinary narrative review, with an evidence-based approach to challenge the assumptions that VR films elicit empathy in the participant—what I refer to as the VR-empathy model. A review of literature from the fields of psychology, computer science, embodiment, medicine, and virtual reality was carried out to question and counter these claims through case studies of both fiction and non-fiction VR experiences. The results reveal that there is little empirical evidence of a correlation between VR exposure and an increase in empathy that motivates pro-social behavior, and a lack of research covering VR films exposure eliciting empathy. Furthermore, the results show an alarming lack of research into the long-term effects of VR films and other VR immersive experiences. This contribution aims to understand and demystify the current “empathy machine” rhetoric and calls for more rigorous, scientific research that can authenticate future claims and systemize ethical best practices.

Fat, sexy, and human? Perceptions of plus-size sexualized women and dehumanization

Past research suggests that sexualized women are dehumanized and viewing sexualized images negatively impacts viewers' body image; however, plus-size women are mostly absent from this research. The current studies investigate how sexualization impacts dehumanization of plus-size women and participants' body image. In Study 1 (N = 277, M_age = 19.52, SD =1.77) men and women viewed images of plus-size and thin sexualized and non-sexualized women and rated the women on traits linked to dehumanization. Results indicated that sexualized thin targets were perceived as less human than plus-size sexualized and non-sexualized targets. Plus-size sexualized targets were also perceived as less human than plus-size non-sexualized targets. In Study 2 (N = 500, M_age = 18.98, SD = 1.51) we investigated the impact of viewing sexualized images on participants' feelings about their own body. Results indicated that sexualization, but not body size, impacted women's objectified body consciousness. Men's body esteem was impacted by the body size of the image. Perceived race of the image also impacted feelings of body control for both men and women. Taken together these results highlight that sexualization, at any body size, impacts women's views about themselves and sexualized women, at any body size, are dehumanized.

Exercising With a Six Pack in Virtual Reality: Examining the Proteus Effect of Avatar Body Shape and Sex on Self-Efficacy for Core-Muscle Exercise, Self-Concept of Body Shape, and Actual Physical Activity

This study investigates the Proteus effect from the first-person perspective and during avatar embodiment in actual exercise. In addition to the immediate measurements of the Proteus effect, prolonged effects such as next-day perception and exercise-related outcomes are also explored. We theorized the Proteus effect as altered perceived self-concept and explored the association between virtual reality (VR) avatar manipulation and self-concept in the exercise context. While existing studies have mainly investigated the Proteus effect in a non-VR environment or after VR embodiment, we aim to contribute to the literature by addressing this concern to explore how the Proteus effect works in actual VR exercise. Through a 2 (avatar body shape: with a six pack vs. normal) × 2 (sex: male vs. female) between-subject experiment, the results partially support the Proteus effect. Regarding actual physical activity, embodying an avatar with a six pack during exercise creates fewer body movements. No significant effect was found for perceived exertion. We also explored the role of sex as a potential moderator in the association of the Proteus effect on exercise outcomes. The Proteus effect was supported by immediate and next-day self-efficacy for core-muscle exercise only among female participants. The between-subject design allowed us to probe how avatar manipulation of muscular body shape with a six pack as opposed to normal body shape influences participants’ self-concept and exercise outcomes, as limited VR studies have employed within-subject comparisons. This also contributes to the literature by providing an upward comparison (e.g., muscular with a six pack vs. normal) as opposed to the previous downward comparison regarding body fitness (e.g., normal vs. obese). The overall results supported the Proteus effect in the context of core-muscle exercise when comparing normal and ideal body shape avatars. However, the Proteus effect as an altered self-concept and its effects on self-efficacy for exercise were supported among females but not males. Whereas the female participants who embodied avatars with a six pack associated themselves more with the muscular concept than other people, the male participants who embodied avatars with a six pack perceived themselves as more normal than others. Theoretical and practical implications are discussed.

Virtual Mirror and Beyond: The Psychological Basis for Avatar Embodiment via a Mirror

In virtual reality (VR), a virtual mirror is often used to display the VR avatar to the user for enhancing the embodiment. The reflected image of the synchronization of the virtual body with the user’s movement is expected to be recognized as the user’s own reflection. In addition to the visuo-motor synchrony, there are some mirror reflection factors that are probably involved in avatar embodiment. This paper reviews literature on the psychological studies that involve mirror-specific self-identification and embodied perception to clarify how the reflected image of the virtual body is embodied. Furthermore, subjective misconceptions about mirror reflections reported in naïve optics have also been reviewed to discuss the potential of virtual mirror displays to modulate avatar embodiment.

The role of social virtual world in increasing psychological resilience during the on-going COVID-19 pandemic

The 2020 COVID-19 pandemic has not only impacted the physical health of individuals but the fear and anxiety of contracting the disease has also contributed to psychological distress among people. The current research identifies a novel coping strategy to strengthen individuals' psychological resilience against the pandemic. Study 1 (N = 210) and Study 2 (N = 93) showed significant beneficial effect of representing oneself via avatar in social virtual world (SVW) on the psychological resilience towards contracting COVID-19. Study 2 also showed that this effect is explained by the disembodied (i.e., out-of-body) experience one encounters in the SVW by digitally representing oneself via an avatar), which enables SVW users to project themselves onto a character in a parallel world that is immune to the COVID-19 virus, thus alleviating the anxiety of contracting the virus themselves in the real world. Additionally, it ruled out alternate explanations like escapism and enjoyment. The findings extend the Proteus effect (i.e., individuals behaviorally conform with their avatar's visual/physical appearance) to a more innate feature of the avatar–its imperviousness from the human body's limitations. The results have important implications for health policy makers along with making a strong case for marketing computer-simulated games like SVWs as virtual therapy tools.

Avatar-User Bond as Meta-Cognitive Experience: Explicating Identification and Embodiment as Cognitive Fluency

Scholars have not reached an agreement on a theoretical foundation that underlies the psychological effects of avatar use on users. One group of scholars focuses on the perceptual nature of avatar use, proposing that perceiving the self-being represented by a virtual representation leads to the effects (i.e., Proteus effect). Another group suggests that social traits in avatars prime users causing them to behave in accordance with the social traits (i.e., priming effects). We combine these two theoretical explanations and present an alternative approach, hinging on a concept of meta-cognitive experience. The psychological mechanism of the avatar-user bond is explicated in terms of cognitive fluency, a type of meta-cognitive experience reflecting an awareness of how readily or easily information is processed. Under this explication, two concepts related to avatar-user bond, identification and embodiment, are understood as the meta-cognitive experience of cognitive fluency at the level of one’s identity and physical body, respectively. Existing empirical evidence on avatar effects is revisited to explore how this new theoretical framework can be applied.

Using avatars in weight management settings: A systematic review

BACKGROUND

Obesity interventions rely predominantly on managing dietary intake and/or increasing physical activity but sustained adherence to behavioural regimens is often poor. Avatar technology is well established within the computer gaming industry and evidence suggests that virtual representations of self may impact real-world behaviour, acting as a catalyst for sustained weight loss behaviour modification. However, the effectiveness of avatar technology in promoting weight loss is unclear.

AIMS

We aimed to assess the quantity and quality of empirical support for the use of avatar technologies in adult weight loss interventions.

METHOD

A systematic review of empirical studies was undertaken. The key objectives were to determine if: (i) the inclusion of avatar technology leads to greater weight loss achievement compared to routine intervention; and (ii) whether weight loss achievement is improved by avatar personalisation (avatar visually reflects self).

RESULTS

We identified 6 papers that reported weight loss data. Avatar-based interventions for weight loss management were found to be effective in the short (4-6 weeks) and medium (3-6 months) term and improved weight loss maintenance in the long term (12 months). Only 2 papers included avatar personalisation, but results suggested there may be some added motivational benefit.

CONCLUSIONS

The current evidence supports that avatars may positively impact weight loss achievement and improve motivation. However, with only 6 papers identified the evidence base is limited and therefore findings need to be interpreted with caution.

Sexualised video games, sexist attitudes and empathy towards victims of rape: Correlational evidence for a relationship is minimal in an online study

BACKGROUND

There is continued debate about whether sexualisation in games can influence sexist attitudes and reduced empathy towards women in real life. There is research evidence both supporting and refuting the possibility.

AIMS

Our aim was to examine the relationship between sexualised content in video games and players' sexist attitudes and empathy. Our research question was, do any such relationships exist once other factors including gender and trait aggression are controlled?

METHODS

An online sample of 125 participants were recruited and asked to rate their video game playing experience, complete a trait aggression scale and record responses to a vignette about rape. Scores were first correlated, and then hierarchical multiple regression was employed followed by PROCESS examination of interactions between sexualised game content and trait aggression.

RESULTS

Exposure to sexualised content in video games was neither correlated with higher sexist attitude ratings nor with lower empathy scores. Sexualised content in games was associated with slightly lower sexist belief scores for those with higher scores on trait aggression (the 12.8% of our current sample at one standard deviation above the mean). No effects were observed for those low in trait aggression.

CONCLUSIONS AND IMPLICATIONS

While it is natural to be concerned about the impact of potentially arousing video games, actual effects may be counterintuitive, so if seeking to regulate, it is important to act from actual information. Further research with groups of particular concern will be important.

Conducting online virtual environment experiments with uncompensated, unsupervised samples

Web-based experimentation with uncompensated and unsupervised samples allows for a larger and more diverse sample population, more generalizable results, and faster theory to experiment cycle. Given that participants are unsupervised, it is still unknown whether the data collected in such settings would be of sufficiently high quality to support robust conclusions. Therefore, we investigated the feasibility of conducting such experiments online using virtual environment technologies. We conducted a conceptual replication of two prior experiments that have been conducted in virtual environments. Our results replicate findings previously obtained in conventional laboratory settings. These results hold across different device types of participants (ranging from desktop, through mobile devices to immersive virtual reality headsets), suggesting that experiments can be conducted online with uncompensated samples in virtual environments.

Virtual reality and chronic low back pain

AIM

Chronic low back pain (CLBP) is a highly prevalent and significant cause of disability which is often resistant to pharmacological management. Virtual reality (VR) is an emerging technology with the potential to influence CLBP, and has been suggested as an alternative to opioids for pain management. VR is a goalfocused, computer-simulated reality allowing modification of the user's experience of their perceived world.

MATERIALS/METHODS

A narrative review of peer-reviewed literature using a systematic search strategy, and sole reviewer for data extraction.

CONCLUSIONS

VR has demonstrated effectiveness in reducing acute, experimental and chronic pain. This review describes the theoretical basis of the therapeutic effects of VR on CLBP via three distinct mechanisms: distraction, neuromodulation and graded exposure therapy. Furthermore, clinical application will be considered, including discussion of ethical issues associated with the technology.Implications for rehabilitationVirtual reality (VR) is suggested as an alternative for opioids in the management of acute and chronic pain.The therapeutic mechanisms of VR in chronic low back pain (CLBP) are equivocal but include distraction, neuromodulation of body perception and graded exposure therapy.VR may show greater efficacy in patients with CLBP with associated kinesiophobia.VR may show greater effect with increased immersion.

Adverse Childhood Experiences and Avatar Preferences in Online Games

This study investigates the relationship between adverse childhood experiences (ACEs), age, and sex with respect to their avatar preference in online games. The analyses comprise a subsample of n = 1817 adolescents and adults from 14 to 60 years within a representative German population-based study. Results indicate that 14 % of this sample uses avatars in online games, with significantly more males (22.6 %) than females (7.7 %) doing so. Persons with multiple ACEs (≥ 4) have a higher OR of 2.05 (95 % CI: 1.418-2.956) to use avatars in online games. Regarding avatar preference, females are more likely to play supporters than males, and males are more likely to choose damagers and mixed-type avatars than females. Participants with an experience of parental divorce during their childhood reported higher preference of playing supporter or mixed-type avatars in comparison with damager avatars. Moreover, participants with mental illness or suicide in the family show a higher preference of mixed-type avatars compared to damager, but not to supporter avatars. Knowledge about the use of avatars can be an interesting source of information for supporting psychotherapeutic treatment in a young age group.

Acceptability, Feasibility, and Preliminary Efficacy of a Theory-Based Relational Embodied Conversational Agent Mobile Phone Intervention to Promote HIV Medication Adherence in Young HIV-Positive African American MSM

An embodied conversational agent can serve as a relational agent and provide information, motivation, and behavioral skills. To evaluate the feasibility, acceptability, and preliminary efficacy of My Personal Health Guide, a theory-based mobile-delivered embodied conversational agent intervention to improve adherence to antiretroviral therapy in young African American men who have sex with men, we conducted this prospective pilot study using a 3-month pre-post design. Outcome measures included adherence, acceptability, feasibility, pre versus post health literacy, and pre versus post self-efficacy. There were 43 participants. Pill count adherence > 80% improved from 62% at baseline to 88% at follow-up (p = .05). The acceptability of the app was high. Feasibility issues identified included loss of usage data from unplanned participant app deletion. Health literacy improved whereas self-efficacy was high at baseline and follow-up. This pilot study of My Personal Health Guide demonstrated acceptability and preliminary efficacy in improving adherence in this important population.

The multidimensional self-objectification process from adolescence to emerging adulthood

This longitudinal study (N = 400, 54.5% female) explores the relationships between three components of self-objectification: the internalization of the media's appearance ideals, the valuing of appearance over competence, and body surveillance. The study adds to the self-objectification literature by taking a long-term, developmental approach. The relationships are examined over 6-month intervals during adolescence and a 5-year interval from adolescence to emerging adulthood. Furthermore, this study is the first to examine relationships between different components of self-objectification at the within-person level and, thus, study personal changes over time. Most notably, an increase in internalization during adolescence predicted subsequent increases in valuing appearance over competence and body surveillance five years later, when the respondents had reached emerging adulthood. No evidence for gender differences was found. Implications for the development of self-objectification from adolescence to emerging adulthood and the difference between within- and between-person effects are discussed.

A Realistic Talking Human Embodied Agent Mobile Phone Intervention to Promote HIV Medication Adherence and Retention in Care in Young HIV-Positive African American Men Who Have Sex With Men: Qualitative Study

Background

Avatars and embodied agents are a promising innovation for human health intervention because they may serve as a relational agent that might augment user engagement in a behavioral change intervention and motivate behavioral change such as antiretroviral adherence and retention in care.

Objective

This study aimed to develop a theory-driven talking avatar-like embodied agent mobile phone intervention guided by the information-motivation-behavioral skills model to promote HIV medication adherence and retention in care in young African American men who have sex with men (MSM).

Methods

We performed 5 iterative focus groups in Chicago with HIV-positive African American MSM aged 18-34 years to inform the ongoing development of a mobile phone app. Participants for the focus groups were recruited from 4 University of Illinois at Chicago Community Outreach Intervention Project sites located in different high HIV incidence areas of the city and the University of Illinois at Chicago HIV clinic using fliers and word of mouth. The focus group data analysis included developing an ongoing list of priorities for app changes and discussion between two of the investigators based on the project timeline, resources, and to what extent they served the app’s objectives.

Results

In this study, 16 men participated, including 3 who participated in two groups. The acceptability for an embodied agent app was universal in all 5 focus groups. The app included the embodied agent response to questions and antiretroviral regimen information, adherence tracking, CD4 count and viral load tracking, motivational spoken messages, and customizability. Concerns that were identified and responded to in the development process included privacy, stigma, avoiding the harsh or commanding tone of voice, avoiding negative motivational statements, and making reminder functions for a variety of health care interactions.

Conclusions

An avatar-like embodied agent mHealth approach was acceptable to young HIV-positive African American MSM. Its relational nature may make it an effective method of informing, motivating, and promoting health behavioral skills. Furthermore, the app’s ease of access, stigma-free environment, and audiovisual format may help overcome some adherence barriers reported in this population.

Learning Empathy Through Virtual Reality: Multiple Strategies for Training Empathy-Related Abilities Using Body Ownership Illusions in Embodied Virtual Reality

Several disciplines have investigated the interconnected empathic abilities behind the proverb "to walk a mile in someone else's shoes" to determine how the presence, and absence, of empathy-related phenomena affect prosocial behavior and intergroup relations. Empathy enables us to learn from others' pain and to know when to offer support. Similarly, virtual reality (VR) appears to allow individuals to step into someone else's shoes, through a perceptual illusion called embodiment, or the body ownership illusion. Considering these perspectives, we propose a theoretical analysis of different mechanisms of empathic practices in order to define a possible framework for the design of empathic training in VR. This is not intended to be an extensive review of all types of practices, but an exploration of empathy and empathy-related phenomena. Empathy-related training practices are analyzed and categorized. We also identify different variables used by pioneer studies in VR to promote empathy-related responses. Finally, we propose strategies for using embodied VR technology to train specific empathy-related abilities.

Videogames for Emotion Regulation: A Systematic Review

INTRODUCTION

Emotion regulation (ER) supports multiple individual functions and promotes mental health and wellbeing. Among the tools that may be used to help people in managing their affective states, videogames are reaching attention and are showing positive effects. Yet, little is known about their effectiveness.

OBJECTIVE

This study aims to assess the amount and quality of studies investigating the effects and modalities of the use of videogames for ER.

MATERIALS AND METHODS

A systematic literature search according to PRISMA guidelines was performed. Subsequently, according to expert advice other few studies have been added.

RESULTS

Twenty-three studies met the inclusion criteria and were included in the review; they can be categorized into three groups, namely (1) cross-sectional and qualitative studies, (2) experimental studies investigating the effects of videogame experience on ER and (3) ER intervention with serious games.

DISCUSSION

Discussion of the reviewed studies highlights that frequent gaming with commercial games offers more opportunities for ER improvement (related to gameplay and enjoyment of fictional properties) than limited-time experiences, such as those supported by bespoke serious games. This research area is still in its infancy and findings need to be interpreted with caution; furthermore, future reviews are encouraged to include clinical populations.

CONCLUSION

Videogames offer several opportunities for ER and a challenge for educational and psychological interventions.

Sexual content in video games: an analysis of the Entertainment Software Rating Board classification from 1994 to 2013

Background Video games are widely used by children and adolescents and have become a significant source of exposure to sexual content. Despite evidence of the important role of media in the development of sexual attitudes and behaviours, little attention has been paid to monitor sexual content in video games.

METHODS

Data was obtained about sexual content and rating for 23722 video games from 1994 to 2013 from the Entertainment Software Rating Board database; release dates and information on the top 100 selling video games was also obtained. A yearly prevalence of sexual content according to rating categories was calculated. Trends and comparisons were estimated using Joinpoint regression.

RESULTS

Sexual content was present in 13% of the video games. Games rated 'Mature' had the highest prevalence of sexual content (34.5%) followed by 'Teen' (30.7%) and 'E10+' (21.3%). Over time, sexual content decreased in the 'Everyone' category, 'E10+' maintained a low prevalence and 'Teen' and 'Mature' showed a marked increase. Both top and non-top video games showed constant increases, with top selling video games having 10.1% more sexual content across the period of study.

CONCLUSION

Over the last 20 years, the prevalence of sexual content has increased in video games with a 'Teen' or 'Mature' rating. Further studies are needed to quantify the potential association between sexual content in video games and sexual behaviour in children and adolescents.

Sexualizing Media Use and Self-Objectification: A Meta-Analysis

Objectification theorists suggest that exposure to sexualizing media increases self-objectification among individuals. Correlational and experimental research examining this relation has received growing attention. The aim of this meta-analysis was to investigate the influence of sexualizing media use on self-objectification among women and men. For this purpose, we analyzed 54 papers yielding 50 independent studies and 261 effect sizes. The data revealed a positive, moderate effect of sexualizing media on self-objectification (r = .19). The effect was significant and robust, 95% CI [.15, .23], p < .0001. We identified a conditional effect of media type, suggesting that the use of video games and/or online media led to stronger self-objectification effects when compared to television use. Other sample characteristics or study characteristics did not moderate the overall effect. Thus, our findings highlight the importance of sexualizing media exposure on women’s and men’s objectified self-concept. We discuss future research directions and implications for practice. We hope that the article will stimulate researchers in their future work to address the research gaps outlined here. Moreover, we hope that the findings will encourage practitioners and parents to reflect on the role of the use of sexualizing media in the development of individuals’ self-objectification. Additional online materials for this article are available on PWQ’s website at http://journals.sagepub.com/doi/suppl10.1177/0361684317743019

Grand Theft Auto is a "Sandbox" Game, but There are Weapons, Criminals, and Prostitutes in the Sandbox: Response to Ferguson and Donnellan (2017)

In this issue, (Ferguson, C. J., & Donnellan, B. D., Journal of Youth and and Adolescence, published online 21 June 2017) criticize one of our studies (Gabbiadini, A., Riva, P., Andrighetto, L., Volpato, C., & Bushman, B. J., PLoS ONE, 11: 1-14, 2016) that found violent sexist video games can reduce empathy for female violence victims in male players who identify with violent male game characters, and do so by increasing masculine beliefs. Their main criticism is a "straw person" argument built on a claim that we never made (i.e., a direct effect of sexist-violent video games on empathy). They also made several other criticisms of our article. We appreciate the opportunity to respond to their criticisms in this article. We also point out some flaws in their reanalysis. Despite their criticisms, the core contributions of our original article remain intact.

Model of Illusions and Virtual Reality

In Virtual Reality (VR) it is possible to induce illusions in which users report and behave as if they have entered into altered situations and identities. The effect can be robust enough for participants to respond “realistically,” meaning behaviors are altered as if subjects had been exposed to the scenarios in reality. The circumstances in which such VR illusions take place were first introduced in the 80's. Since then, rigorous empirical evidence has explored a wide set of illusory experiences in VR. Here, we compile this research and propose a neuroscientific model explaining the underlying perceptual and cognitive mechanisms that enable illusions in VR. Furthermore, we describe the minimum instrumentation requirements to support illusory experiences in VR, and discuss the importance and shortcomings of the generic model.

Immersive Virtual Reality for Pediatric Pain

Children must often endure painful procedures as part of their treatment for various medical conditions. Those with chronic pain endure frequent or constant discomfort in their daily lives, sometimes severely limiting their physical capacities. With the advent of affordable consumer-grade equipment, clinicians have access to a promising and engaging intervention for pediatric pain, both acute and chronic. In addition to providing relief from acute and procedural pain, virtual reality (VR) may also help to provide a corrective psychological and physiological environment to facilitate rehabilitation for pediatric patients suffering from chronic pain. The special qualities of VR such as presence, interactivity, customization, social interaction, and embodiment allow it to be accepted by children and adolescents and incorporated successfully into their existing medical therapies. However, the powerful and transformative nature of many VR experiences may also pose some risks and should be utilized with caution. In this paper, we review recent literature in pediatric virtual reality for procedural pain and anxiety, acute and chronic pain, and some rehabilitation applications. We also discuss the practical considerations of using VR in pediatric care, and offer specific suggestions and information for clinicians wishing to adopt these engaging therapies into their daily clinical practice.

Lifetime Video Game Consumption, Interpersonal Aggression, Hostile Sexism, and Rape Myth Acceptance: A Cultivation Perspective

Although previous research has investigated relationships between media consumption, sexism, and rape myth acceptance (RMA), limited research has investigated video games despite their emergence as one of the most popular forms of media entertainment globally. Given that video games typically feature even less diverse and more objectified representations of women than traditional mainstream media, we predicted that there would be relationships between video game consumption and negative beliefs and attitudes about women. In this study, we conducted a survey (N = 351) of male and female adults and used structural equation modeling to analyze relationships among video game consumption, trait interpersonal aggression, ambivalent sexism, and first-order (percentage of false rape accusations) and second-order cultivation effects (RMA). We found support for the hypothesized cultivation model, indicating a relationship between video game consumption and RMA via interpersonal aggression and hostile sexism. Although these findings cannot be interpreted causally, we discuss the implications of these associations and future directions for research.

Media and Sexualization: State of Empirical Research, 1995-2015

Sexually objectifying portrayals of women are a frequent occurrence in mainstream media, raising questions about the potential impact of exposure to this content on others' impressions of women and on women's views of themselves. The goal of this review was to synthesize empirical investigations testing effects of media sexualization. The focus was on research published in peer-reviewed, English-language journals between 1995 and 2015. A total of 109 publications that contained 135 studies were reviewed. The findings provided consistent evidence that both laboratory exposure and regular, everyday exposure to this content are directly associated with a range of consequences, including higher levels of body dissatisfaction, greater self-objectification, greater support of sexist beliefs and of adversarial sexual beliefs, and greater tolerance of sexual violence toward women. Moreover, experimental exposure to this content leads both women and men to have a diminished view of women's competence, morality, and humanity. Limitations with the existing research approaches and measures are discussed, and suggestions for future research directions are provided.