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Russo S, Tibermacine IE, Tibermacine A, Chebana D, Nahili A, Starczewscki J, Napoli C. Analyzing EEG patterns in young adults exposed to different acrophobia levels: a VR study. Front Hum Neurosci 2024; 18:1348154. [PMID: 38770396 PMCID: PMC11102978 DOI: 10.3389/fnhum.2024.1348154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction The primary objective of this research is to examine acrophobia, a widely prevalent and highly severe phobia characterized by an overwhelming dread of heights, which has a substantial impact on a significant proportion of individuals worldwide. The objective of our study was to develop a real-time and precise instrument for evaluating levels of acrophobia by utilizing electroencephalogram (EEG) signals. Methods EEG data was gathered from a sample of 18 individuals diagnosed with acrophobia. Subsequently, a range of classifiers, namely Support Vector Classifier (SVC), K-nearest Neighbors (KNN), Random Forest (RF), Decision Tree (DT), Adaboost, Linear Discriminant Analysis (LDA), Convolutional Neural Network (CNN), and Artificial Neural Network (ANN), were employed in the analysis. These methodologies encompass both machine learning (ML) and deep learning (DL) techniques. Results The Convolutional Neural Network (CNN) and Artificial Neural Network (ANN) models demonstrated notable efficacy. The Convolutional Neural Network (CNN) model demonstrated a training accuracy of 96% and a testing accuracy of 99%, whereas the Artificial Neural Network (ANN) model attained a training accuracy of 96% and a testing accuracy of 97%. The findings of this study highlight the effectiveness of the proposed methodology in accurately categorizing real-time degrees of acrophobia using EEG data. Further investigation using correlation matrices for each level of acrophobia showed substantial EEG frequency band connections. Beta and Gamma mean values correlated strongly, suggesting cognitive arousal and acrophobic involvement could synchronize activity. Beta and Gamma activity correlated strongly with acrophobia, especially at higher levels. Discussion The results underscore the promise of this innovative approach as a dependable and sophisticated method for evaluating acrophobia. This methodology has the potential to make a substantial contribution toward the comprehension and assessment of acrophobia, hence facilitating the development of more individualized and efficacious therapeutic interventions.
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Affiliation(s)
- Samuele Russo
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Imad Eddine Tibermacine
- Department of Computer, Automation and Management Engineering, Sapienza University of Rome, Rome, Italy
| | - Ahmed Tibermacine
- Department of Computer Science, University of Biskra, Biskra, Algeria
| | - Dounia Chebana
- Department of Computer Science, University of Biskra, Biskra, Algeria
| | - Abdelhakim Nahili
- Department of Computer Science, University of Biskra, Biskra, Algeria
| | - Janusz Starczewscki
- Department of Computational Intelligence, Czestochowa University of Technology, Czestochowa, Poland
| | - Christian Napoli
- Department of Computer, Automation and Management Engineering, Sapienza University of Rome, Rome, Italy
- Department of Computational Intelligence, Czestochowa University of Technology, Czestochowa, Poland
- Institute for Systems Analysis and Computer Science, Italian National Research Council, Rome, Italy
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Lafortune D, Dubé S, Lapointe V, Bonneau J, Champoux C, Sigouin N. Virtual Reality Could Help Assess Sexual Aversion Disorder. JOURNAL OF SEX RESEARCH 2024; 61:588-602. [PMID: 37556729 DOI: 10.1080/00224499.2023.2241860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Virtual reality (VR) may improve our understanding of sexual dysfunctions' manifestations, although research in this area remains limited. This study assessed the potential use of a VR Behavior Avoidance Test (VR-BAT) as a tool for examining the clinical features of Sexual Aversion Disorder (SAD): the experience of fear, disgust, and avoidance when facing sexual cues/contexts. A sample of 55 adults (≥ 18y) with (n = 27) and without SAD (n = 28) completed a self-report measure of sexual avoidance. Their anxiety, disgust, electrodermal activity, heart rate, and visual and behavioral avoidance were then examined during two VR-BATs involving sexual or non-sexual stimuli. Mixed repeated measures ANOVAs, t-tests, and correlational analyses were performed. Results showed that individuals in the SAD group reported greater anxiety and disgust compared to their non-SAD counterparts during the sexual stimuli condition. Sexual avoidance scores were largely positively related to anxiety and disgust during the VR sexual condition, and moderately negatively related to the time spent touching the virtual character's genitals. This study is important given the prevalence of sexual difficulties, such as SAD, and the new research avenues offered by emerging technologies, like VR.
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Affiliation(s)
- D Lafortune
- Department of Sexology, Université du Québec à Montréal
| | - S Dubé
- Department of Psychology, Concordia University
| | - V Lapointe
- Department of Psychology, Université du Québec à Montréal
| | - J Bonneau
- School of Media, Université du Québec à Montréal
| | - C Champoux
- School of Media, Université du Québec à Montréal
| | - N Sigouin
- School of Media, Université du Québec à Montréal
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Diemer J, Kothgassner OD, Herrmann MJ, Zwanzger P. [VR-supported therapy for anxiety and posttraumatic stress disorder: current possibilities and limitations]. DER NERVENARZT 2024; 95:223-229. [PMID: 38051348 DOI: 10.1007/s00115-023-01570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Virtual reality (VR) is increasingly used in psychotherapy, and the speed of development of therapeutic VR tools is continuously increasing. OBJECTIVE This narrative review provides an overview of the state of the art regarding VR applications for psychotherapy. MATERIAL AND METHODS The current state of VR therapy research for anxiety disorders and posttraumatic stress disorder (PTSD) is summarized. The focus lies on VR exposure therapy. Current developments in the field are outlined. RESULTS For anxiety disorders, especially phobic disorders, there are already positive recommendations in the current German S3 guidelines. For PTSD, the development of VR therapy tools is still in a relatively early stage. CONCLUSION The development of mobile cost-effective VR solutions in recent years has enabled entirely new applications for VR. The empirical challenges of these new developments are considerable. Nevertheless, the chances for an improvement of psychotherapeutic routine care are good.
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Affiliation(s)
- Julia Diemer
- Fachbereich Psychosomatische Medizin, Kompetenzschwerpunkt Angst, Versorgungsforschung, kbo-Inn-Salzach-Klinikum, Gabersee 7, 83512, Wasserburg am Inn, Deutschland
- Department Psychologie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Oswald D Kothgassner
- Stress in Childhood & Adolescence Research Unit (SCAR-Unit), Universitätsklinik für Kinder- und Jugendpsychiatrie, Medizinische Universität Wien, Wien, Österreich
| | - Martin J Herrmann
- Zentrum für Psychische Gesundheit (ZEP), Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Peter Zwanzger
- Fachbereich Psychosomatische Medizin, Kompetenzschwerpunkt Angst, Versorgungsforschung, kbo-Inn-Salzach-Klinikum, Gabersee 7, 83512, Wasserburg am Inn, Deutschland.
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, München, Deutschland.
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Kodithuwakku Arachchige SNK, Chander H, Shojaei A, Knight AC, Brown C, Freeman HR, Burch V RF, Chen CC. Effects of virtual heights, dual-tasking, and training on static postural stability. APPLIED ERGONOMICS 2024; 114:104145. [PMID: 37837914 DOI: 10.1016/j.apergo.2023.104145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/16/2023]
Abstract
Working at altitudes, dual-tasking (DT), and lack of experience cause falls. This study aimed to investigate the impact of virtual heights, DT, and training on static postural stability. Twenty-eight volunteers' balance at seven virtual environments [VE; ground (G), altitude 1 (A1), edge 1 (E1), altitude 2 (A2), edge 2 (E2), altitude 3 (A3), and edge 3 (E3)] were recorded during single-tasking (ST) and DT over three days. Independent variables were analyzed using a 7 (VE) x 3 (DAY) x 2 (TASK) factorial repeated measures ANOVA. Greater postural sway was observed in A3 and E1, on DAY 1, and during DT. The study demonstrated static postural stability deteriorates at higher virtual altitudes and during DT and improves with training. The findings of the study suggest that virtual reality is a great altitude simulator, which could be used as a potential balance training tool in ergonomic settings.
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Affiliation(s)
- Sachini N K Kodithuwakku Arachchige
- Human Performance Laboratory, Department of Exercise and Nutrition Sciences, Weber State University, Dept 2805, 1435 Village Dr, Ogden, UT, 84408-5150, USA.
| | - Harish Chander
- Neuromechanics Laboratory, Department of Kinesiology, Mississippi State University, PO Box 6186 216, McCarthy Gym, Mississippi State, MS, 39762, USA; Human Factors & Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, 200 Research Blvd, Starkville, MS, 39759, USA.
| | - Alireza Shojaei
- Myers-Lawson School of Construction, Virginia Tech, 1345 Perry St, Blacksburg, VA, 24061, USA.
| | - Adam C Knight
- Neuromechanics Laboratory, Department of Kinesiology, Mississippi State University, PO Box 6186 216, McCarthy Gym, Mississippi State, MS, 39762, USA.
| | - Caitlyn Brown
- Neuromechanics Laboratory, Department of Kinesiology, Mississippi State University, PO Box 6186 216, McCarthy Gym, Mississippi State, MS, 39762, USA.
| | - Hannah R Freeman
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL, 35233, USA.
| | - Reuben F Burch V
- Human Factors & Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, 200 Research Blvd, Starkville, MS, 39759, USA; Department of Industrial & Systems Engineering, Mississippi State University, 479-2 Hardy Road, 260McCain Hall, Box 9542, Mississippi State, MS, 39762, USA.
| | - Chih-Chia Chen
- Cognitive and Motor Control Laboratory, Department of Kinesiology, Mississippi State University, PO Box 6186, 216 McCarthy Gym, Mississippi State, MS, 39762, USA.
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Diemer J, Mühlberger A, Yassouridis A, Zwanzger P. Distraction versus focusing during VR exposure therapy for acrophobia: A randomized controlled trial. J Behav Ther Exp Psychiatry 2023; 81:101860. [PMID: 37141687 DOI: 10.1016/j.jbtep.2023.101860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 01/03/2023] [Accepted: 04/15/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The therapeutic mechanisms of exposure therapy are not well understood. Research suggests that focusing on the most feared aspect might not be necessary, and that distraction with a low cognitive load (e.g., conversation) might enhance exposure. We aimed at systematically testing the efficacy of exposure therapy with focusing vs. conversational distraction, hypothesizing that distracted exposure would yield superior effects. METHODS Thirty-eight patients with acrophobia (specific phobia of heights; clinician-determined) (free from relevant somatic or other mental disorders) were randomly assigned (1:1) to one virtual reality (VR) session of either focused (n = 20) or distracted exposure (n = 18). This monocentric trial took place at a psychiatric university hospital. RESULTS Both conditions resulted in a significant reduction of acrophobic fear and avoidance, and a significant increase of self-efficacy (primary outcome variables). However, condition did not have a significant effect on any of these variables. Effects were stable at four-week follow-up. Heart rate and skin conductance level indicated significant arousal, but did not differ between conditions. LIMITATIONS Eye-tracking was unavailable, nor did we assess emotions other than fear. Power was limited due to sample size. CONCLUSIONS A balanced exposure protocol combining attention to fear cues with conversational distraction, while not being superior, might be as effective as focused exposure for acrophobia, at least during the initial stages of exposure therapy. These results support previous findings. This study demonstrates how VR can be exploited for therapy process research, as VR supports dismantling designs and the incorporation of online process measures.
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Affiliation(s)
- Julia Diemer
- Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149, Muenster, Germany; kbo-Inn-Salzach-Klinikum, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, Gabersee 7, 83512, Wasserburg/Inn, Germany; Department of Psychology, LMU Munich, Leopoldstr. 13, 80802, Munich, Germany.
| | - Andreas Mühlberger
- Department of Clinical Psychology and Psychotherapy, University of Regensburg, Universitaetsstr. 31, 93053, Regensburg, Germany
| | - Alexander Yassouridis
- Max-Planck-Institute of Psychiatry, Kraepelinstr. 2-10, 80804, Munich, Germany; Ethics Committee, LMU Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Peter Zwanzger
- Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149, Muenster, Germany; kbo-Inn-Salzach-Klinikum, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, Gabersee 7, 83512, Wasserburg/Inn, Germany; Department of Psychiatry and Psychotherapy, LMU Munich, Nußbaumstr. 7, 80336, Munich, Germany
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Kodithuwakku Arachchige SN, Chander H, Turner AJ, Shojaei A, Knight AC, Griffith A, Burch RF, Chen CC. Physiological and Subjective Measures of Anxiety with Repeated Exposure to Virtual Construction Sites at Different Heights. Saf Health Work 2023; 14:303-308. [PMID: 37818213 PMCID: PMC10562126 DOI: 10.1016/j.shaw.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 10/12/2023] Open
Abstract
Background Occupational workers at altitudes are more prone to falls, leading to catastrophic outcomes. Acrophobia, height-related anxiety, and affected executive functions lead to postural instabilities, causing falls. This study investigated the effects of repeated virtual height exposure and training on cognitive processing and height-related anxiety. Methods Twenty-eight healthy volunteers (age 20.48 ± 1.26 years; mass 69.52 ± 13.78 kg) were recruited and tested in seven virtual environments (VE) [ground (G), 2-story altitude (A1), 2-story edge (E1), 4-story altitude (A2), 4-story edge (E2), 6-story altitude (A3), and 6-story edge (E3)] over three days. At each VE, participants identified occupational hazards present in the VE and completed an Attitude Towards Heights Questionnaire (ATHQ) and a modified State-Trait Anxiety Inventory Questionnaire (mSTAIQ). The number of hazards identified and the ATHQ and mSTAIQ scores were analyzed using a 7 (VE; G, A1, A2, A3, E1, E2, E3) x 3 (DAY; DAY 1, DAY 2, DAY 3) factorial repeated measures analysis of variance. Results The participants identified the lowest number of hazards at A3 and E3 VEs and on DAY 1 compared to other VEs and DAYs. ATHQ scores were lowest at G, A1, and E1 VEs. Conclusion Cognitive processing is negatively affected by virtual altitudes, while it improves with short-term training. The features of virtual reality, such as higher involvement, engagement, and reliability, make it a better training tool to be considered in ergonomic settings. The findings of this study will provide insights into cognitive dual-tasking at altitude and its challenges, which will aid in minimizing occupational falls.
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Affiliation(s)
| | - Harish Chander
- Department of Kinesiology, Mississippi State University, MS, USA
- Human Factors & Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, MS, USA
| | - Alana J. Turner
- Department of Kinesiology, Coastal Carolina University, Conway, SC, USA
| | - Alireza Shojaei
- Myers-Lawson School of Construction, Virginia Tech, Blacksburg, VA, USA
| | - Adam C. Knight
- Department of Kinesiology, Mississippi State University, MS, USA
| | - Aaron Griffith
- Department of Kinesiology, Mississippi State University, MS, USA
| | - Reuben F. Burch
- Human Factors & Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, MS, USA
- Department of Industrial & Systems Engineering, Mississippi State University, MS, USA
| | - Chih-Chia Chen
- Department of Kinesiology, Mississippi State University, MS, USA
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El Basbasse Y, Packheiser J, Peterburs J, Maymon C, Güntürkün O, Grimshaw G, Ocklenburg S. Walk the plank! Using mobile electroencephalography to investigate emotional lateralization of immersive fear in virtual reality. ROYAL SOCIETY OPEN SCIENCE 2023; 10:221239. [PMID: 37266038 PMCID: PMC10230188 DOI: 10.1098/rsos.221239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 04/03/2023] [Indexed: 06/03/2023]
Abstract
Most studies on emotion processing induce emotions through images or films. However, this method lacks ecological validity, limiting generalization to real-life emotion processing. More realistic paradigms using virtual reality (VR) may be better suited to investigate authentic emotional states and their neuronal correlates. This pre-registered study examines the neuronal underpinnings of naturalistic fear, measured using mobile electroencephalography (EEG). Seventy-five healthy participants walked across a virtual plank which extended from the side of a skyscraper-either 80 storeys up (the negative condition) or at street level (the neutral condition). Subjective ratings showed that the negative condition induced feelings of fear. Following the VR experience, participants passively viewed negative and neutral images from the international affective picture system (IAPS) outside of VR. We compared frontal alpha asymmetry between the plank and IAPS task and across valence of the conditions. Asymmetry indices in the plank task revealed greater right-hemispheric lateralization during the negative VR condition, relative to the neutral VR condition and to IAPS viewing. Within the IAPS task, no significant asymmetries were detected. In summary, our findings indicate that immersive technologies such as VR can advance emotion research by providing more ecologically valid ways to induce emotion.
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Affiliation(s)
- Yasmin El Basbasse
- Department of Biopsychology, Faculty of Psychology, Institute of Cognitive Neuroscience, Ruhr-University Bochum, Universitätsstrasse 150, 44780 Bochum, Germany
| | - Julian Packheiser
- Netherlands Institute for Neuroscience, Social Brain Lab, 1105 BA Amsterdam, The Netherlands
| | - Jutta Peterburs
- Institute for Systems Medicine & Department of Human Medicine, MSH Medical School Hamburg, Victoria University of Wellington, Wellington 6140, New Zealand
| | - Christopher Maymon
- School of Psychology, Victoria University of Wellington, Wellington 6140, New Zealand
| | - Onur Güntürkün
- Department of Biopsychology, Faculty of Psychology, Institute of Cognitive Neuroscience, Ruhr-University Bochum, Universitätsstrasse 150, 44780 Bochum, Germany
- Research Center One Health Ruhr, Research Alliance Ruhr, Ruhr University Bochum, Bochum, Germany
| | - Gina Grimshaw
- School of Psychology, Victoria University of Wellington, Wellington 6140, New Zealand
| | - Sebastian Ocklenburg
- Department of Biopsychology, Faculty of Psychology, Institute of Cognitive Neuroscience, Ruhr-University Bochum, Universitätsstrasse 150, 44780 Bochum, Germany
- Department of Psychology, MSH Medical School Hamburg, Am Kaiserkai 1, 20457 Hamburg, Germany
- Institute for Cognitive and Affective Neuroscience, Medical School Hamburg, Am Kaiserkai 1, 20457 Hamburg, Germany
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Zhu HY, Chen HT, Lin CT. The Effects of Virtual and Physical Elevation on Physiological Stress During Virtual Reality Height Exposure. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2023; 29:1937-1950. [PMID: 34898434 DOI: 10.1109/tvcg.2021.3134412] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Advances in virtual reality technology have greatly benefited the acrophobia research field. Virtual reality height exposure is a reliable method of inducing stress with low variance across ages and demographics. When creating a virtual height exposure environment, researchers have often used haptic feedback elements to improve the sense of realism of a virtual environment. While the quality of the rendered for the virtual environment increases over time, the physical environment is often simplified to a conservative passive haptic feedback platform. The impact of the increasing disparity between the virtual and physical environment on the induced stress levels is unclear. This article presents an experiment that explored the effect of combining an elevated physical platform with different levels of virtual heights to induce stress. Eighteen participants experienced four different conditions of varying physical and virtual heights. The measurements included gait parameters, heart rate, heart rate variability, and electrodermal activity. The results show that the added physical elevation at a low virtual height shifts the participant's walking behaviour and increases the perception of danger. However, the virtual environment still plays an essential role in manipulating height exposure and inducing physiological stress. Another finding is that a person's behaviour always corresponds to the more significant perceived threat, whether from the physical or virtual environment.
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Wonghempoom A, Chuangchai W, Selanon P. Physiological Stress Responses to Fear and Anxiety in a Height Change Experiment among Non-Labor Teenagers. SAFETY 2023. [DOI: 10.3390/safety9020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Working on elevated surfaces without prior experience can be dangerous, particularly for young people, who are significantly more at risk of developing fear and anxiety, which might lead to falls and fatalities. This critical problem has, however, received limited research attention. The present study aimed to demonstrate the associations among physiological responses, fear, and anxiety in Thai teenagers at various height levels. Sixty teenagers (30 males and 30 females) between the ages of 15 and 18 who had no labor skills were recruited to perform the task at 11 levels, starting at zero meters and increasing by one meter at each level. The measurements were examined and recorded once the task at each level was finished. The main results indicated that heart rate was partially positively associated with mean arterial pressure, fear, and anxiety (with all p values < 0.001) in all teenagers (after controlling for level and sex), as well as male and female teenagers (after controlling for level). The present study suggested monitoring heart rate data in teenagers conducting activities at heights, which can be triggered by fear and anxiety, as a strategy for preventing falls from height hazards.
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Stasiak JE, Mitchell WJ, Reisman SS, Gregory DF, Murty VP, Helion C. Physiological arousal guides situational appraisals and metacognitive recall for naturalistic experiences. Neuropsychologia 2023; 180:108467. [PMID: 36610494 DOI: 10.1016/j.neuropsychologia.2023.108467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/25/2022] [Accepted: 01/01/2023] [Indexed: 01/06/2023]
Abstract
As individuals navigate the world, they are bound to have emotionally intense experiences. These events not only influence momentary physiological and affective responses, but may also have a powerful impact on one's memory for their emotional experience. In this research, we used the naturalistic context of a haunted house to examine how physiological arousal is associated with metacognitive emotional memory (i.e., the extent to which an individual remembers having experienced a certain emotion). Participants first navigated the haunted house while heart rate and explicit situational appraisals were recorded, and then recalled specific events from the haunted house and the intensity of these affective events approximately one week later. We found that heart rate predicted both the intensity of reported scariness in the haunted house and meta-cognitive memory of affect during recall. Critically, we found evidence for malleability in metacognitive emotional memory based on how the event was initially labeled. Individuals tended to recall events that they explicitly labeled as fear-evoking as being more intense than they reported at the time of the event. We found the opposite relationship for events that they labeled as not fear-evoking. Taken together, this indicates that there are strong relationships between physiological arousal and emotional experiences in naturalistic contexts, but that affective labeling can modulate the relationship between these features when reflecting on the emotionality of that experience in memory.
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Affiliation(s)
- Joanne E Stasiak
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, USA
| | | | - Samantha S Reisman
- Department of Cognitive, Linguistics, and Psychological Sciences, Brown University, USA
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Wiebe A, Kannen K, Selaskowski B, Mehren A, Thöne AK, Pramme L, Blumenthal N, Li M, Asché L, Jonas S, Bey K, Schulze M, Steffens M, Pensel MC, Guth M, Rohlfsen F, Ekhlas M, Lügering H, Fileccia H, Pakos J, Lux S, Philipsen A, Braun N. Virtual reality in the diagnostic and therapy for mental disorders: A systematic review. Clin Psychol Rev 2022; 98:102213. [PMID: 36356351 DOI: 10.1016/j.cpr.2022.102213] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/21/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders. OBJECTIVE To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders. DATA SOURCE Systematic literature searches via PubMed (last literature update: 9th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders. ELIGIBILITY CRITERIA To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology. STUDY EVALUATION For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria. RESULTS Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder. CONCLUSION While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application. REVIEW REGISTRATION PROSPERO register CRD42020188436. FUNDING The review was funded by budgets from the University of Bonn. No third party funding was involved.
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Affiliation(s)
- Annika Wiebe
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Kyra Kannen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Benjamin Selaskowski
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Aylin Mehren
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Ann-Kathrin Thöne
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lisa Pramme
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Nike Blumenthal
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mengtong Li
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Laura Asché
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Stephan Jonas
- Institute for Digital Medicine, University Hospital Bonn, Bonn, Germany
| | - Katharina Bey
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Marcel Schulze
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Maria Steffens
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Max Christian Pensel
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Matthias Guth
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Felicia Rohlfsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mogda Ekhlas
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Lügering
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Fileccia
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Julian Pakos
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
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12
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Radhakrishnan U, Chinello F, Koumaditis K. Investigating the effectiveness of immersive VR skill training and its link to physiological arousal. VIRTUAL REALITY 2022; 27:1091-1115. [PMID: 36405878 PMCID: PMC9663202 DOI: 10.1007/s10055-022-00699-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/13/2022] [Indexed: 06/05/2023]
Abstract
This paper details the motivations, design, and analysis of a study using a fine motor skill training task in both VR and physical conditions. The objective of this between-subjects study was to (a) investigate the effectiveness of immersive virtual reality for training participants in the 'buzz-wire' fine motor skill task compared to physical training and (b) investigate the link between participants' arousal with their improvements in task performance. Physiological arousal levels in the form of electro-dermal activity (EDA) and ECG (Electrocardiogram) data were collected from 87 participants, randomly distributed across the two conditions. Results indicated that VR training is as good as, or even slightly better than, training in physical training in improving task performance. Moreover, the participants in the VR condition reported an increase in self-efficacy and immersion, while marginally significant differences were observed in the presence and the temporal demand (retrieved from NASA-TLX measurements). Participants in the VR condition showed on average less arousal than those in the physical condition. Though correlation analyses between performance metrics and arousal levels did not depict any statistically significant results, a closer examination of EDA values revealed that participants with lower arousal levels during training, across conditions, demonstrated better improvements in performance than those with higher arousal. These findings demonstrate the effectiveness of VR in training and the potential of using arousal and training performance data for designing adaptive VR training systems. This paper also discusses implications for researchers who consider using biosensors and VR for motor skill experiments. Supplementary Information The online version contains supplementary material available at 10.1007/s10055-022-00699-3.
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Affiliation(s)
- Unnikrishnan Radhakrishnan
- Department of Business Development and Technology, Aarhus University, Birk Centerpark 15, 7400 Herning, Denmark
| | - Francesco Chinello
- Department of Business Development and Technology, Aarhus University, Birk Centerpark 15, 7400 Herning, Denmark
| | - Konstantinos Koumaditis
- Department of Business Development and Technology, Aarhus University, Birk Centerpark 15, 7400 Herning, Denmark
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13
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Fear, psychophysiological arousal, and cognitions during a Virtual Social Skills Training in Social Anxiety Disorder while manipulating gaze duration. Biol Psychol 2022; 175:108432. [DOI: 10.1016/j.biopsycho.2022.108432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 08/29/2022] [Accepted: 09/28/2022] [Indexed: 11/20/2022]
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14
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Wang J, Wang H, Jiang J, Cheng X, Xu K, Xia F, Chang L, Ji Y, Feng Z. The Validity of Virtual Courage for Trainees in High-Risk Occupations. Psychol Res Behav Manag 2022; 15:1783-1796. [PMID: 35860202 PMCID: PMC9292066 DOI: 10.2147/prbm.s371653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/30/2022] [Indexed: 12/01/2022] Open
Abstract
Background Employees in high-risk occupations are exposed to tremendous work stress that hinders organizational effectiveness and personal mental health. Based on positive psychology, courage can be considered a protective factor that buffers the adverse effect of high-risk surroundings on employees. However, little is known about the way courage is simulated or evaluated in response to safety concerns. Virtual reality (VR) is an accessible tool for courage simulation due to its immersive qualities, presence and interactive features and may provide a promising pathway to achieve a scientific, accurate and ecologically valid evaluation of high-risk employees. Methods The sample consisted of 51 high-risk employees who were recruited voluntarily. Before and after experiencing the VR courage scenarios, the participants completed the VR features questionnaire, the Physical Courage at Work Scale (PCWS), the Courage Measure (CM), and the Positive and Negative Affect Scale (PANAS). During the process of watching the VR courage scenarios, the participants’ heart rate and skin conductance at resting-state baseline and during virtual courage scenarios were recorded through HTC VIVE Pro Eye and BioGraph Infiniti 8. Results The results support the hypothesis and reveal that the interaction, immersion and presence scores of the scenarios were all significantly higher than the median 4 points. The score for the CM in the posttest was significantly higher than that in the pretest. The scared and afraid scores for the posttest were significantly higher than those for the pretest. The heart rate and skin conductance of each scenario showed an increase compared with the baseline. The Pearson’s correlation between physiological indicators and the score of the PCWS was 0.28~0.54. Conclusion This study developed virtual courage for high-risk occupations based on well-established theory and VR technology. Experimental data revealed that the paradigm conformed to the requirements of VR features and was able to activate fear and evoke the quality of courage. Thus, the virtual courage paradigms have good validity in simulating scenarios for high-risk employees, which might accelerate organizational effectiveness while buffering working stress.
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Affiliation(s)
- Jia Wang
- Department of Developmental Psychology of Armyman, School of Psychology, Army Medical University, Chongqing, People's Republic of China
| | - Huizhong Wang
- School of Psychology, Army Medical University, Chongqing, People's Republic of China
| | - Juan Jiang
- School of Psychology, Army Medical University, Chongqing, People's Republic of China
| | - Xiaotong Cheng
- Unit 32298 of the Chinese People's Liberation Army, Weifang, People's Republic of China
| | - Ke Xu
- Shigatse Branch, Xinqiao Hospital, Army 953 Hospital, Army Medical University, Shigatse, People's Republic of China
| | - Fan Xia
- School of Psychology, Army Medical University, Chongqing, People's Republic of China
| | - Le Chang
- School of Psychology, Army Medical University, Chongqing, People's Republic of China
| | - Yede Ji
- Army Engineering University, Xuzhou, People's Republic of China
| | - Zhengzhi Feng
- Department of Developmental Psychology of Armyman, School of Psychology, Army Medical University, Chongqing, People's Republic of China
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15
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Dammen LV, Finseth TT, McCurdy BH, Barnett NP, Conrady RA, Leach AG, Deick AF, Van Steenis AL, Gardner R, Smith BL, Kay A, Shirtcliff EA. Evoking stress reactivity in virtual reality: A systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 138:104709. [PMID: 35644278 DOI: 10.1016/j.neubiorev.2022.104709] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/08/2022] [Accepted: 05/21/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Virtual reality (VR) research probes stress environments that are infeasible to create in the real world. However, because research simulations are applied to narrow populations, it remains unclear if VR simulations can stimulate a broadly applicable stress-response. This systematic review and meta-analysis was conducted on studies using VR stress tasks and biomarkers. METHODS Included papers (N = 52) measured cortisol, heart rate (HR), galvanic skin response (GSR), systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory sinus arrhythmia (RSA), parasympathetic activity (RMSSD), sympathovagal balance (LF/HF), and/or salivary alpha-amylase (sAA). Effect sizes (ES) and confidence intervals (CI) were calculated based on standardized mean change of baseline-to-peak biomarker levels. RESULTS From baseline-to-peak (ES, CI), analyses showed a statistically significant change in cortisol (0.56, 0.28-0.83), HR (0.68, 0.53-0.82), GSR (0.59, 0.36-0.82), SBP (.55, 0.19-0.90), DBP (.64, 0.23-1.05), RSA (-0.59, -0.88 to -0.30), and sAA (0.27, 0.092-0.45). There was no effect for RMSSD and LF/HF. CONCLUSION VR stress tasks elicited a varied magnitude of physiological stress reactivity. VR may be an effective tool in stress research.
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Affiliation(s)
- Lotte van Dammen
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Tor T Finseth
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA.
| | - Bethany H McCurdy
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Neil P Barnett
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Roselynn A Conrady
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Alexis G Leach
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Andrew F Deick
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | | | - Reece Gardner
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Brandon L Smith
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Anita Kay
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
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16
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Bzdúšková D, Marko M, Hirjaková Z, Kimijanová J, Hlavačka F, Riečanský I. The Effects of Virtual Height Exposure on Postural Control and Psychophysiological Stress Are Moderated by Individual Height Intolerance. Front Hum Neurosci 2022; 15:773091. [PMID: 35095450 PMCID: PMC8789875 DOI: 10.3389/fnhum.2021.773091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/14/2021] [Indexed: 12/21/2022] Open
Abstract
Virtual reality (VR) enables individuals to be exposed to naturalistic environments in laboratory settings, offering new possibilities for research in human neuroscience and treatment of mental disorders. We used VR to study psychological, autonomic and postural reactions to heights in individuals with varying intensity of fear of heights. Study participants (N = 42) were immersed in a VR of an unprotected open-air elevator platform in an urban area, while standing on an unstable ground. Virtual elevation of the platform (up to 40 m above the ground level) elicited robust and reliable psychophysiological activation including increased distress, heart rate, and electrodermal activity, which was higher in individuals suffering from fear of heights. In these individuals, compared with individuals with low fear of heights, the VR height exposure resulted in higher velocity of postural movements as well as decreased low-frequency (<0.5 Hz) and increased high-frequency (>1 Hz) body sway oscillations. This indicates that individuals with strong fear of heights react to heights with maladaptive rigidity of posture due to increased weight of visual input for balance control, while the visual information is less reliable at heights. Our findings show that exposure to height in a naturalistic VR environment elicits a complex reaction involving correlated changes of the emotional state, autonomic activity, and postural balance, which are exaggerated in individuals with fear of heights.
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Affiliation(s)
- Diana Bzdúšková
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Martin Marko
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
- Department of Applied Informatics, Faculty of Mathematics, Physics and Informatics, Comenius University in Bratislava, Bratislava, Slovakia
| | - Zuzana Hirjaková
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Jana Kimijanová
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - František Hlavačka
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Igor Riečanský
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
- Department of Psychiatry, Faculty of Medicine, Slovak Medical University in Bratislava, Bratislava, Slovakia
- *Correspondence: Igor Riečanský,
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17
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Azgomi HF, Faghih RT. Enhancement of Closed-Loop Cognitive Stress Regulation using Supervised Control Architectures. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2022; 3:7-17. [PMID: 35399789 PMCID: PMC8979622 DOI: 10.1109/ojemb.2022.3143686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/06/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022] Open
Abstract
Goal: We propose novel supervised control architectures to regulate the cognitive stress state and close the loop. Methods: We take information present in underlying neural impulses of skin conductance signals and employ model-based control techniques to close the loop in a state-space framework. For performance enhancement, we establish a supervised knowledge-based layer to update control system in real time. In the supervised architecture, the controller parameters are being updated in real-time. Results: Statistical analyses demonstrate the efficiency of supervised control architectures in improving the closed-loop results while maintaining stress levels within a desired range with more optimized control efforts. The model-based approaches would guarantee the control system-perspective criteria such as stability and optimality, and the proposed supervised knowledge-based layer would further enhance their efficiency. Conclusion: Outcomes in this in silico study verify the proficiency of the proposed supervised architectures to be implemented in the real world.
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Affiliation(s)
- Hamid Fekri Azgomi
- Department of Electrical and Computer EngineeringUniversity of Houston Houston TX 77004 USA
- Department of Neurological SurgeryUniversity of California San Francisco San Francisco CA 94143 USA
| | - Rose T Faghih
- Department of Biomedical EngineeringNew York University New York NY 10010 USA
- Department of Electrical and Computer EngineeringUniversity of Houston Houston TX 77004 USA
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18
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Geraets CNW, Wallinius M, Sygel K. Use of Virtual Reality in Psychiatric Diagnostic Assessments: A Systematic Review. Front Psychiatry 2022; 13:828410. [PMID: 35295778 PMCID: PMC8918631 DOI: 10.3389/fpsyt.2022.828410] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/03/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Technological developments such as Virtual reality (VR) provide new opportunities to extend and innovate mental healthcare. VR as a tool for clinical assessment has been described as promising, as it can enable real-time assessment within real-like environments or contexts as opposed to self-report and behavioral tasks in laboratory settings. OBJECTIVE With this systematic review we aimed to provide an overview of recent studies using VR in the assessment of psychiatric disorders. METHODS A systematic search was performed using Pubmed, Embase, PsycInfo, and Web of Science between 2016 and 2020. Studies were included if they used immersive VR, concerned assessment of psychiatric symptoms/disorders, and included adult patients with psychiatric disorders. RESULTS The search resulted in 3,163 potentially eligible articles, from which a total of 27 studies fulfilled inclusion criteria. Most studies considered anxiety (n = 7), addictive, (n = 7), or psychotic disorders (n = 5). Regarding ADHD (n = 3), PTSD (n = 3), and pedophilic disorder (n = 1), a few studies had been performed since 2016. The majority of the included studies compared patient groups to healthy control groups. DISCUSSION Recent studies on VR-assisted psychiatric assessments have been conducted to validate VR environments, to assess symptoms for diagnostics or therapy goals, search for biomarkers, and to gain knowledge on psychiatric disorders. VR tasks were able to detect some difference between patient and healthy control groups, mainly with regard to self-report measures. Despite previous, promising prospects, the use of VR as a tool in clinical assessments must still be considered as a field in need of continued developments and evaluations. SYSTEMATIC REVIEW REGISTRATION www.crd.york.ac.uk/prospero, identifier: CRD42021233772.
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Affiliation(s)
- Chris N W Geraets
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Research and Development Unit, Regional Forensic Psychiatric Clinic, Växjö, Sweden.,Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Märta Wallinius
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Research and Development Unit, Regional Forensic Psychiatric Clinic, Växjö, Sweden.,Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Kristina Sygel
- Research and Development Unit, Regional Forensic Psychiatric Clinic, Växjö, Sweden.,Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Forensic Psychiatry, National Board of Forensic Medicine, Stockholm, Sweden
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19
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Pallavicini F, Pepe A, Clerici M, Mantovani F. Virtual Reality Applications in Medicine During the COVID-19 Pandemic: Systematic Review (Preprint). JMIR Serious Games 2021; 10:e35000. [PMID: 36282554 PMCID: PMC9605086 DOI: 10.2196/35000] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/18/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Virtual reality can play an important role during the COVID-19 pandemic in the health care sector. This technology has the potential to supplement the traditional in-hospital medical training and treatment, and may increase access to training and therapies in various health care settings. Objective This systematic review aimed to describe the literature on health care–targeted virtual reality applications during the COVID-19 crisis. Methods We conducted a systematic search of the literature on the PsycINFO, Web of Science, and MEDLINE databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search string was as follows: “[(virtual reality)] AND [(COVID-19) OR (coronavirus) OR (SARS-CoV-2) OR (healthcare)].” Papers published in English after December 2019 in peer-reviewed journals were selected and subjected to the inclusion and exclusion criteria. We used the Mixed Methods Appraisal Tool to assess the quality of studies and the risk of bias. Results Thirty-nine studies met the inclusion criteria. Seventeen studies showed the usefulness of virtual reality during the COVID-19 crisis for reducing stress, anxiety, depression, and pain, and promoting physical activity. Twenty-two studies revealed that virtual reality was a helpful learning and training tool during the COVID-19 crisis in several areas, including emergency medicine, nursing, and pediatrics. This technology was also used as an educational tool for increasing public understanding of the COVID-19 pandemic. Different levels of immersion (ie, immersive and desktop virtual reality), types of head-mounted displays (ie, PC-based, mobile, and standalone), and content (ie, 360° videos and photos, virtual environments, virtual reality video games, and embodied virtual agents) have been successfully used. Virtual reality was helpful in both face-to-face and remote trials. Conclusions Virtual reality has been applied frequently in medicine during the COVID-19 pandemic, with positive effects for treating several health conditions and for medical education and training. Some barriers need to be overcome for the broader adoption of virtual reality in the health care panorama. Trial Registration International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) INPLASY202190108; https://inplasy.com/inplasy-2021-9-0108/
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Affiliation(s)
- Federica Pallavicini
- Department of Human Sciences for Education, Università degli Studi di Milano-Bicocca, Milano, Italy
- Gamers VR Lab, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Alessandro Pepe
- Department of Human Sciences for Education, Università degli Studi di Milano-Bicocca, Milano, Italy
- Gamers VR Lab, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Fabrizia Mantovani
- Department of Human Sciences for Education, Università degli Studi di Milano-Bicocca, Milano, Italy
- Gamers VR Lab, Università degli Studi di Milano-Bicocca, Milano, Italy
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20
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Multi-modal physiological signals based fear of heights analysis in virtual reality scenes. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Zwanzger P, Sich M, Diemer J. Virtuelle Realität bei Angsterkrankungen – vom
experimentellen Tool zur klinischen Praxis. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:617-621. [PMID: 34384117 DOI: 10.1055/a-1526-2210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Anxiety disorders are among the most frequent psychiatric disorders. According to national and international guidelines, psychopharmacological as well as psychotherapeutic approaches are recommended as first-choice treatments, depending on diagnosis and severity. Among psychotherapeutic approaches, cognitive-behavioral therapy (CBT) has been investigated most. Here, exposure is of special relevance as the core element of treatment. The technology of virtual reality (VR) has been increasingly investigated as a possible add-on strategy or alternative to conventional exposure therapy. Numerous studies of VR exposure for anxiety disorders have been published. Further, the comparison of exposure treatment in vivo vs. in VR has been investigated in meta-analyses. The results are promising overall, however they do not yet justify a general recommendation of this treatment. There is still the need for more research, especially regarding treatment efficacy in large-scale studies with larger patient samples.
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Affiliation(s)
- Peter Zwanzger
- kbo-Inn-Salzach-Klinikum Fachbereich Psychosomatische Medizin, Kompetenzschwerpunkt Angst, Versorgungsforschung, Wasserburg am Inn.,Klinik für Psychiatrie und Psychotherapie der Ludwig-Maximilians-Universität München
| | - Magdalena Sich
- kbo-Inn-Salzach-Klinikum Fachbereich Psychosomatische Medizin, Kompetenzschwerpunkt Angst, Versorgungsforschung, Wasserburg am Inn
| | - Julia Diemer
- kbo-Inn-Salzach-Klinikum Fachbereich Psychosomatische Medizin, Kompetenzschwerpunkt Angst, Versorgungsforschung, Wasserburg am Inn.,Department Psychologie, Ludwig-Maximilians-Universität München
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22
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Bell IH, Nicholas J, Alvarez-Jimenez M, Thompson A, Valmaggia L. Virtual reality as a clinical tool in mental health research and practice
. DIALOGUES IN CLINICAL NEUROSCIENCE 2021; 22:169-177. [PMID: 32699517 PMCID: PMC7366939 DOI: 10.31887/dcns.2020.22.2/lvalmaggia] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Virtual reality (VR) is a potentially powerful technology for enhancing assessment
in mental health. At any time or place, individuals can be transported into immersive
and interactive virtual worlds that are fully controlled by the researcher or clinician.
This capability is central to recent interest in how VR might be harnessed in both
treatment and assessment of mental health conditions. The current review provides a
summary of the advantages of using VR for assessment in mental health, focusing on
increasing ecological validity of highly controlled environments, enhancing
personalization and engagement, and capturing real-time, automated data in real-world
contexts. Considerations for the implementation of VR in research and clinical settings
are discussed, including current issues with cost and access, developing evidence base,
technical challenges, and ethical implications. The opportunities and challenges of VR
are important to understand as researchers and clinicians look to harness this
technology to improve mental health outcomes.
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Affiliation(s)
- Imogen H Bell
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Jennifer Nicholas
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Andrew Thompson
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia; University of Warwick - Division of Mental Health and Wellbeing, University of Warwick, UK
| | - Lucia Valmaggia
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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23
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The appeal of virtual chocolate: A systematic comparison of psychological and physiological food cue responses to virtual and real food. Food Qual Prefer 2021. [DOI: 10.1016/j.foodqual.2020.104167] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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24
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Hernández-Serrano O, Ghiţă A, Fernández-Ruiz J, Monràs M, Gual A, Gacto M, Porras-García B, Ferrer-García M, Gutiérrez-Maldonado J. Determinants of Cue-Elicited Alcohol Craving and Perceived Realism in Virtual Reality Environments among Patients with Alcohol Use Disorder. J Clin Med 2021; 10:2241. [PMID: 34064120 PMCID: PMC8196721 DOI: 10.3390/jcm10112241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/31/2022] Open
Abstract
The identification of variables that can modulate the efficacy of cue exposure using virtual reality (VR) is crucial. This study aimed to explore determinant variables of cue-elicited alcohol craving and perceived realism (PR) of environments and alcoholic beverages during a VR cue-exposure session among alcohol use disorder (AUD) outpatients. A prospective cohort study was conducted amongst 72 outpatients with AUD from a clinical setting. Alcohol craving experienced during VR exposure and PR of virtual environments and alcoholic drinks were evaluated after a VR session of exposure to alcohol-related contexts and cues. Sociodemographic, psychological and consumption characteristics were examined as possible predicting variables. Multiple linear regression analyses showed that the AUD severity and PR of beverages were predictors of cue-elicited alcohol craving. Educational level, PR of beverages and age were predictors of the PR of VR environments. In relation to the PR of VR beverages, cue-elicited alcohol craving and the PR of environments were predictors. A simple mediational model was also performed to analyze the influence of the PR of beverages on the relationship between the AUD severity and alcohol craving experienced during VR exposure: an indirect or mediational effect was found. PR of alcoholic beverages was (1) a key predictor of the PR of VR environments (and vice versa) and the alcohol craving (and vice versa) experienced during VR cue-exposure sessions using ALCO-VR software among AUD patients and (2) a mediator between AUD severity and cue-elicited alcohol craving.
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Affiliation(s)
- Olga Hernández-Serrano
- Department of Psychology, Catholic University of Saint Anthony, Av. de los Jerónimos, 135, Guadalupe de Maciascoque, 30107 Murcia, Spain;
| | - Alexandra Ghiţă
- Department of Psychology, Health and Technology, University of Twente, Drienerlolaan, 5, 7522 NB Enschede, The Netherlands;
| | - Jolanda Fernández-Ruiz
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron 175, 08035 Barcelona, Spain; (J.F.-R.); (B.P.-G.); (M.F.-G.)
| | - Miquel Monràs
- Addictive Behaviors Unit, Hospital Clinic of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain; (M.M.); (A.G.)
| | - Antoni Gual
- Addictive Behaviors Unit, Hospital Clinic of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain; (M.M.); (A.G.)
| | - Mariano Gacto
- Department of Physical Therapy, Faculty of Medicine, Campus Espinardo, University of Murcia, 30100 Murcia, Spain;
| | - Bruno Porras-García
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron 175, 08035 Barcelona, Spain; (J.F.-R.); (B.P.-G.); (M.F.-G.)
| | - Marta Ferrer-García
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron 175, 08035 Barcelona, Spain; (J.F.-R.); (B.P.-G.); (M.F.-G.)
| | - José Gutiérrez-Maldonado
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron 175, 08035 Barcelona, Spain; (J.F.-R.); (B.P.-G.); (M.F.-G.)
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Bolinski F, Etzelmüller A, De Witte NAJ, van Beurden C, Debard G, Bonroy B, Cuijpers P, Riper H, Kleiboer A. Physiological and self-reported arousal in virtual reality versus face-to-face emotional activation and cognitive restructuring in university students: A crossover experimental study using wearable monitoring. Behav Res Ther 2021; 142:103877. [PMID: 34029860 DOI: 10.1016/j.brat.2021.103877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/16/2021] [Accepted: 04/26/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Arousal may be important for learning to restructure ones' negative cognitions, a core technique in depression treatment. In virtual reality (VR), situations may be experienced more vividly than, e.g., in an imaginative approach, potentially aiding the emotional activation of negative cognitions. However, it is unclear whether such activation and subsequent cognitive restructuring in VR elicits more physiological, e.g. changes in skin conductance (SC), heart rate (HR), and self-reported arousal. METHOD In a cross-over experiment, 41 healthy students experienced two sets, one in VR, one face-to-face (F2F), of three situations aimed at activating negative cognitions. Order of the sets and mode of delivery were randomised. A wristband wearable monitored SC and HR; self-reported arousal was registered verbally. RESULTS Repeated measures analyses of variance revealed significantly more SC peaks per minute, F (1, 40) = 13.89, p = .001, higher mean SC, F (1,40) = 7.47, p = .001, and higher mean HR, F (1, 40) = 75.84, p < .001 in VR compared to F2F. No differences emerged on the paired-samples t-test for self-reported arousal, t (40) = -1.35, p = .18. DISCUSSION To the best of our knowledge, this is the first study indicating that emotional activation and subsequent cognitive restructuring in VR can lead to significantly more physiological arousal compared to an imaginative approach. These findings need to be replicated before they can be extended to patient populations.
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Affiliation(s)
- Felix Bolinski
- Vrije Universiteit Amsterdam, Department of Clinical, Neuro- & Developmental Psychology, Section of Clinical Psychology, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands.
| | - Anne Etzelmüller
- Vrije Universiteit Amsterdam, Department of Clinical, Neuro- & Developmental Psychology, Section of Clinical Psychology, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands; GET.ON Institute/HelloBetter, Hamburg, Germany
| | - Nele A J De Witte
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Cecile van Beurden
- Vrije Universiteit Amsterdam, Department of Clinical, Neuro- & Developmental Psychology, Section of Clinical Psychology, Amsterdam, the Netherlands
| | - Glen Debard
- Mobilab & Care, Thomas More University of Applied Sciences, Geel, Belgium
| | - Bert Bonroy
- Mobilab & Care, Thomas More University of Applied Sciences, Geel, Belgium
| | - Pim Cuijpers
- Vrije Universiteit Amsterdam, Department of Clinical, Neuro- & Developmental Psychology, Section of Clinical Psychology, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Heleen Riper
- Vrije Universiteit Amsterdam, Department of Clinical, Neuro- & Developmental Psychology, Section of Clinical Psychology, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Annet Kleiboer
- Vrije Universiteit Amsterdam, Department of Clinical, Neuro- & Developmental Psychology, Section of Clinical Psychology, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
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Gemonet E, Bougard C, Masfrand S, Honnet V, Mestre DR. Car drivers coping with hazardous events in real versus simulated situations: Declarative, behavioral and physiological data used to assess drivers' feeling of presence. PLoS One 2021; 16:e0247373. [PMID: 33606849 PMCID: PMC7894925 DOI: 10.1371/journal.pone.0247373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/05/2021] [Indexed: 11/18/2022] Open
Abstract
More than 1.3 million people lose their lives every year in traffic accidents. Improving road safety requires designing better vehicles and investigating drivers’ abilities more closely. Driving simulators are constantly being used for this purpose, but the question which often arises as to their validity tends to be a barrier to developments in this field. Here we studied the validity of a simulator, defined as how closely users’ behavior under simulated conditions resembles their behavior on the road, based on the concept of drivers’ feeling of presence. For this purpose, the driving behavior, physiological state and declarative data of 41 drivers were tested in the Sherpa2 simulator and in a real vehicle on a track while driving at a constant speed. During each trial, drivers had to cope with an unexpected hazardous event (a one-meter diameter gym ball crossing the road right in front of the vehicle), which occurred twice. During the speed-maintenance task, the simulator showed absolute validity, in terms of the driving and physiological parameters recorded. During the first hazardous event, the physiological parameters showed that the level of arousal (Low Heart Rate/High Heart Rate ratio x10) increased up to the end of the drive. On the other hand, the drivers’ behavioral (braking) responses were 20% more frequent in the simulator than in the real vehicle, and the physiological state parameters showed that stress reactions occurred only in the real vehicle (+5 beats per minute, +2 breaths per minute and the phasic skin conductance increased by 2). In the subjects’ declarative data, several feeling of presence sub-scales were lower under simulated conditions. These results suggest that the validity of motion based simulators for testing drivers coping with hazards needs to be questioned.
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Affiliation(s)
- Elise Gemonet
- Institut des Sciences du Mouvement, Centre National de la Recherche Scientifique, Aix-Marseille Université, Marseille, France
- Groupe PSA, Centre technique de Vélizy, Vélizy-Villacoublay, France
- * E-mail:
| | - Clément Bougard
- Groupe PSA, Centre technique de Vélizy, Vélizy-Villacoublay, France
| | | | - Vincent Honnet
- Groupe PSA, Centre technique de Vélizy, Vélizy-Villacoublay, France
| | - Daniel R. Mestre
- Institut des Sciences du Mouvement, Centre National de la Recherche Scientifique, Aix-Marseille Université, Marseille, France
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Kritikos J, Alevizopoulos G, Koutsouris D. Personalized Virtual Reality Human-Computer Interaction for Psychiatric and Neurological Illnesses: A Dynamically Adaptive Virtual Reality Environment That Changes According to Real-Time Feedback From Electrophysiological Signal Responses. Front Hum Neurosci 2021; 15:596980. [PMID: 33643010 PMCID: PMC7906990 DOI: 10.3389/fnhum.2021.596980] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/18/2021] [Indexed: 02/03/2023] Open
Abstract
Virtual reality (VR) constitutes an alternative, effective, and increasingly utilized treatment option for people suffering from psychiatric and neurological illnesses. However, the currently available VR simulations provide a predetermined simulative framework that does not take into account the unique personality traits of each individual; this could result in inaccurate, extreme, or unpredictable responses driven by patients who may be overly exposed and in an abrupt manner to the predetermined stimuli, or result in indifferent, almost non-existing, reactions when the stimuli do not affect the patients adequately and thus stronger stimuli are recommended. In this study, we present a VR system that can recognize the individual differences and readjust the VR scenarios during the simulation according to the treatment aims. To investigate and present this dynamically adaptive VR system we employ an Anxiety Disorder condition as a case study, namely arachnophobia. This system consists of distinct anxiety states, aiming to dynamically modify the VR environment in such a way that it can keep the individual within a controlled, and appropriate for the therapy needs, anxiety state, which will be called "desired states" for the study. This happens by adjusting the VR stimulus, in real-time, according to the electrophysiological responses of each individual. These electrophysiological responses are collected by an external electrodermal activity biosensor that serves as a tracker of physiological changes. Thirty-six diagnosed arachnophobic individuals participated in a one-session trial. Participants were divided into two groups, the Experimental Group which was exposed to the proposed real-time adaptive virtual simulation, and the Control Group which was exposed to a pre-recorded static virtual simulation as proposed in the literature. These results demonstrate the proposed system's ability to continuously construct an updated and adapted virtual environment that keeps the users within the appropriately chosen state (higher or lower intensity) for approximately twice the time compared to the pre-recorded static virtual simulation. Thus, such a system can increase the efficiency of VR stimulations for the treatment of central nervous system dysfunctions, as it provides numerically more controlled sessions without unexpected variations.
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Affiliation(s)
- Jacob Kritikos
- Department of Bioengineering, Imperial College London, South Kensington Campus, London, United Kingdom
| | - Georgios Alevizopoulos
- Psychiatric Clinic, Agioi Anargyroi General Oncological Hospital of Kifisia, Athens, Greece
| | - Dimitris Koutsouris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
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Wang Q, Wang H, Hu F, Hua C, Wang D. Using convolutional neural networks to decode EEG-based functional brain network with different severity of acrophobia. J Neural Eng 2021; 18. [DOI: 10.1088/1741-2552/abcdbd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022]
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Parsons TD. Ethical Challenges of Using Virtual Environments in the Assessment and Treatment of Psychopathological Disorders. J Clin Med 2021; 10:378. [PMID: 33498255 PMCID: PMC7863955 DOI: 10.3390/jcm10030378] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 12/17/2022] Open
Abstract
Clinicians are increasingly interested in the potential of virtual environments for research and praxes. Virtual environments include both immersive and non-immersive simulations of everyday activities. Moreover, algorithmic devices and adaptive virtual environments allow clinicians a medium for personalizing technologies to their patients. There is also increasing recognition of social virtual environments that connect virtual environments to social networks. Although there has been a great deal of deliberation on these novel technologies for assessment and treatment, less discourse has occurred around the ethical challenges that may ensue when these technologies are applied clinically. In this paper, some of the ethical issues involved in the clinical use of novel technologies are discussed.
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Affiliation(s)
- Thomas D. Parsons
- iCenter for Affective Technologies (iCAN), University of North Texas, Denton, TX 76207, USA;
- Computational Neuropsychology and Simulation (CNS), University of North Texas, Denton, TX 76207, USA
- College of Information, University of North Texas, Denton, TX 76207, USA
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Bouchard S, Berthiaume M, Robillard G, Forget H, Daudelin-Peltier C, Renaud P, Blais C, Fiset D. Arguing in Favor of Revising the Simulator Sickness Questionnaire Factor Structure When Assessing Side Effects Induced by Immersions in Virtual Reality. Front Psychiatry 2021; 12:739742. [PMID: 34803762 PMCID: PMC8604025 DOI: 10.3389/fpsyt.2021.739742] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Two issues are increasingly of interest in the scientific literature regarding unwanted virtual reality (VR) induced side effects: (1) whether the latent structure of the Simulator Sickness Questionnaire (SSQ) is comprised of two or three factors, and (2) if the SSQ measures symptoms of anxiety that can be misattributed to unwanted negative side effects induced by immersions in VR. Study 1 was conducted with a sample of 876 participants. A confirmatory factor analysis clearly supported a two-factor model composed of nausea and oculomotor symptoms instead of the 3-factor structure observed in simulators. To tease-out symptoms of anxiety from unwanted negative side effects induced by immersions in VR, Study 2 was conducted with 88 participants who were administered the Trier Stress Social Test in groups without being immersed in VR. A Spearman correlation showed that 11 out of 16 side effects correlated significantly with anxiety. A factor analysis revealed that items measuring general discomfort, difficulty concentrating, sweating, nausea, and vertigo loaded significantly on the anxiety factor comprised of items from the State-Trait Anxiety Inventory. Finally, a multiple regression indicated that the items measuring general discomfort and difficulty concentrating significantly predicted increases in anxiety. The overall results support the notion that side effects associated with immersions in VR consist mostly of a nausea and an oculomotor latent structure and that a few items are confounding anxiety and cybersickness. The data support the suggestion to revise the scoring procedures of the Simulator Sickness Questionnaire when using this instrument with immersions in VR.
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Affiliation(s)
- Stéphane Bouchard
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Gatineau, QC, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada.,Centre de recherche du Centre Intégré de Santé et des Services Sociaux de l'Outaouais, Gatineau, QC, Canada
| | | | - Geneviève Robillard
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Gatineau, QC, Canada.,Innovation, Science and Economic Development Canada, Ottawa, ON, Canada
| | - Hélène Forget
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Gatineau, QC, Canada
| | - Camille Daudelin-Peltier
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Gatineau, QC, Canada
| | - Patrice Renaud
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Gatineau, QC, Canada
| | - Caroline Blais
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Gatineau, QC, Canada
| | - Daniel Fiset
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Gatineau, QC, Canada
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Kritikos J, Zoitaki C, Tzannetos G, Mehmeti A, Douloudi M, Nikolaou G, Alevizopoulos G, Koutsouris D. Comparison between Full Body Motion Recognition Camera Interaction and Hand Controllers Interaction used in Virtual Reality Exposure Therapy for Acrophobia. SENSORS 2020; 20:s20051244. [PMID: 32106452 PMCID: PMC7085665 DOI: 10.3390/s20051244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 11/16/2022]
Abstract
Virtual Reality has already been proven as a useful supplementary treatment tool for anxiety disorders. However, no specific technological importance has been given so far on how to apply Virtual Reality with a way that properly stimulates the phobic stimulus and provide the necessary means for lifelike experience. Thanks to technological advancements, there is now a variety of hardware that can help enhance stronger emotions generated by Virtual Reality systems. This study aims to evaluate the feeling of presence during different hardware setups of Virtual Reality Exposure Therapy, and, particularly how the user's interaction with those setups can affects their sense of presence during the virtual simulation. An acrophobic virtual scenario is used as a case study by 20 phobic individuals and the Witmer-Singer presence questionnaire was used for presence evaluation by the users of the system. Statistical analysis on their answers revealed that the proposed full body Motion Recognition Cameras system generates a better feeling of presence compared to the Hand Controllers system. This is thanks to the Motion Recognition Cameras, which track and allow display of the user's entire body within the virtual environment. Thus, the users are enabled to interact and confront the anxiety-provoking stimulus as in real world. Further studies are recommended, in which the proposed system could be used in Virtual Reality Exposure Therapy trials with acrophobic patients and other anxiety disorders as well, since the proposed system can provide natural interaction in various simulated environments.
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Affiliation(s)
- Jacob Kritikos
- School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece; (C.Z.); (G.T.)
- Correspondence: (J.K.); (D.K.)
| | - Chara Zoitaki
- School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece; (C.Z.); (G.T.)
| | - Giannis Tzannetos
- School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece; (C.Z.); (G.T.)
| | - Anxhelino Mehmeti
- Department of Informatics and Telecommunications, National Kapodistrian University of Athens, 15784 Athens, Greece; (A.M.); (G.N.)
| | - Marilina Douloudi
- Department of Biology, National Kapodistrian University of Athens, 15784 Athens, Greece;
| | - George Nikolaou
- Department of Informatics and Telecommunications, National Kapodistrian University of Athens, 15784 Athens, Greece; (A.M.); (G.N.)
| | | | - Dimitris Koutsouris
- School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece; (C.Z.); (G.T.)
- Correspondence: (J.K.); (D.K.)
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32
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Martens MAG, Antley A, Freeman D, Slater M, Harrison PJ, Tunbridge EM. It feels real: physiological responses to a stressful virtual reality environment and its impact on working memory. J Psychopharmacol 2019; 33:1264-1273. [PMID: 31294651 PMCID: PMC6764008 DOI: 10.1177/0269881119860156] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Virtual reality (VR) is increasingly used to study and treat psychiatric disorders. Its fidelity depends in part on the extent to which the VR environment provides a convincing simulation, for example whether a putatively stressful VR situation actually produces a stress response. METHODS We studied the stress response in 28 healthy men exposed either to a stressor VR elevator (which simulated travelling up the outside of a tall building and culminated in the participant being asked to step off the elevator platform), or to a control elevator. We measured psychological and physiological (salivary cortisol and alpha-amylase, blood pressure, pulse, skin conductance) stress indices. We also measured subsequent performance on the N-back task because acute stress has been reported to impact on working memory. RESULTS Compared to participants in the control elevator, those in the external elevator had increases in skin conductance, pulse and subjective stress and anxiety ratings, altered heart rate variability, and a delayed rise in cortisol. N-back performance was unaffected. CONCLUSIONS A putatively stressful VR elevator produces a physiological as well as a psychological stress response, supporting its use in the investigation and treatment of stress-related disorders, and its potential value as an experimental laboratory stressor.
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Affiliation(s)
- Marieke AG Martens
- Department of Psychiatry, University of
Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust,
Warneford Hospital, Oxford, UK
| | - Angus Antley
- Department of Psychiatry, University of
Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust,
Warneford Hospital, Oxford, UK
| | - Daniel Freeman
- Department of Psychiatry, University of
Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust,
Warneford Hospital, Oxford, UK
| | - Mel Slater
- Department of Clinical Psychology and
Psychobiology, University of Barcelona, Barcelona, Spain
| | - Paul J Harrison
- Department of Psychiatry, University of
Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust,
Warneford Hospital, Oxford, UK
| | - Elizabeth M Tunbridge
- Department of Psychiatry, University of
Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust,
Warneford Hospital, Oxford, UK,Elizabeth M Tunbridge, University Department
of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
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33
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Anxiety Level Recognition for Virtual Reality Therapy System Using Physiological Signals. ELECTRONICS 2019. [DOI: 10.3390/electronics8091039] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Virtual reality exposure therapy (VRET) can have a significant impact towards assessing and potentially treating various anxiety disorders. One of the main strengths of VRET systems is that they provide an opportunity for a psychologist to interact with virtual 3D environments and change therapy scenarios according to the individual patient’s needs. However, to do this efficiently the patient’s anxiety level should be tracked throughout the VRET session. Therefore, in order to fully use all advantages provided by the VRET system, a mental stress detection system is needed. The patient’s physiological signals can be collected with wearable biofeedback sensors. Signals like blood volume pressure (BVP), galvanic skin response (GSR), and skin temperature can be processed and used to train the anxiety level classification models. In this paper, we combine VRET with mental stress detection and highlight potential uses of this kind of VRET system. We discuss and present a framework for anxiety level recognition, which is a part of our developed cloud-based VRET system. Physiological signals of 30 participants were collected during VRET-based public speaking anxiety treatment sessions. The acquired data were used to train a four-level anxiety recognition model (where each level of ‘low’, ‘mild’, ‘moderate’, and ‘high’ refer to the levels of anxiety rather than to separate classes of the anxiety disorder). We achieved an 80.1% cross-subject accuracy (using leave-one-subject-out cross-validation) and 86.3% accuracy (using 10 × 10 fold cross-validation) with the signal fusion-based support vector machine (SVM) classifier.
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Abstract
PURPOSE OF REVIEW The purpose of this paper is to provide a current review of the recent literature (2015-2018) on psychophysiological markers of fear and anxiety. RECENT FINDING Relative to healthy controls, fear-based disorders are characterised by heightened physiological reactivity to circumscribe threat salient stimuli, whereas anxiety-related disorders are associated with a more blunted pattern of physiological reactivity. Fear and anxiety disorders are marked by abnormal patterns of physiological reactivity, characterised by hyper- and hypo-reactivity in response to stimuli varying in threat salience.
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Affiliation(s)
- Jamiah Hyde
- School of Applied Psychology, Griffith University, Mt. Gravatt, Australia
| | - Katherine M Ryan
- School of Applied Psychology, Griffith University, Mt. Gravatt, Australia
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Mt. Gravatt, Australia.
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Wuehr M, Breitkopf K, Decker J, Ibarra G, Huppert D, Brandt T. Fear of heights in virtual reality saturates 20 to 40 m above ground. J Neurol 2019; 266:80-87. [PMID: 31102019 DOI: 10.1007/s00415-019-09370-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 01/22/2023]
Abstract
Recent epidemiological studies indicate that about one-third of the general population suffers from a more or less disabling height intolerance, with a relevant impact on quality of life in many of them. Acrophobia, the most severe form of visual height intolerance, has a life-time prevalence of around 5%. Although it is commonly believed that fear of heights should continuously aggravate with increasing elevation, this issue has not been systematically investigated yet. Here, we examined this topic using immersive virtual reality, an established tool in therapy for fear of heights, that allows to flexibly manipulate height stimuli. In a comprehensive cohort (including insusceptible subjects as well as subjects with height intolerance up to acrophobia) height intolerance severity was graded by an established metric scale (vHISS). Participants were randomly exposed to different virtual elevations using a head-mounted display. Behavioral responses to virtual height exposure were analogous to exposure in vivo. Participants exhibited increased anxiety and musculoskeletal stiffening with enhanced high-frequency body sway, to an extend that corresponded to the individual subjective height intolerance rating. For all behavioral responses, we observed a saturation above a certain altitude. Body sway and musculoskeletal stiffening became maximal at 20 m above ground, whereas anxiety saturated above 40 m. These results suggest that fear of heights is characterized by a nonlinear stimulus-response relationship and a dissociation between visual-height-induced bodily and emotional reactions.
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Affiliation(s)
- Max Wuehr
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, 81377, Munich, Germany.
| | - Katharina Breitkopf
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Julian Decker
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Gerardo Ibarra
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- Institute for Clinical Neurosciences, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, Munich, 81377, Germany
- Department of Neurology, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, Munich, 81377, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- Institute for Clinical Neurosciences, Ludwig-Maximilians-University, University Hospital, Marchioninistr. 15, Munich, 81377, Germany
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Gantiva C, Sotaquirá M, Marroquín M, Carné C, Parada L, Muñoz MA. Size matters in the case of graphic health warnings: Evidence from physiological measures. Addict Behav 2019; 92:64-68. [PMID: 30597332 DOI: 10.1016/j.addbeh.2018.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/30/2018] [Accepted: 12/04/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVES >50 countries use graphic health warnings (GHWs) with the minimum size that is recommended by the World Health Organization (WHO). The aim of the present study was to evaluate the effect of the size of GHWs on physiological responses that serve as indices of arousal and aversive motivation in nonsmokers, weekly smokers, and daily smokers. METHODS The skin conductance response, corrugator muscle activity, and startle reflex were recorded in 35 nonsmokers, 35 weekly smokers, and 35 daily smokers while they observed pictures of cigarette packs without GHWs, cigarette packs with GHWs that covered 30% of the pack, and cigarette packs with GHWs that covered 60% of the pack. RESULTS Cigarette packs with 30% GHWs did not generate significantly higher responses on any of the physiological measures compared with cigarette packs without GHWs. Conversely, cigarette packs with GHWs that covered 60% of the pack generated a greater skin conductance response, greater corrugator muscle activity, and an increase in the startle reflex compared with cigarette packs without GHWs. No significant differences were found between groups in any of the physiological measures. CONCLUSIONS The minimum size of GHW that is recommended by the WHO is insufficient to generate an emotional response that favors avoidance of the cigarette pack. GHW that cover 60% of the cigarette pack significantly reduced the attractiveness of the tobacco packaging and generated greater arousal responses.
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Gromer D, Reinke M, Christner I, Pauli P. Causal Interactive Links Between Presence and Fear in Virtual Reality Height Exposure. Front Psychol 2019; 10:141. [PMID: 30761054 PMCID: PMC6363698 DOI: 10.3389/fpsyg.2019.00141] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/15/2019] [Indexed: 12/13/2022] Open
Abstract
Virtual reality plays an increasingly important role in research and therapy of pathological fear. However, the mechanisms how virtual environments elicit and modify fear responses are not yet fully understood. Presence, a psychological construct referring to the ‘sense of being there’ in a virtual environment, is widely assumed to crucially influence the strength of the elicited fear responses, however, causality is still under debate. The present study is the first that experimentally manipulated both variables to unravel the causal link between presence and fear responses. Height-fearful participants (N = 49) were immersed into a virtual height situation and a neutral control situation (fear manipulation) with either high versus low sensory realism (presence manipulation). Ratings of presence and verbal and physiological (skin conductance, heart rate) fear responses were recorded. Results revealed an effect of the fear manipulation on presence, i.e., higher presence ratings in the height situation compared to the neutral control situation, but no effect of the presence manipulation on fear responses. However, the presence ratings during the first exposure to the high quality neutral environment were predictive of later fear responses in the height situation. Our findings support the hypothesis that experiencing emotional responses in a virtual environment leads to a stronger feeling of being there, i.e., increase presence. In contrast, the effects of presence on fear seem to be more complex: on the one hand, increased presence due to the quality of the virtual environment did not influence fear; on the other hand, presence variability that likely stemmed from differences in user characteristics did predict later fear responses. These findings underscore the importance of user characteristics in the emergence of presence.
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Affiliation(s)
- Daniel Gromer
- Department of Psychology, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Max Reinke
- Department of Psychology, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Isabel Christner
- Department of Psychology, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Paul Pauli
- Department of Psychology, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany.,Center of Mental Health, Medical Faculty, University of Würzburg, Würzburg, Germany
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Landowska A, Roberts D, Eachus P, Barrett A. Within- and Between-Session Prefrontal Cortex Response to Virtual Reality Exposure Therapy for Acrophobia. Front Hum Neurosci 2018; 12:362. [PMID: 30443209 PMCID: PMC6221970 DOI: 10.3389/fnhum.2018.00362] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 08/23/2018] [Indexed: 01/30/2023] Open
Abstract
Exposure Therapy (ET) has demonstrated its efficacy in the treatment of phobias, anxiety and Post-traumatic Stress Disorder (PTSD), however, it suffers a high drop-out rate because of too low or too high patient engagement in treatment. Virtual Reality Exposure Therapy (VRET) is comparably effective regarding symptom reduction and offers an alternative tool to facilitate engagement for avoidant participants. Neuroimaging studies have demonstrated that both ET and VRET normalize brain activity within a fear circuit. However, previous studies have employed brain imaging technology which restricts people's movement and hides their body, surroundings and therapist from view. This is at odds with the way engagement is typically controlled. We used a novel combination of neural imaging and VR technology-Functional Near-Infrared Spectroscopy (fNIRS) and Immersive Projection Technology (IPT), to avoid these limitations. Although there are a few studies that have investigated the effect of VRET on a brain function after the treatment, the present study utilized technologies which promote ecological validity to measure brain changes after VRET treatment. Furthermore, there are no studies that have measured brain activity within VRET session. In this study brain activity within the prefrontal cortex (PFC) was measured during three consecutive exposure sessions. N = 13 acrophobic volunteers were asked to walk on a virtual plank with a 6 m drop below. Changes in oxygenated (HbO) hemoglobin concentrations in the PFC were measured in three blocks using fNIRS. Consistent with previous functional magnetic resonance imaging (fMRI) studies, the analysis showed decreased activity in the DLPFC and MPFC during first exposure. The activity increased toward normal across three sessions. The study demonstrates potential efficacy of a method for measuring within-session neural response to virtual stimuli that could be replicated within clinics and research institutes, with equipment better suited to an ET session and at fraction of the cost, when compared to fMRI. This has application in widening access to, and increasing ecological validity of, immersive neuroimaging across understanding, diagnosis, assessment and treatment of, a range of mental disorders such as phobia, anxiety and PTSD or addictions.
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Affiliation(s)
- Aleksandra Landowska
- Department of Psychology, School of Health Sciences, University of Salford, Salford, United Kingdom
| | - David Roberts
- Department of Psychology, School of Health Sciences, University of Salford, Salford, United Kingdom
| | - Peter Eachus
- Department of Psychology, School of Health Sciences, University of Salford, Salford, United Kingdom
| | - Alan Barrett
- Military Veterans’ Service, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, United Kingdom
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Affiliation(s)
- Peter Zwanzger
- kbo-Inn-Salzach-Klinikum, Gabersee 7, D-83512, Wasserburg am Inn, Deutschland.
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Gromer D, Madeira O, Gast P, Nehfischer M, Jost M, Müller M, Mühlberger A, Pauli P. Height Simulation in a Virtual Reality CAVE System: Validity of Fear Responses and Effects of an Immersion Manipulation. Front Hum Neurosci 2018; 12:372. [PMID: 30319376 PMCID: PMC6167601 DOI: 10.3389/fnhum.2018.00372] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/30/2018] [Indexed: 12/05/2022] Open
Abstract
Acrophobia is characterized by intense fear in height situations. Virtual reality (VR) can be used to trigger such phobic fear, and VR exposure therapy (VRET) has proven effective for treatment of phobias, although it remains important to further elucidate factors that modulate and mediate the fear responses triggered in VR. The present study assessed verbal and behavioral fear responses triggered by a height simulation in a 5-sided cave automatic virtual environment (CAVE) with visual and acoustic simulation and further investigated how fear responses are modulated by immersion, i.e., an additional wind simulation, and presence, i.e., the feeling to be present in the VE. Results revealed a high validity for the CAVE and VE in provoking height related self-reported fear and avoidance behavior in accordance with a trait measure of acrophobic fear. Increasing immersion significantly increased fear responses in high height anxious (HHA) participants, but did not affect presence. Nevertheless, presence was found to be an important predictor of fear responses. We conclude that a CAVE system can be used to elicit valid fear responses, which might be further enhanced by immersion manipulations independent from presence. These results may help to improve VRET efficacy and its transfer to real situations.
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Affiliation(s)
- Daniel Gromer
- Department of Psychology, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Octávia Madeira
- Department of Psychology, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Philipp Gast
- Department of Psychology, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Markus Nehfischer
- Department of Psychology, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Michael Jost
- Department of Psychology, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Mathias Müller
- Department of Psychology, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Andreas Mühlberger
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Paul Pauli
- Department of Psychology, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany.,Center of Mental Health, Medical Faculty, University of Würzburg, Würzburg, Germany
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Jerdan SW, Grindle M, van Woerden HC, Kamel Boulos MN. Head-Mounted Virtual Reality and Mental Health: Critical Review of Current Research. JMIR Serious Games 2018; 6:e14. [PMID: 29980500 PMCID: PMC6054705 DOI: 10.2196/games.9226] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/11/2018] [Accepted: 04/03/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND eHealth interventions are becoming increasingly used in public health, with virtual reality (VR) being one of the most exciting recent developments. VR consists of a three-dimensional, computer-generated environment viewed through a head-mounted display. This medium has provided new possibilities to adapt problematic behaviors that affect mental health. VR is no longer unaffordable for individuals, and with mobile phone technology being able to track movements and project images through mobile head-mounted devices, VR is now a mobile tool that can be used at work, home, or on the move. OBJECTIVE In line with recent advances in technology, in this review, we aimed to critically assess the current state of research surrounding mental health. METHODS We compiled a table of 82 studies that made use of head-mounted devices in their interventions. RESULTS Our review demonstrated that VR is effective in provoking realistic reactions to feared stimuli, particularly for anxiety; moreover, it proved that the immersive nature of VR is an ideal fit for the management of pain. However, the lack of studies surrounding depression and stress highlight the literature gaps that still exist. CONCLUSIONS Virtual environments that promote positive stimuli combined with health knowledge could prove to be a valuable tool for public health and mental health. The current state of research highlights the importance of the nature and content of VR interventions for improved mental health. While future research should look to incorporate more mobile forms of VR, a more rigorous reporting of VR and computer hardware and software may help us understand the relationship (if any) between increased specifications and the efficacy of treatment.
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Affiliation(s)
- Shaun W Jerdan
- Department of Digital Health, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
| | - Mark Grindle
- Department of Digital Health, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
| | - Hugo C van Woerden
- Public Health Directorate, NHS Highland, Inverness, United Kingdom.,Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
| | - Maged N Kamel Boulos
- The Alexander Graham Bell Centre for Digital Health, Moray College UHI, University of the Highlands and Islands, Elgin, United Kingdom
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Schäfer SK, Ihmig FR, Lara H KA, Neurohr F, Kiefer S, Staginnus M, Lass-Hennemann J, Michael T. Effects of heart rate variability biofeedback during exposure to fear-provoking stimuli within spider-fearful individuals: study protocol for a randomized controlled trial. Trials 2018; 19:184. [PMID: 29548298 PMCID: PMC5857097 DOI: 10.1186/s13063-018-2554-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 02/15/2018] [Indexed: 02/24/2023] Open
Abstract
Background Specific phobias are among the most common anxiety disorders. Exposure therapy is the treatment of choice for specific phobias. However, not all patients respond equally well to it. Hence, current research focuses on therapeutic add-ons to increase and consolidate the effects of exposure therapy. One potential therapeutic add-on is biofeedback to increase heart rate variability (HRV). A recent meta-analysis shows beneficial effects of HRV biofeedback interventions on stress and anxiety symptoms. Therefore, the purpose of the current trial is to evaluate the effects of HRV biofeedback, which is practiced before and utilized during exposure, in spider-fearful individuals. Further, this trial is the first to differentiate between the effects of a HRV biofeedback intervention and those of a low-load working memory (WM) task. Methods Eighty spider-fearful individuals participate in the study. All participants receive a training session in which they practice two tasks (HRV biofeedback and a motor pseudo-biofeedback task or two motor pseudo-biofeedback tasks). Afterwards, they train both tasks at home for 6 days. One week later, during the exposure session, they watch 16 1-min spider video clips. Participants are divided into four groups: group 1 practices the HRV biofeedback and one motor pseudo-task before exposure and utilizes HRV biofeedback during exposure. Group 2 receives the same training, but continues the pseudo-biofeedback task during exposure. Group 3 practices two pseudo-biofeedback tasks and continues one of them during exposure. Group 4 trains in two pseudo-biofeedback tasks and has no additional task during exposure. The primary outcome is fear of spiders (measured by the Fear of Spiders Questionnaire and the Behavioral Approach Test). Secondary outcomes are physiological measures based on electrodermal activity, electrocardiogram and respiration. Discussion This RCT is the first one to investigate the effects of using a pre-trained HRV biofeedback during exposure in spider-fearful individuals. The study critically contrasts the effects of the biofeedback intervention with those of pseudo-tasks, which also require WM capacity, but which do not have a physiological base. If HRV biofeedback is effective in reducing fear of spiders, it would represent an easy-to-use tool to improve exposure-therapy outcomes. Trial registration Deutsches Register Klinischer Studien, DRKS00012278. Registered on 23 May 2017, amendment on 5 October 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2554-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah K Schäfer
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Building A 1.3, 66123, Saarbrücken, Germany
| | - Frank R Ihmig
- Department of Biomedical Microsystems, Fraunhofer-Institut fuer Biomedizinische Technik (IBMT), Sulzbach, Saar, Germany
| | - Karen A Lara H
- Department of Biomedical Microsystems, Fraunhofer-Institut fuer Biomedizinische Technik (IBMT), Sulzbach, Saar, Germany
| | - Frank Neurohr
- Department of Biomedical Microsystems, Fraunhofer-Institut fuer Biomedizinische Technik (IBMT), Sulzbach, Saar, Germany
| | - Stephan Kiefer
- Department of Biomedical Microsystems, Fraunhofer-Institut fuer Biomedizinische Technik (IBMT), Sulzbach, Saar, Germany
| | - Marlene Staginnus
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Building A 1.3, 66123, Saarbrücken, Germany
| | - Johanna Lass-Hennemann
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Building A 1.3, 66123, Saarbrücken, Germany
| | - Tanja Michael
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Building A 1.3, 66123, Saarbrücken, Germany.
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Hong YJ, Kim HE, Jung YH, Kyeong S, Kim JJ. Usefulness of the Mobile Virtual Reality Self-Training for Overcoming a Fear of Heights. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2017; 20:753-761. [DOI: 10.1089/cyber.2017.0085] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Yeon-Ju Hong
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hesun Erin Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Hoon Jung
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sunghyon Kyeong
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Jin Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Psychiatry, Yonsei University Gangnam Severance Hospital, Seoul, Korea
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Reichenberger J, Diemer J, Zwanzger P, Notzon S, Mühlberger A. Soziales Kompetenztraining in Virtueller Realität bei sozialer Angst. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Soziale Kompetenztrainings sind wichtige Werkzeuge bei der Psychotherapie der Sozialen Angststörung. Die Durchführung in Virtueller Realität (VR) könnte die Verfügbarkeit und Effektivität erhöhen, allerdings besteht ein Bedarf an validierten VR-Szenarien. Fragestellung: Geprüft wird die Validität von zwei in Anlehnung an das Gruppentraining sozialer Kompetenzen von Hinsch und Pfingsten (2015) entwickelten VR-Szenarien. Es wird angenommen, dass die durch das Szenario ausgelösten Komponenten sozialer Angst auf subjektiver, psychophysiologischer und kognitiver Ebene signifikant zwischen höher (HSA) und niedriger (NSA) sozial ängstlichen Personen differenzieren. Methode: Insgesamt durchliefen N = 55 HSA und NSA Studierende zwei VR-Szenarien vom Typ „Recht durchsetzen“. Zusätzlich wurde experimentell die Blickkontaktdauer des virtuellen Gesprächspartners variiert. Hauptoutcome war die erlebte Angst in den Rollenspielen. Zusätzlich wurden Herzschlagfrequenz, Hautleitfähigkeit sowie die Einschätzung der eigenen Kompetenz erfasst. Ergebnisse: HSA im Vergleich zu NSA berichteten für beide Szenarien signifikant höhere Angst sowie negative Verzerrungen in Bezug auf die Einschätzung der eigenen Kompetenz. Zusätzlich zeigte sich eine physiologische Aktivierung während der Rollenspiele, aber keine Differenzierung zwischen beiden Gruppen. Beide VR-Szenarien wurden als realistisch empfunden. Schlussfolgerungen: Virtuelle Interaktionsszenarien können zu Trainingszwecken genutzt werden und Soziale Kompetenztrainings in VR haben ein großes Potential für den Einsatz als psychotherapeutisches Verfahren bei Sozialer Angststörung.
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Affiliation(s)
- Jonas Reichenberger
- Institut für Psychologie, Lehrstuhl für Klinische Psychologie und Psychotherapie, Universität Regensburg
| | - Julia Diemer
- Institut für Psychologie, Lehrstuhl für Klinische Psychologie und Psychotherapie, Universität Regensburg
- kbo-Inn-Salzach-Klinikum, Wasserburg am Inn
| | - Peter Zwanzger
- kbo-Inn-Salzach-Klinikum, Wasserburg am Inn
- Lehrstuhl für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München
| | - Swantje Notzon
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Münster
| | - Andreas Mühlberger
- Institut für Psychologie, Lehrstuhl für Klinische Psychologie und Psychotherapie, Universität Regensburg
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Mayer SE, Snodgrass M, Liberzon I, Briggs H, Curtis GC, Abelson JL. The psychology of HPA axis activation: Examining subjective emotional distress and control in a phobic fear exposure model. Psychoneuroendocrinology 2017; 82:189-198. [PMID: 28233588 PMCID: PMC5478447 DOI: 10.1016/j.psyneuen.2017.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 12/11/2022]
Abstract
The HPA axis plays a key role in mediating the effects of "stress" on health, but clarifying mechanisms requires an understanding of psycho-biological linkages. There has long been an implicit assumption that subjective emotional distress (e.g., fear) should activate the HPA axis. Although this assumption was challenged 25 years ago (Curtis, 1976), laboratory studies in humans are limited. In this study we sought to replicate Curtis' findings and extend it by investigating if presence or absence of stressor control shapes HPA axis reactivity in a phobic fear exposure model. We recruited 19-45-year-old specific phobia participants (n=32 spider/snake phobia; n=14 claustrophobia) and gradually exposed them to their feared object or situation while measuring hormonal (ACTH and cortisol) and subjective (emotional distress, perceived control) responses. Utilizing a dyadic yoked design, we compared HPA reactivity when the pace of exposure was controlled by participants to identical exposure given to matched participants in the absence of control. Results showed that phobic fear exposure generated intense emotional distress without a corresponding increase in HPA axis activity. Although our actual manipulation of control failed to impact HPA responses, perceived control during exposure was associated with lower cortisol, an effect that was moderated by actual availability of stressor control. Our findings replicate Curtis' findings and challenge the still common but unsupported assumption that HPA axis activity reflects subjective distress. These results also highlight the importance of both perceived and actual aspects of stressor control in understanding what is truly "stressful" to the HPA axis system.
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Affiliation(s)
- Stefanie E. Mayer
- Department of Psychology, University of Michigan, 530 Church Street, Arbor, MI 48109, USA
| | - Michael Snodgrass
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Arbor, MI 48109, USA
| | - Israel Liberzon
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Arbor, MI 48109, USA
| | - Hedieh Briggs
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Arbor, MI 48109, USA
| | - George C. Curtis
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Arbor, MI 48109, USA
| | - James L. Abelson
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Arbor, MI 48109, USA,Corresponding author: James L. Abelson, M.D., Ph.D., 4250 Plymouth Rd (Box 5765, Rm. 2733) Ann Arbor, MI 48109-2700, Phone: 734-764-5348; fax: 734-936-7868,
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Naranjo EN, Cleworth TW, Allum JHJ, Inglis JT, Lea J, Westerberg BD, Carpenter MG. Threat effects on human oculo-motor function. Neuroscience 2017; 359:289-298. [PMID: 28733210 DOI: 10.1016/j.neuroscience.2017.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 06/11/2017] [Accepted: 07/11/2017] [Indexed: 11/27/2022]
Abstract
Neuro-anatomical evidence supports the potential for threat-related factors, such as fear, anxiety and vigilance, to influence brainstem motor nuclei controlling eye movements, as well as the vestibular nuclei. However, little is known about how threat influences human ocular responses, such as eye saccades (ES), smooth pursuit eye tracking (SP), and optokinetic nystagmus (OKN), and whether these responses can be facilitated above normal baseline levels with a natural source of threat. This study was designed to examine the effects of height-induced postural threat on the gain of ES, SP and OKN responses in humans. Twenty participants stood at two different surface heights while performing ES (ranging from 8° to 45° from center), SP (15, 20, 30°/s) and OKN (15, 30, 60°/s) responses in the horizontal plane. Height did not significantly increase the slope of the relationship between ES peak velocity and initial amplitude, or the gain of ES amplitude. In contrast height significantly increased SP and OKN gain. Significant correlations were found between changes in physiological arousal and OKN gain. Observations of changes with height in OKN and SP support neuro-anatomical evidence of threat-related mechanisms influencing both oculo-motor nuclei and vestibular reflex pathways. Although further study is warranted, the findings suggest that potential influences of fear, anxiety and arousal/alertness should be accounted for, or controlled, during clinical vestibular and oculo-motor testing.
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Affiliation(s)
- E N Naranjo
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - T W Cleworth
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - J H J Allum
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada; Department of ORL, University of Basel Hospital, Basel, Switzerland
| | - J T Inglis
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - J Lea
- BC Rotary Hearing and Balance Centre at St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - B D Westerberg
- BC Rotary Hearing and Balance Centre at St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - M G Carpenter
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
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Shiban Y, Diemer J, Müller J, Brütting-Schick J, Pauli P, Mühlberger A. Diaphragmatic breathing during virtual reality exposure therapy for aviophobia: functional coping strategy or avoidance behavior? a pilot study. BMC Psychiatry 2017; 17:29. [PMID: 28100203 PMCID: PMC5242013 DOI: 10.1186/s12888-016-1181-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/30/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Although there is solid evidence for the efficacy of in vivo and virtual reality (VR) exposure therapy for a specific phobia, there is a significant debate over whether techniques promoting distraction or relaxation have impairing or enhancing effects on treatment outcome. In the present pilot study, we investigated the effect of diaphragmatic breathing (DB) as a relaxation technique during VR exposure treatment. METHOD Twenty-nine patients with aviophobia were randomly assigned to VR exposure treatment either with or without diaphragmatic breathing (six cycles per minute). Subjective fear ratings, heart rate and skin conductance were assessed as indicators of fear during both the exposure and the test session one week later. RESULTS The group that experienced VR exposure combined with diaphragmatic breathing showed a higher tendency to effectively overcome the fear of flying. Psychophysiological measures of fear decreased and self-efficacy increased in both groups with no significant difference between the groups. CONCLUSIONS Our findings indicate that diaphragmatic breathing during VR exposure does not interfere with the treatment outcome and may even enhance treatment effects of VR exposure therapy for aviophobic patients. TRIAL REGISTRATION Retrospectively registered. ClinicalTrials.gov NCT02990208 . Registered 07 December 2016.
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Affiliation(s)
- Youssef Shiban
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Universitätsstraße 31, 93053 Regensburg, Germany
| | - Julia Diemer
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Universitätsstraße 31, 93053 Regensburg, Germany
| | - Jana Müller
- Department of Psychology (Biological Psychology, Clinical Psychology and Psychotherapy), University of Würzburg, Marcusstraße 9-11, 97070 Würzburg, Germany
| | - Johanna Brütting-Schick
- Department of Psychology (Biological Psychology, Clinical Psychology and Psychotherapy), University of Würzburg, Marcusstraße 9-11, 97070 Würzburg, Germany
| | - Paul Pauli
- Department of Psychology (Biological Psychology, Clinical Psychology and Psychotherapy), University of Würzburg, Marcusstraße 9-11, 97070 Würzburg, Germany
| | - Andreas Mühlberger
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Universitätsstraße 31, 93053 Regensburg, Germany
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Trier Social Stress Test in vivo and in virtual reality: Dissociation of response domains. Int J Psychophysiol 2016; 110:47-55. [PMID: 27742258 DOI: 10.1016/j.ijpsycho.2016.10.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 11/19/2022]
Abstract
The Trier Social Stress Test (TSST) is considered a reliable paradigm for inducing psychosocial stress. Virtual reality (VR) has successfully been applied to ensure a greater degree of efficiency and standardization in the TSST. Studies using the TSST in VR (VR-TSST) have reported significant stress reactions, with subjective and peripheral physiological reactions comparable to those in response to the in vivo TSST and with lower cortisol reactions. The current study examined whether an additional virtual competitive factor triggers larger stress responses than a standard VR-TSST. Forty-five male participants were randomly assigned to either in vivo TSST, VR-TSST (VR) or VR-TSST with a virtual competitor (VR+). A significant increase of self-reported stress, electrodermal activity, and heart rate indicated a pronounced stress reaction with no differences between groups. For salivary cortisol, however, responder rates differed significantly between groups, with in vivo participants showing overall higher response rates (86%) than participants of both VR groups (VR: 33%, VR+: 47%). In contrast, participants of both VR groups judged the task significantly more challenging than did in vivo TSST participants. In sum, our results indicate successful stress induction in all experimental conditions, and a marked dissociation of salivary cortisol levels on the one hand, and the physiological and psychological stress reactions on the other hand. The competitive scenario did not significantly enhance stress reactions. VR technology may serve as a standardized tool for inducing social stress in experimental settings, but further research is needed to clarify why the stress reaction as assessed by cortisol differs from peripheral and subjective stress reactions in VR.
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