The Use of Virtual Reality in Psychology: A Case Study in Visual Perception

Digital therapeutics using virtual reality-based visual perceptual learning for visual field defects in stroke: A double-blind randomized trial

INTRODUCTION

Visual field defects (VFDs) represent a debilitating poststroke complication, characterized by unseen parts of the visual field. Visual perceptual learning (VPL), involving repetitive visual training in blind visual fields, may effectively restore visual field sensitivity in cortical blindness. This current multicenter, double-blind, randomized, controlled clinical trial investigated the efficacy and safety of VPL-based digital therapeutics (Nunap Vision [NV]) for treating poststroke VFDs.

METHODS

Stroke outpatients with VFDs (>6 months after stroke onset) were randomized into NV (defective field training) or Nunap Vision-Control (NV-C, central field training) groups. Both interventions provided visual perceptual training, consisting of orientation, rotation, and depth discrimination, through a virtual reality head-mounted display device 5 days a week for 12 weeks. The two groups received VFD assessments using Humphrey visual field (HVF) tests at baseline and 12-week follow-up. The final analysis included those completed the study (NV, n = 40; NV-C, n = 35). Efficacy measures included improved visual area (sensitivity ≥6 dB) and changes in the HVF scores during the 12-week period.

RESULTS

With a high compliance rate, NV and NV-C training improved the visual areas in the defective hemifield (>72 degrees2) and the whole field (>108 degrees2), which are clinically meaningful improvements despite no significant between-group differences. According to within-group analyses, mean total deviation scores in the defective hemifield improved after NV training (p = .03) but not after NV-C training (p = .12).

CONCLUSIONS

The current trial suggests that VPL-based digital therapeutics may induce clinically meaningful visual improvements in patients with poststroke VFDs. Yet, between-group differences in therapeutic efficacy were not found as NV-C training exhibited unexpected improvement comparable to NV training, possibly due to learning transfer effects.

Color constancy mechanisms in virtual reality environments

Prior research has demonstrated high levels of color constancy in real-world scenarios featuring single light sources, extensive fields of view, and prolonged adaptation periods. However, exploring the specific cues humans rely on becomes challenging, if not unfeasible, with actual objects and lighting conditions. To circumvent these obstacles, we employed virtual reality technology to craft immersive, realistic settings that can be manipulated in real time. We designed forest and office scenes illuminated by five colors. Participants selected a test object most resembling a previously shown achromatic reference. To study color constancy mechanisms, we modified scenes to neutralize three contributors: local surround (placing a uniform-colored leaf under test objects), maximum flux (keeping the brightest object constant), and spatial mean (maintaining a neutral average light reflectance), employing two methods for the latter: changing object reflectances or introducing new elements. We found that color constancy was high in conditions with all cues present, aligning with past research. However, removing individual cues led to varied impacts on constancy. Local surrounds significantly reduced performance, especially under green illumination, showing strong interaction between greenish light and rose-colored contexts. In contrast, the maximum flux mechanism barely affected performance, challenging assumptions used in white balancing algorithms. The spatial mean experiment showed disparate effects: Adding objects slightly impacted performance, while changing reflectances nearly eliminated constancy, suggesting human color constancy relies more on scene interpretation than pixel-based calculations.

Virtual reality headsets for perimetry testing: a systematic review

Standard automated perimetery is considered the gold standard for evaluating a patient's visual field. However, it is costly and requires a fixed testing environment. In response, perimetric devices using virtual reality (VR) headsets have emerged as an alternative way to measure visual fields in patients. This systematic review aims to characterize both novel and established VR headsets in the literature and explore their potential applications within visual field testing. A search was conducted using MEDLINE, Embase, CINAHL, and the Core Collection (Web of Science) for articles published until January 2023. Subject headings and keywords related to virtual reality and visual field were used to identify studies specific to this topic. Records were first screened by title/abstract and then by full text using predefined criteria. Data was extracted accordingly. A total of 2404 records were identified from the databases. After deduplication and the two levels of screening, 64 studies describing 36 VR headset perimetry devices were selected for extraction. These devices encompassed various visual field measurement techniques, including static and kinetic perimetry, with some offering vision rehabilitation capabilities. This review reveals a growing consensus that VR headset perimetry devices perform comparably to, or even better than, standard automated perimetry. They are better tolerated by patients in terms of gaze fixation, more cost-effective, and generally more accessible for patients with limited mobility.

PTVR - A software in Python to make virtual reality experiments easier to build and more reproducible

Researchers increasingly use virtual reality (VR) to perform behavioral experiments, especially in vision science. These experiments are usually programmed directly in so-called game engines that are extremely powerful. However, this process is tricky and time-consuming as it requires solid knowledge of game engines. Consequently, the anticipated prohibitive effort discourages many researchers who want to engage in VR. This paper introduces the Perception Toolbox for Virtual Reality (PTVR) library, allowing visual perception studies in VR to be created using high-level Python script programming. A crucial consequence of using a script is that an experiment can be described by a single, easy-to-read piece of code, thus improving VR studies' transparency, reproducibility, and reusability. We built our library upon a seminal open-source library released in 2018 that we have considerably developed since then. This paper aims to provide a comprehensive overview of the PTVR software for the first time. We introduce the main objects and features of PTVR and some general concepts related to the three-dimensional (3D) world. This new library should dramatically reduce the difficulty of programming experiments in VR and elicit a whole new set of visual perception studies with high ecological validity.

Using virtual reality to induce multi-trial inattentional blindness despite trial-by-trial measures of awareness

Unconscious processing has been widely examined using diverse and well-controlled methodologies. However, the extent to which these findings are relevant to real-life instances of information processing without awareness is limited. Here, we present a novel inattentional blindness (IB) paradigm in virtual reality (VR). In three experiments, we managed to repeatedly induce IB while participants foveally viewed salient stimuli for prolonged durations. The effectiveness of this paradigm demonstrates the close relationship between top-down attention and subjective experience. Thus, this method provides an ecologically valid setup to examine processing without awareness.

The Virtual Navigation Toolbox: Providing tools for virtual navigation experiments

Spatial navigation research in humans increasingly relies on experiments using virtual reality (VR) tools, which allow for the creation of highly flexible, and immersive study environments, that can react to participant interaction in real time. Despite the popularity of VR, tools simplifying the creation and data management of such experiments are rare and often restricted to a specific scope-limiting usability and comparability. To overcome those limitations, we introduce the Virtual Navigation Toolbox (VNT), a collection of interchangeable and independent tools for the development of spatial navigation VR experiments using the popular Unity game engine. The VNT's features are packaged in loosely coupled and reusable modules, facilitating convenient implementation of diverse experimental designs. Here, we depict how the VNT fulfils feature requirements of different VR environments and experiments, guiding through the implementation and execution of a showcase study using the toolbox. The presented showcase study reveals that homing performance in a classic triangle completion task is invariant to translation velocity of the participant's avatar, but highly sensitive to the number of landmarks. The VNT is freely available under a creative commons license, and we invite researchers to contribute, extending and improving tools using the provided repository.

The deep past in the virtual present: developing an interdisciplinary approach towards understanding the psychological foundations of palaeolithic cave art

Virtual Reality (VR) has vast potential for developing systematic, interdisciplinary studies to understand ephemeral behaviours in the archaeological record, such as the emergence and development of visual culture. Upper Palaeolithic cave art forms the most robust record for investigating this and the methods of its production, themes, and temporal and spatial changes have been researched extensively, but without consensus over its functions or meanings. More compelling arguments draw from visual psychology and posit that the immersive, dark conditions of caves elicited particular psychological responses, resulting in the perception-and depiction-of animals on suggestive features of cave walls. Our research developed and piloted a novel VR experiment that allowed participants to perceive 3D models of cave walls, with the Palaeolithic art digitally removed, from El Castillo cave (Cantabria, Spain). Results indicate that modern participants' visual attention corresponded to the same topographic features of cave walls utilised by Palaeolithic artists, and that they perceived such features as resembling animals. Although preliminary, our results support the hypothesis that pareidolia-a product of our cognitive evolution-was a key mechanism in Palaeolithic art making, and demonstrates the potential of interdisciplinary VR research for understanding the evolution of art, and demonstrate the potential efficacy of the methodology.

Individualized Virtual Reality for Increasing Self-Compassion: Evaluation Study

BACKGROUND

Depression and anxiety are common and debilitating mental disorders with severe negative repercussions at both individual and societal levels. Although virtual reality (VR) has emerged as a safe and effective tool for the treatment of anxiety disorders, studies of the therapeutic application of VR to treat depression are more limited.

OBJECTIVE

The purpose of this study was to test whether a novel type of individualized VR (iVR) can be used to improve self-compassion and decrease depressive symptoms and to evaluate the usability and acceptability of this approach, as rated by participants. The iVR system was designed and developed based on the feedback obtained from a previous study, with improved appearance and feel of the avatar and enhanced graphical quality.

METHODS

A total of 36 young adult participants were recruited from a university community social media site. Participants were aware that the study was investigating a treatment for depression but were not recruited based on depression diagnosis. Participants were asked to complete 2 iVR sessions, spaced 2 weeks apart. At baseline and upon completion of each iVR session, participants were asked to complete validated measures of self-compassion and depression. Upon completion of both iVR sessions, additional measures were administered to assess participants' perceptions about the perceived usability and system acceptability of the iVR approach.

RESULTS

Self-compassion was assessed at the beginning of session 1 (preintervention baseline) and at the end of session 1 (postintervention assessment). Owing to COVID-19 constraints, 36% (13/36) of the participants were unable to complete the follow-up iVR session. Self-compassion was assessed again for the remaining 64% (23/36) of the participants at the end of session 2 (postintervention assessment). Within-group analyses revealed that self-compassion was significantly increased at the end of both session 1 (P=.01) and session 2 (P=.03) relative to baseline. There was also a nonsignificant trend for depressive symptoms to be low at the end of session 2 relative to baseline. Both quantitative and qualitative participant data supported the iVR approach as being acceptable and usable.

CONCLUSIONS

Although these data must be treated as preliminary owing to the small sample size and potential selection bias, the data provide encouraging initial evidence that iVR might be a useful tool to enhance self-compassion and reduce depressive symptoms, highlighting the need for randomized controlled trials in the future.

Manipulating free will beliefs using online video games

Research in social psychology and experimental philosophy has investigated lay people's free will beliefs (FWB). Using different approaches (i.e. experimental manipulations and vignette studies), they investigated how FWB relate to other concepts, and whether changing FWB has an impact on downstream processes such as social behavior. However, both approaches have shortcomings. While experimental manipulations used in social psychology suffer from demand effects, vignettes used in experimental philosophy are often highly abstract. Across two pre-registered studies, we developed a new approach by merging them in an online video game setting. Using this novel, experience-based FWB manipulation, we found that decreasing FWB impacted variables such as perceived control and responsibility in both studies. While the experience-based manipulation influenced participants' beliefs in free will within the context of the experience ("Within the context of the scenario, would the agent believe in free will?") in the first study, this manipulation effect did not transfer to participants' general FWB ("Do you believe in free will?") in the second study. Overall, our findings suggest a way forward in studying laypeople's beliefs in free will.

Measurement Accuracy of the HTC VIVE Tracker 3.0 Compared to Vicon System for Generating Valid Positional Feedback in Virtual Reality

For realistic and reliable full-body visualization in virtual reality, the HTC VIVE Tracker could be an alternative to highly complex and cost- and effort-intensive motion capture systems such as Vicon. Due to its lighter weight and smaller dimensions, the latest generation of trackers is proving to be very promising for capturing human movements. The aim of this study was to investigate the accuracy of the HTC VIVE Tracker 3.0 compared to the gold-standard Vicon for different arrangements of the base stations and various velocities during an athletic movement. Therefore, the position data from three trackers attached to the hip, knee and ankle of one sporty participant were recorded while riding a bicycle ergometer at different pedaling frequencies and different base station arrangements. As parameters for the measurement accuracy, the trajectories of the linear motion of the knee and the circular motion of the ankle were compared between VIVE and Vicon by calculating the spatial distance from the raw data at each point in time. Both the pedaling frequency and the arrangement of the base stations significantly affected the measurement accuracy, with the lowest pedaling frequency of 80 rpm and the rectangular arrangement recommended by the manufacturer showing the smallest spatial differences of 10.4 mm ± 4.5 mm at the knee and 11.3 mm ± 5.1 mm at the ankle. As the pedaling frequency increased gradually (120 rpm and 160 rpm), the measurement accuracy of the trackers per step decreased less at the knee (approximately 5 mm) than at the ankle (approximately 10 mm). In conclusion, the measurement accuracy for various athletic skills was high enough to enable the visualization of body limbs or the entire body using inverse kinematics in VR on the one hand and, on the other hand, to provide initial insights into the quality of certain techniques at lower speeds in sports science research. However, the VIVE trackers are not suitable for exact biomechanical analyses.

Cognitive aging at work and in daily life-a narrative review on challenges due to age-related changes in central cognitive functions

Demographic change is leading to an increasing proportion of older employees in the labor market. At the same time, work activities are becoming more and more complex and require a high degree of flexibility, adaptability, and cognitive performance. Cognitive control mechanism, which is subject to age-related changes and is important in numerous everyday and work activities, plays a special role. Executive functions with its core functions updating, shifting, and inhibition comprises cognitive control mechanisms that serve to plan, coordinate, and achieve higher-level goals especially in inexperienced and conflicting actions. In this review, influences of age-related changes in cognitive control are demonstrated with reference to work and real-life activities, in which the selection of an information or response in the presence of competing but task-irrelevant stimuli or responses is particularly required. These activities comprise the understanding of spoken language under difficult listening conditions, dual-task walking, car driving in critical traffic situations, and coping with work interruptions. Mechanisms for compensating age-related limitations in cognitive control and their neurophysiological correlates are discussed with a focus on EEG measures. The examples illustrate how to access influences of age and cognitive control on and in everyday and work activities, focusing on its functional role for the work ability and well-being of older people.

A study on how to improve users' perceived playfulness in and continuance intention with VR technology to paint in virtual natural landscapes

COVID-19 has adversely affected public access to public green spaces. As a means of interacting with nature, parks and green spaces are an important aspect of residents' daily lives. In this study, the focus is on new digital solutions, such as the experience of painting in virtual natural settings through virtual reality technologies. This study examines factors that affect the user's perceived playfulness and continuance intention to paint in a virtual environment. A total of 732 valid samples were collected through a questionnaire survey, and a theoretical model was developed through structural equation model by analyzing attitude, perceived behavioral control, behavioral intention, continuance intention, and perceived playfulness. Results demonstrate that perceived novelty and perceived sustainability increase the positive attitude of users toward VR painting functions, whereas perceived interactivity and aesthetics have no impact on it within VR painting context. As users use VR painting, they are more concerned about time and money than equipment compatibility. This makes resource facilitating conditions a more influential factor for perceived behavior control than technology facilitating conditions.

A multi-scale analysis of basketball throw in virtual reality for tracking perceptual-motor expertise

To benefit from virtual reality (VR) as a complementary tool for training, coaches must determine the proper tools and variables for tracking sports performance. We explored the basketball shooting at several scales (basket-ball, ball-player, and player systems) by monitoring success-rate, and ball and body kinematics. We measured how these scales of analysis allowed tracking players' expertise and perceptual sensitivity to basket distance. Experienced and novice players were instructed to naturally throw and swish an instrumented ball in a stereoscopically rendered virtual basket. We challenged their perceptual-motor systems by manipulating the distance of the virtual basket while keeping the surrounding environment unchanged. The success-rate accounted for the players' shooting adjustments to the manipulation of basket distance and allowed tracking their expertise. Ball kinematics also reflected the manipulation of distance and allowed detecting gender, but did not reflect the players' expertise. Finally, body kinematics variables did not echo players' adjustments to the distance manipulation but reflected their expertise and gender. The results gained at each scale of analysis are discussed with regard to the simulator's construct, biomechanical, and psychological fidelity.

Using Extended Reality to Study the Experience of Presence

Extended reality (XR), encompassing various forms of virtual reality (VR) and augmented reality (AR), has become a powerful experimental tool in consciousness research due to its capability to create holistic and immersive experiences of oneself and surrounding environments through simulation. One hallmark of a successful XR experience is when it elicits a strong sense of presence, which can be thought of as a subjective sense of reality of the self and the world. Although XR research has shed light on many factors that may influence presence (or its absence) in XR environments, there remains much to be discovered about the detailed and diverse phenomenology of presence, and the neurocognitive mechanisms that underlie it. In this chapter, we analyse the concept of presence and relate it to the way in which humans may generate and maintain a stable sense of reality during both natural perception and virtual experiences. We start by reviewing the concept of presence as developed in XR research, covering both factors that may influence presence and potential ways of measuring presence. We then discuss the phenomenological characteristics of presence in human consciousness, drawing on clinical examples where presence is disturbed. Next, we describe two experiments using XR that investigated the effects of sensorimotor contingency and affordances on a specific form of presence related to the sense of objects as really existing in the world, referred to as 'objecthood'. We then go beyond perceptual presence to discuss the concept of 'conviction about reality', which corresponds to people's beliefs about the reality status of their perceptual experiences. We finish by exploring how the novel XR method of 'Substitutional Reality' can allow experimental investigation of these topics, opening new experimental directions for studying presence beyond the 'as-if' experience of fully simulated environments.

Examining the Auditory Selective Attention Switch in a Child-Suited Virtual Reality Classroom Environment

The ability to focus ones attention in different acoustical environments has been thoroughly investigated in the past. However, recent technological advancements have made it possible to perform laboratory experiments in a more realistic manner. In order to investigate close-to-real-life scenarios, a classroom was modeled in virtual reality (VR) and an established paradigm to investigate the auditory selective attention (ASA) switch was translated from an audio-only version into an audiovisual VR setting. The new paradigm was validated with adult participants in a listening experiment, and the results were compared to the previous version. Apart from expected effects such as switching costs and auditory congruency effects, which reflect the robustness of the overall paradigm, a difference in error rates between the audio-only and the VR group was found, suggesting enhanced attention in the new VR setting, which is consistent with recent studies. Overall, the results suggest that the presented VR paradigm can be used and further developed to investigate the voluntary auditory selective attention switch in a close-to-real-life classroom scenario.

The potential of remote XR experimentation: Defining benefits and limitations through expert survey and case study

Experimentation using extended reality (XR) technology is predominantly conducted in-lab with a co-present researcher. Remote XR experiments, without co-present researchers, have been less common, despite the success of remote approaches for non-XR investigations. In order to understand why remote XR experiments are atypical, this article outlines the perceived limitations, as well as potential benefits, of conducting remote XR experiments, through a thematic analysis of responses to a 30-item survey of 46 XR researchers. These are synthesized into five core research questions for the XR community, and concern types of participant, recruitment processes, potential impacts of remote setup and settings, the data-capture affordances of XR hardware and how remote XR experiment development can be optimized to reduce demands on the researcher. It then explores these questions by running two experiments in a fully “encapsulated” remote XR case study, in which the recruitment and experiment processes is distributed and conducted unsupervised. It discusses the design, experiment, and results from this case study in the context of these core questions.

Action-Specific Perception & Performance on a Fitts's Law Task in Virtual Reality: The Role of Haptic Feedback

While user's perception and performance are predominantly examined independently in virtual reality, the Action-Specific Perception (ASP) theory postulates that the performance of an individual on a task modulates this individual's spatial and time perception pertinent to the task's components and procedures. This paper examines the association between performance and perception and the potential effects that tactile feedback modalities could generate. This paper reports a user study (N=24), in which participants performed a standardized Fitts's law target acquisition task by using three feedback modalities: visual, visuo-electrotactile, and visuo-vibrotactile. The users completed 3 Target Sizes × 2 Distances × 3 feedback modalities = 18 trials. The size perception, distance perception, and (movement) time perception were assessed at the end of each trial. Performance-wise, the results showed that electrotactile feedback facilitates a significantly better accuracy compared to vibrotactile and visual feedback, while vibrotactile provided the worst accuracy. Electrotactile and visual feedback enabled a comparable reaction time, while the vibrotactile offered a substantially slower reaction time than visual feedback. Although amongst feedback types the pattern of differences in perceptual aspects were comparable to performance differences, none of them was statistically significant. However, performance indeed modulated perception. Significant action-specific effects on spatial and time perception were detected. Changes in accuracy modulate both size perception and time perception, while changes in movement speed modulate distance perception. Also, the index of difficulty was found to modulate all three perceptual aspects. However, individual differences appear to affect the magnitude of action-specific effects. These outcomes highlighted the importance of haptic feedback on performance, and importantly the significance of action-specific effects on spatial and time perception in VR, which should be considered in future VR studies.

Self-Illusion: A Study on Cognition of Role-Playing in Immersive Virtual Environments

We present the design and results of an experiment investigating the occurrence of self-illusion and its contribution to realistic behavior consistent with a virtual role in virtual environments. Self-illusion is a generalized illusion about one's self in cognition, eliciting a sense of being associated with a role in a virtual world, despite sure knowledge that this role is not the actual self in the real world. We validate and measure self-illusion through an experiment where each participant occupies a non-human perspective and plays a non-human role using this role's behavior patterns. 77 participants were enrolled for the user study according to the priori power analysis. In the mixed-design experiment with different levels of manipulations, we asked the participants to play a cat (a non-human role) within an immersive VE and captured their different kinds of responses, finding that the participants with higher self-illusion can connect themselves to the virtual role more easily. Based on statistical analysis of questionnaires and behavior data, there is some evidence that self-illusion can be considered a novel psychological component of presence because it is dissociated from sense of embodiment (SoE), plausibility illusion (Psi), and place illusion (PI). Moreover, self-illusion has the potential to be an effective evaluation metric for user experience in a virtual reality system for certain applications.

Remote iVR for Nutrition Education: From Design to Evaluation

While different crowdsourcing platforms promote remote data collection, experiments in the immersive Virtual Reality (iVR) research community are predominantly performed in person. The COVID-19 pandemic, however, has forced researchers in different disciplines, including iVR, to seriously consider remote studies. In this paper, we present a remote study using the Immersive Virtual Alimentation and Nutrition (IVAN) application, designed to educate users about food-energy density and portion size control. We report on the results of a remote experiment with 45 users using the IVAN app. In IVAN, users actively construct knowledge about energy density by manipulating virtual food items, and explore the concept of portion size control through hypothesis testing and assembling virtual meals in iVR. To explore the feasibility of conducting remote iVR studies using an interactive health-related application for nutrition education, two conditions were devised (interactive vs. passive). The results demonstrate the feasibility of conducting remote iVR studies using health-related applications. Furthermore, the results also indicate that regardless of level of interactivity learners significantly improved their knowledge about portion size control after using the IVAN (p < 0.0001). Adding interactivity, however, suggests that the perceived learning experience of users could be partially affected. Learners reported significantly higher scores for immediacy of control in the interactive condition compared to those in the passive condition (p < 0.05). This study demonstrates the feasibility of conducting an unsupervised remote iVR experiment using a complex and interactive health-related iVR app.

Effects of Restorative Environment and Presence on Anxiety and Depression Based on Interactive Virtual Reality Scenarios

Anxiety and depression have been growing global mental health problems. The following studies explored the effect of interactive VR scenarios to find a low-cost and high-efficiency solution. Study 1 designed a 2 (anxiety and depression state) × 4 (interactive VR scenarios) experiment, the results of 20 participants showed that the designed scenarios had good restoration and presence, assisting to improve depression mood for people with mild to moderate anxiety and depression. Study 2 further investigated the intervention effects of two environment types (urban and park) and four interactive activities (automatic viewing, free-roaming, fishing, and watering plants in the park environment), based on data from a 10-minute experiment conducted by 195 participants with mild to moderate anxiety and depression. The subjective scales, EEG and EMG, and scenario experience were analyzed and the results showed that: (1) the restorative and present VR scenarios were beneficial in alleviating state anxiety and depression; (2) the restorative environment and presence were significantly and positively related to the reduction of anxiety and depression respectively, moreover, presence mediated the restorative environment on the recovery from anxiety and depression; (3) the environmental settings, the complexity of interaction, human factors, and maturity of VR devices and technology were also key factors that influenced the effects of interactive VR scenario experience and intervention. These studies revealed VR psychological intervention scenarios could be designed with comprehensive factors. Moreover, they might help pave the way for future study in exploring the physiology and psychology mode in virtual and real spaces, enhancing intervention effectiveness.

Review on visualization technology in simulation training system for major natural disasters

Major natural disasters have occurred frequently in the last few years, resulting in increased loss of life and economic damage. Most emergency responders do not have first-hand experience with major natural disasters, and thus, there is an urgent need for pre-disaster training. Due to the scenes unreality of traditional emergency drills, the failure to appeal to the target audience and the novel coronavirus pandemic, people are forced to maintain safe social distancing. Therefore, it is difficult to carry out transregional or transnational emergency drills in many countries under the lockdown. There is an increasing demand for simulation training systems that use virtual reality, augmented reality, and mixed reality visualization technologies to simulate major natural disasters. The simulation training system related to natural disasters provides a new way for popular emergency avoidance science education and emergency rescue personnel to master work responsibilities and improve emergency response capabilities. However, to our knowledge, there is no overview of the simulation training system for major natural disasters. Hence, this paper uncovers the visualization techniques commonly used in simulation training systems, and compares, analyses and summarizes the architecture and functions of the existing simulation training systems for different emergency phases of common natural disasters. In addition, the limitations of the existing simulation training system in practical applications and future development directions are discussed to provide reference for relevant researchers to better understand the modern simulation training system.

Virtual reality cognitive intervention for heart failure: CORE study protocol

Introduction

Heart failure (HF) is a prevalent, serious chronic illness that affects 6.5 million adults in the United States. Among patients with HF, the prevalence of attention impairment is reported to range from 15% to 27%. Although attention is fundamental to human activities including HF self-care, cognitive interventions for patients with HF that target improvement in attention are scarce. The COgnitive intervention to Restore attention using nature Environment (CORE) study aims to test the preliminary efficacy of the newly developed Nature-VR, a virtual reality-based cognitive intervention that is based on the restorative effects of nature. Nature-VR development was guided by Attention Restoration Theory. The target outcomes are attention, HF self-care, and health-related quality of life (HRQoL). Our exploratory aims examine the associations between attention and several putative/established HF biomarkers (eg, oxygen saturation, brain-derived neurotrophic factor, apolipoprotein E, dopamine receptor, and dopamine transporter genes) as well as the effect of Nature-VR on cognitive performance in other domains (ie, global cognition, memory, visuospatial, executive function, and language), cardiac and neurological events, and mortality.

Methods

This single-blinded, two-group randomized-controlled pilot study will enroll 74 participants with HF. The Nature-VR intervention group will view three-dimensional nature pictures using a virtual reality headset for 10 minutes per day, 5 days per week for 4 weeks (a total of 200 minutes). The active comparison group, Urban-VR, will view three-dimensional urban pictures using a virtual reality headset to match the Nature-VR intervention in intervention dose and delivery mode, but not in content. After baseline interviews, four follow-up interviews will be conducted to assess sustained effects of Nature-VR at 4, 8, 26, and 52 weeks.

Discussion

The importance and novelty of this study consists of using a first-of-its kind, immersive virtual reality technology to target attention and in investigating the health outcomes of the Nature-VR cognitive intervention among patients with HF.

Deep-Breathing Biofeedback Trainability in a Virtual-Reality Action Game: A Single-Case Design Study With Police Trainers

It is widely recognized that police performance may be hindered by psychophysiological state changes during acute stress. To address the need for awareness and control of these physiological changes, police academies in many countries have implemented Heart-Rate Variability (HRV) biofeedback training. Despite these trainings now being widely delivered in classroom setups, they typically lack the arousing action context needed for successful transfer to the operational field, where officers must apply learned skills, particularly when stress levels rise. The study presented here aimed to address this gap by training physiological control skills in an arousing decision-making context. We developed a Virtual-Reality (VR) breathing-based biofeedback training in which police officers perform deep and slow diaphragmatic breathing in an engaging game-like action context. This VR game consisted of a selective shoot/don’t shoot game designed to assess response inhibition, an impaired capacity in high arousal situations. Biofeedback was provided based on adherence to a slow breathing pace: the slower and deeper the breathing, the less constrained peripheral vision became, facilitating accurate responses to the in-game demands. A total of nine male police trainers completed 10 sessions over a 4-week period as part of a single-case experimental ABAB study-design (i.e., alternating sessions with and without biofeedback). Results showed that eight out of nine participants showed improved breathing control in action, with a positive effect on breathing-induced low frequency HRV, while also improving their in-game behavioral performance. Critically, the breathing-based skill learning transferred to subsequent sessions in which biofeedback was not presented. Importantly, all participants remained highly engaged throughout the training. Altogether, our study showed that our VR environment can be used to train breathing regulation in an arousing and active decision-making context.

Influence of body visualization in VR during the execution of motoric tasks in different age groups

Virtual reality (VR) has become a common tool and is often considered for sport-specific purposes. Despite the increased usage, the transfer of VR-adapted skills into the real-world (RW) has not yet been sufficiently studied, and it is still unknown how much of the own body must be visible to complete motoric tasks within VR. In addition, it should be clarified whether older adults also need to perceive their body within VR scenarios to the same extent as younger people extending the usability. Therefore, younger (18-30 years old) and elderly adults (55 years and older) were tested (n = 42) performing a balance-, grasping- and throwing task in VR (HMD based) accompanied with different body visualization types in VR and in the RW having the regular visual input of body's components. Comparing the performances between the age groups, the time for completion, the number of steps (balance task), the subjective estimation of difficulty, the number of errors, and a rating system revealing movements' quality were considered as examined parameters. A one-way ANOVA/Friedmann with repeated measurements with factor [body visualization] was conducted to test the influence of varying body visualizations during task completion. Comparisons between the conditions [RW, VR] were performed using the t-Tests/Wilcoxon tests, and to compare both age groups [young, old], t-Tests for independent samples/Mann-Whitney-U-Test were used. The analyses of the effect of body visualization on performances showed a significant loss in movement's quality when no body part was visualized (p < .05). This did not occur for the elderly adults, for which no influence of the body visualization on their performance could be proven. Comparing both age groups, the elderly adults performed significantly worse than the young age group in both conditions (p < .05). In VR, both groups showed longer times for completion, a higher rating of tasks' difficulty in the balance and throwing task, and less performance quality in the grasping task. Overall, the results suggest using VR for the elderly with caution to the task demands, and the visualization of the body seemed less crucial for generating task completion. In summary, the actual task demands in VR could be successfully performed by elderly adults, even once one has to reckon with losses within movement's quality. Although more different movements should be tested, basic elements are also realizable for elderly adults expanding possible areas of VR applications.

The usefulness of virtual, augmented, and mixed reality technologies in the diagnosis and treatment of attention deficit hyperactivity disorder in children: an overview of relevant studies

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by attention problems, excessive physical activity, and impulsivity. ADHD affects not only the patients but also their families. The development and use of technologies such as virtual reality (VR), augmented reality (AR), and mixed reality (MR) for ADHD has increased over recent years. However, little is known about their potential usefulness. This overview aimed to clarify the current knowledge about the use of these three innovative technologies for the diagnosis and treatment of children with ADHD.

METHODS

This overview was conducted using the PubMed, Web of Science, and Scopus databases until January 24th, 2021. The following descriptive information was compiled from the identified studies: country, year of publication, sample size, study design, ADHD diagnosis methods, applied technology, hardware equipment, clinical target, and main findings.

RESULTS

The initial database searches yielded 409 articles, but 103 were removed as duplicates. Eventually, 30 eligible studies remained for analysis, the majority of which were case-control (n = 22, 73%). Regarding the applied technology/hardware equipment, VR (n = 27; 90%), head-mounted displays (n = 19, 63%), VR-based continuous performance tests (VR-CPT) (n = 21, 70%) were most frequently used. Most studies (n = 21, 70%) used the DSM criteria for the diagnosis of childhood ADHD. They primarily evaluated the utility of these technologies in assessing ADHD symptoms (n = 10, 33%) and improving the ADHD diagnostic process (n = 7, 23%).

CONCLUSION

This comprehensive overview evaluated the studies on the use of VR, AR, and MR technologies for children with ADHD. These technologies seem to be promising tools for improving the diagnosis and management of ADHD in this population.

Body Orientation Affects the Perceived Size of Objects

Here, we investigate how body orientation relative to gravity affects the perceived size of visual targets. When in virtual reality, participants judged the size of a visual target projected at simulated distances of between 2 and 10 m and compared it to a physical reference length held in their hands while they were standing or lying prone or supine. Participants needed to make the visual size of the target 5.4% larger when supine and 10.1% larger when prone, compared to when they were in an upright position to perceive that it matched the physical reference length. Needing to make the target larger when lying compared to when standing suggests some not mutually exclusive possibilities. It may be that while tilted participants perceived the targets as smaller than when they were upright. It may be that participants perceived the targets as being closer while tilted compared to when upright. It may also be that participants perceived the physical reference length as longer while tilted. Misperceiving objects as larger and/or closer when lying may provide a survival benefit while in such a vulnerable position.

Impaired remapping of social relationships in older adults

Social relationships are a central aspect of our everyday life, yet our ability to change established social relationships is an under-investigated topic. Here, we use the concept of cognitive mapping to investigate the plasticity of social relationships in younger and older adults. We describe social relationships within a 'social space', defined as a two-dimensional grid composed of the axis 'power' and 'affiliation', and investigate it using a 3D virtual environment with interacting avatars. We show that participants remap dimensions in 'social space' when avatars show conflicting behavior compared to consistent behavior and that, while older adults show similar updating behavior than younger adults, they show a distinct reduction in remapping social space. Our data provide first evidence that older adults show more rigid social behavior when avatars change their behavior in the dimensions of power and affiliation, which may explain age-related social behavior differences in everyday life.

Colour Calibration of a Head Mounted Display for Colour Vision Research Using Virtual Reality

Virtual reality (VR) technology offers vision researchers the opportunity to conduct immersive studies in simulated real-world scenes. However, an accurate colour calibration of the VR head mounted display (HMD), both in terms of luminance and chromaticity, is required to precisely control the presented stimuli. Such a calibration presents significant new challenges, for example, due to the large field of view of the HMD, or the software implementation used for scene rendering, which might alter the colour appearance of objects. Here, we propose a framework for calibrating an HMD using an imaging colorimeter, the I29 (Radiant Vision Systems, Redmond, WA, USA). We examine two scenarios, both with and without using a rendering software for visualisation. In addition, we present a colour constancy experiment design for VR through a gaming engine software, Unreal Engine 4. The colours of the objects of study are chosen according to the previously defined calibration. Results show a high-colour constancy performance among participants, in agreement with recent studies performed on real-world scenarios. Our studies show that our methodology allows us to control and measure the colours presented in the HMD, effectively enabling the use of VR technology for colour vision research.

Implementation of Virtual Reality to Parent-Child Interaction Therapy for Enhancement of Positive Parenting Skills: Study Protocol for Single-Case Experimental Design with Multiple Baselines (Preprint)

Background

Disruptive behavior is a common reason for young children to be referred to mental health care services worldwide. Research indicates that treatments for child disruptive behavior where parents are the primary agents of change are most impactful. Parent-Child Interaction Therapy (PCIT) is an effective parent management training program currently implemented in therapeutic settings within the Netherlands. Ongoing research into improving the effectiveness of PCIT is being done within these settings. To further promote the key elements of PCIT, this study focuses on creating the opportunity for parents to practice positive parenting skills more outside of the clinical setting by adding virtual reality (VR) as an additional homework element. PCIT has shown to make impactful long-term improvements in parental warmth, responsiveness, and the parent-child relationship. Through VR, parents practice the taught parenting skills out loud in the comfort of their own homes in VR scenarios. We expect that VR addition will innovatively increase the effectiveness of PCIT.

Objective

This study aimed to evaluate the added value of VR to PCIT by using a multiple baseline single-case experimental design (SCED). We expect to find that PCIT-VR will ameliorate positive parenting skills. By implementing the VR element, we secondarily expected that meeting the skill criteria will be achieved sooner, treatment completion rates will increase, and the parent-child relationship will be better, whereas parental stress and child disruptive behavior will decrease.

Methods

A total of 15 children (aged 2-7 years) with disruptive behavior and their parents will be followed throughout the PCIT-VR treatment. Using a multiple baseline SCED with 3 phases, 15 families will fill out questionnaires weekly, in addition to having pre- and posttreatment and follow-up measurements to monitor their positive parenting skills, child disruptive behavior, parenting stress, and VR progress. Moreover, quantitative information and qualitative interviews will be analyzed visually and statistically and summarized to provide a complete picture of experiences.

Results

As of February 2021, 6 families have been enrolled in the study at the moment of submission. Data collection is projected to be completed in 2023. Quantitative and qualitative results are planned to be published in peer-reviewed journals, as well as being presented at national and international conferences.

Conclusions

The SCED—with its phased design, randomization, and the opportunity to replicate and assess both individual and group treatment effects—and adaptability of the VR technology are the strengths of the study. The risks of increased type I errors, maturation effects, or technological failure will be mitigated with the right statistical support. This study aims to magnify the scope of the treatment through additional skill training, ultimately in support of routinely implementing VR within PCIT.

International Registered Report Identifier (IRRID)

DERR1-10.2196/34120

Similarity of gaze patterns across physical and virtual versions of an installation artwork

An experiment was conducted to compare museum visitors' gaze patterns using mobile eye-trackers, whilst they were engaging with a physical and a virtual reality (VR) installation of Piet Mondrian's Neo-plasticist room design. Visitors' eye movements produced approximately 25,000 fixations and were analysed using linear mixed-effects models. Absolute and area-normalized dwell time analyses yielded mostly non-significant main effects of the environment, indicating similarity of visual exploration patterns between physical and VR settings. One major difference observed was the decrease of average fixation duration in VR, where visitors tended to more rapidly switch focus in this environment with shorter bursts of attentional focus. The experiment demonstrated the ability to compare gaze data between physical and virtual environments as a proxy to measure the similarity of aesthetic experience. Similarity of viewing patterns along with questionnaire results suggested that virtual galleries can be treated as ecologically valid environments that are parallel to physical art galleries.

Spatial Learning in a Virtual Environment: The Role of Self-Efficacy Feedback and Individual Visuospatial Factors

We examined the roles self-efficacy plays in environmental learning in terms of self-efficacy feedback and task-specific (navigation-based) self-efficacy. We manipulated self-efficacy using positive and neutral feedback to investigate the relationship between receiving positive feedback and environmental learning performance and subsequent recall. A total of 231 participants were administered visuospatial tasks, where 117 received positive feedback, and 114 received neutral feedback. Then, we tested environmental learning using route retracing, pointing, and map-completion tasks. Before each environmental task, participants evaluated their task-specific self-efficacy. A series of spatial self-reported preferences were gathered as well. Mediation models showed that receiving positive feedback after a visuospatial task influences environmental recall performance through the mediation of task-specific self-efficacy. Moreover, after accounting for experimental manipulation and gender, we found that task-specific self-efficacy, sense of direction, and visuospatial abilities influence spatial-recall task performance, even with some differences as a function of the specific recall tasks considered. Overall, our findings suggest that among individual characteristics, task-specific self-efficacy can sustain environmental learning. Furthermore, giving positive feedback can improve spatial self-efficacy before conducting spatial-recall tasks.

Avatars with faces of real people: A construction method for scientific experiments in virtual reality

Experimental psychology research typically employs methods that greatly simplify the real-world conditions within which cognition occurs. This approach has been successful for isolating cognitive processes, but cannot adequately capture how perception operates in complex environments. In turn, real-world environments rarely afford the access and control required for rigorous scientific experimentation. In recent years, technology has advanced to provide a solution to these problems, through the development of affordable high-capability virtual reality (VR) equipment. The application of VR is now increasing rapidly in psychology, but the realism of its avatars, and the extent to which they visually represent real people, is captured poorly in current VR experiments. Here, we demonstrate a user-friendly method for creating photo-realistic avatars of real people and provide a series of studies to demonstrate their psychological characteristics. We show that avatar faces of familiar people are recognised with high accuracy (Study 1), replicate the familiarity advantage typically observed in real-world face matching (Study 2), and show that these avatars produce a similarity-space that corresponds closely with real photographs of the same faces (Study 3). These studies open the way to conducting psychological experiments on visual perception and social cognition with increased realism in VR.

Accuracy and precision of visual and auditory stimulus presentation in virtual reality in Python 2 and 3 environments for human behavior research

Virtual reality (VR) is a new methodology for behavioral studies. In such studies, the millisecond accuracy and precision of stimulus presentation are critical for data replicability. Recently, Python, which is a widely used programming language for scientific research, has contributed to reliable accuracy and precision in experimental control. However, little is known about whether modern VR environments have millisecond accuracy and precision for stimulus presentation, since most standard methods in laboratory studies are not optimized for VR environments. The purpose of this study was to systematically evaluate the accuracy and precision of visual and auditory stimuli generated in modern VR head-mounted displays (HMDs) from HTC and Oculus using Python 2 and 3. We used the newest Python tools for VR and Black Box Toolkit to measure the actual time lag and jitter. The results showed that there was an 18-ms time lag for visual stimulus in both HMDs. For the auditory stimulus, the time lag varied between 40 and 60 ms, depending on the HMD. The jitters of those time lags were 1 ms for visual stimulus and 4 ms for auditory stimulus, which are sufficiently low for general experiments. These time lags were robustly equal, even when auditory and visual stimuli were presented simultaneously. Interestingly, all results were perfectly consistent in both Python 2 and 3 environments. Thus, the present study will help establish a more reliable stimulus control for psychological and neuroscientific research controlled by Python environments.

Immersion, presence, and episodic memory in virtual reality environments

Although virtual reality (VR) represents a promising tool for psychological research, much remains unknown about how properties of VR environments affect episodic memory. Two closely related characteristics of VR are immersion (i.e., the objective degree to which VR naturalistically portrays a real-world environment) and presence (i.e., the subjective sense of being "mentally transported" to the virtual world). Although some research has demonstrated benefits of increased immersion on VR-based learning, it is uncertain how broadly and consistently this benefit extends to individual components of immersion. Moreover, it is unclear whether presence may mediate the effect of immersion on memory. Three experiments assessed how presence and memory were affected by three manipulations of immersion: field of view, unimodal (visual only) vs. bimodal (audiovisual) environments, and the realism of lighting effects (e.g., the occurrence or absence of shadows). Results indicated that effects of different manipulations of immersion are heterogeneous, affecting memory in some instances and presence in others, but not necessarily both. Importantly, no evidence for a mediating effect of presence emerged in any of these experiments, nor in a combined cross-experimental analysis. This outcome demonstrates a degree of independence between immersion and presence with regard to their influence on episodic memory performance.

Multisensory Integration as per Technological Advances: A Review

Multisensory integration research has allowed us to better understand how humans integrate sensory information to produce a unitary experience of the external world. However, this field is often challenged by the limited ability to deliver and control sensory stimuli, especially when going beyond audio-visual events and outside laboratory settings. In this review, we examine the scope and challenges of new technology in the study of multisensory integration in a world that is increasingly characterized as a fusion of physical and digital/virtual events. We discuss multisensory integration research through the lens of novel multisensory technologies and, thus, bring research in human-computer interaction, experimental psychology, and neuroscience closer together. Today, for instance, displays have become volumetric so that visual content is no longer limited to 2D screens, new haptic devices enable tactile stimulation without physical contact, olfactory interfaces provide users with smells precisely synchronized with events in virtual environments, and novel gustatory interfaces enable taste perception through levitating stimuli. These technological advances offer new ways to control and deliver sensory stimulation for multisensory integration research beyond traditional laboratory settings and open up new experimentations in naturally occurring events in everyday life experiences. Our review then summarizes these multisensory technologies and discusses initial insights to introduce a bridge between the disciplines in order to advance the study of multisensory integration.

Looking Back From the Future: Perspective Taking in Virtual Reality Increases Future Self-Continuity

In the current study, we tested a novel perspective-taking exercise aimed at increasing the connection participants felt toward their future self, i.e., future self-continuity. Participants role-played as their successful future self and answered questions about what it feels like to become their future and the path to get there. The exercise was also conducted in a virtual reality environment and in vivo to investigate the possible added value of the virtual environment with respect to improved focus, perspective-taking, and effectiveness for participants with less imagination. Results show that the perspective taking exercise in virtual reality substantially increased all four domains of future self-continuity, i.e., connectedness, similarity, vividness, and liking, while the in vivo equivalent increased only liking and vividness. Although connectedness and similarity were directionally, but not significantly different between the virtual and in vivo environments, neither the focus, perspective taking, or individual differences in imagination could explain this difference—which suggests a small, but non-significant, placebo effect of the virtual reality environment. However, lower baseline vividness in the in vivo group may explain this difference and suggests preliminary evidence for the dependency of connectedness and similarity domains upon baseline vividness. These findings show that the perspective taking exercise in a VR environment can reliably increase the future self-continuity domains.

Considerations and practical protocols for using virtual reality in psychological research and practice, as evidenced through exposure-based therapy

Everyday client stressors are often challenging to replicate in clinical and research environments, which hinders the ability to reliably reproduce clinical outcomes. To overcome this obstacle, tools that can bridge the inherent disconnect between these settings and the real-world experiences of clients are urgently needed. Virtual reality (VR) promises to provide immersive experiences within controlled laboratory or clinical settings. While the potential opportunities and challenges of VR applications have been scientifically reviewed, clinical adoptions into psychology are hampered by a paucity of practical and methodological publications. This paper intends to address that gap, by providing a four-step process for decision-making considerations, including practical recommendations and an applied case study of developing an exposure-based system for obsessive-compulsive disorder. We provide a framework to make VR accessible for clinician-researchers to create similar systems that realise the promise while encouraging ongoing scientific rigour.

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

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.

Multi-modal responses to the Virtual Reality Trier Social Stress Test: A comparison with standard interpersonal and control conditions

The Trier Social Stress Test (TSST) is a reliable social-evaluative stressor. To overcome limitations of the in vivo TSST, a standardized virtual reality TSST (VR-TSST) was developed. The present study compares the emotional (anxiety) and physiological (heart period and variability) response to a VR-TSST with an in vivo TSST and a control condition. Participants took part in either an in vivo TSST (N = 106, 64% female), VR-TSST (N = 52, 100% female), or a control TSST (N = 20, 40% female). Mixed linear modeling examined response profile differences related to TSST type. While there was an equivalent anxiety response to the in vivo TSST as the VR-TSST, we found a smaller heart period and heart rate variability response in VR-TSST compared to the in vivo TSST, especially in response to the math part of the test. The present findings demonstrate that social evaluative stress can be successfully induced in a VR setting, producing similar emotional and slightly attenuated cardiovascular responses.

Spatial orientation in virtual environment compared to real-world

Virtual reality (VR) is popular across many disciplines and has been increasingly used in sports as a training tool lately. However, it is not clear whether the spatial orientation of humans works equally within VR and in the real-world. In this paper, two studies are presented, in which natural body movements were allowed and demanded. Firstly, a series of verbal and walking distance estimation tests were conducted in both the virtual and the real environment. The non-parametric Friedman test with pairwise comparisons showed no significant differences neither in verbal nor in walking distance estimations between the conditions (all p > 0.05). However, shorter distances (0.9-1.5 m) were estimated more precisely than larger distances (2.6-2.8 m) in both environments. Secondly, a self-developed route recall test to examine the spatial orientation was performed in the virtual and the real environment. The participants visually perceived the predefined route and were instructed to follow these routes with their eyes blindfolded and afterward to return to their starting position. Between the ending and the starting position, no difference between the two environments was observed (p > 0.05). Based on these two studies, the performance of the human spatial orientation preliminarily verified the same in a virtual and real environment.

Eyewitness identifications after witnessing threatening and non-threatening scenes in 360-degree virtual reality (or 2D) from first and third person perspectives

In eyewitness research the frequent use of video playback presented on a computer screen (i.e., 2D videos) in laboratory-based research is problematic due to the low realism of this method when presenting, for example, threatening (and non-threatening) first-person (and third-person) scenarios. However, in contrast to 2D videos, 360-degree videos presented in virtual reality (VR) presents the opportunity of achieving more realistic and immersive scenarios that might be better suited to mimic real-life incidents, as for example, in the case of a threatening first-person robbery. In the present study, we asked 37 participants to watch eight pre-recorded threatening or non-threatening 2D and VR videos, viewed from either a first- or third-person perspective. After each video, participants assessed the observed target’s appearance and were then presented with either a target present (TP) or target absent (TA) six-person photograph line-up. We expected that VR would result in higher degrees of accuracy in both TP and TA line-ups compared with 2D and that the differences between manipulations would be more pronounced within VR compared with 2D. We found that TP (but not TA) accuracy was higher in 2D compared with VR videos (91 vs. 66%), that there was no main effect of perspective, and that threatening scenes increased TP (but not TA) accuracy compared to non-threatening scenes (86 vs. 70%). Furthermore, in VR (but not in 2D), threatening scenes increased TP (but not TA) accuracy compared with non-threatening scenes (85 vs. 40%). The results go against the expected increased accuracy in VR (vs. 2D) videos but support the notion that threatening (vs. non-threatening) scenes can increase identification accuracy in VR but not necessarily in 2D.

Virtual Reality Potentiates Emotion and Task Effects of Alpha/Beta Brain Oscillations

The progress of technology has increased research on neuropsychological emotion and attention with virtual reality (VR). However, direct comparisons between conventional two-dimensional (2D) and VR stimulations are lacking. Thus, the present study compared electroencephalography (EEG) correlates of explicit task and implicit emotional attention between 2D and VR stimulation. Participants (n = 16) viewed angry and neutral faces with equal size and distance in both 2D and VR, while they were asked to count one of the two facial expressions. For the main effects of emotion (angry vs. neutral) and task (target vs. nontarget), established event related potentials (ERP), namely the late positive potential (LPP) and the target P300, were replicated. VR stimulation compared to 2D led to overall bigger ERPs but did not interact with emotion or task effects. In the frequency domain, alpha/beta-activity was larger in VR compared to 2D stimulation already in the baseline period. Of note, while alpha/beta event related desynchronization (ERD) for emotion and task conditions were seen in both VR and 2D stimulation, these effects were significantly stronger in VR than in 2D. These results suggest that enhanced immersion with the stimulus materials enabled by VR technology can potentiate induced brain oscillation effects to implicit emotion and explicit task effects.

Virtual Reality as Distraction Analgesia for Office-Based Procedures: A Randomized Crossover-Controlled Trial

OBJECTIVE

The purpose of this study was to explore the use of immersive and interactive virtual reality (VR) for analgesia, anxiety reduction, and overall satisfaction in patients undergoing outpatient postoperative debridements.

STUDY DESIGN

Randomized crossover-controlled trial.

SETTING

Academic outpatient clinic.

SUBJECTS AND METHODS

Adult patients who had functional endoscopic sinus surgery and skull base surgery and were undergoing office-based postoperative nasal endoscopy and debridement were recruited and followed for 2 consecutive office visits. Participants were randomized to receive either the control or experimental analgesia for the first postoperative visit (PO1) and crossed over into the opposite treatment arm during the second postoperative visit (PO2). Outcomes included procedural pain, anxiety and satisfaction scores, procedural time, and reflexive head movements per minute (RHM).

RESULTS

Eighty-two participants were recruited. At PO1, 39 received standard analgesia, and 43 received an immersive VR experience. At PO1, the VR group experienced significantly less anxiety (P = .043) and fewer RHM (P = .00016) than the control group. At PO2, the VR group experienced significantly fewer RHM (P = .0002). At PO2, patients who received the experimental treatment after initially receiving the control treatment had significantly decreased pain, anxiety, and RHM. This effect was not seen in the second group. Overall, 69.51% of patients felt that the VR treatment was better; 19.51% thought that it was the same; and 9.76% found it to be worse.

CONCLUSION

VR technology holds promise as a nonpharmacologic analgesic and anxiolytic intervention for otolaryngology office-based procedures. Further study of VR use in other procedures is warranted.

LEVEL OF EVIDENCE

1, randomized controlled trial.

Physical exploration of a virtual reality environment: Effects on spatiotemporal associative recognition of episodic memory

Associative memory has been increasingly investigated in immersive virtual reality (VR) environments, but conditions that enable physical exploration remain heavily under-investigated. To address this issue, we designed two museum rooms in VR throughout which participants could physically walk (i.e., high immersive and interactive fidelity). Participants were instructed to memorize all room details, which each contained nine paintings and two stone sculptures. On a subsequent old/new recognition task, we examined to what extent shared associated context (i.e., spatial boundaries, ordinal proximity) and physically travelled distance between paintings facilitated recognition of paintings from the museum rooms. Participants more often correctly recognized a sequentially probed old painting when the directly preceding painting was encoded within the same room or in a proximal position, relative to those encoded across rooms or in a distal position. A novel finding was that sequentially probed paintings from the same room were also recognized better when the physically travelled spatial or temporal distance between the probed paintings was shorter, as compared with longer distances. Taken together, our results in highly immersive VR support the notion that spatiotemporal context facilitates recognition of associated event content.

The Trade-Off of Virtual Reality Training for Dart Throwing: A Facilitation of Perceptual-Motor Learning With a Detriment to Performance

Advancements in virtual reality (VR) technology now allow for the creation of highly immersive virtual environments and for systems to be commercially available at an affordable price. Despite increased availability, this access does not ensure that VR is appropriate for training for all motor skills. Before the implementation of VR for training sport-related skills takes place, it must first be established whether VR utilization is appropriate. To this end, it is crucial to better understand the mechanisms that drive learning in these new environments which will allow for optimization of VR to best facilitate transfer of learned skills to the real world. In this study we sought to examine how a skill acquired in VR compares to one acquired in the real world (RW), utilizing training to complete a dart-throwing task in either a virtual or real environment. We adopted a perceptual-motor approach in this study, employing measures of task performance (i.e., accuracy), as well as of perception (i.e., visual symptoms and oculomotor behavior) and motor behaviors (i.e., throwing kinematics and coordination). Critically, the VR-trained group performed significantly worse in terms of throwing accuracy compared to both the RW-trained group and their own baseline performance. In terms of perception, the VR-trained group reported greater acute visual symptoms compared to the RW-trained group, though oculomotor behaviors were largely the same across groups. In terms of motor behaviors, the VR-trained group exhibited different dart-throwing kinematics during training, but in the follow-up test adapted their throwing pattern to one similar to the RW-trained group. In total, VR training impaired real-world task performance, suggesting that virtual environments may offer different learning constraints compared to the real world. These results thus emphasize the need to better understand how some elements of virtual learning environments detract from transfer of an acquired sport skill to the real world. Additional work is warranted to further understand how perceptual-motor behaviors are acquired differently in virtual spaces.

Exploring Visual Perceptions of Spatial Information for Wayfinding in Virtual Reality Environments

Human cognitive processes in wayfinding may differ depending on the time taken to accept visual information in environments. This study investigated users’ wayfinding processes using eye-tracking experiments, simulating a complex cultural space to analyze human visual movements in the perception and the cognitive processes through visual perception responses. The experiment set-up consisted of several paths in COEX Mall, Seoul—from the entrance of the shopping mall Starfield to the Star Hall Library to the COEX Exhibition Hall—using visual stimuli created by virtual reality (four stimuli and a total of 60 seconds stimulation time). The participants in the environment were 24 undergraduate or graduate students, with an average age of 24.8 years. Participants’ visual perception processes were analyzed in terms of the clarity and the recognition of spatial information and the activation of gaze fixation on spatial information. That is, the analysis of the visual perception process was performed by extracting “conscious gaze perspective” data comprising more than 50 consecutive 200 ms continuous gaze fixations; “visual understanding perspective” data were also extracted for more than 300 ms of continuous gaze fixation. The results show that the methods for analyzing the gaze data may vary in terms of processing, analysis, and scope of the data depending on the purpose of the virtual reality experiments. Further, they demonstrate the importance of what purpose statements are given to the subject during the experiment and the possibility of a technical approach being used for the interpretation of spatial information.

Using Virtual Reality to Assess Landscape: A Comparative Study Between On-Site Survey and Virtual Reality of Aesthetic Preference and Landscape Cognition

In recent years, research on landscape perception has been generally overoptimistic about the use of virtual reality (VR); however, few have questioned the validity of VR. It is necessary to examine whether on-site stimulation can be substituted by VR. The purpose of this study was to assess the degree of agreement between on-site survey and VR for landscape perception. The sample included 11 representative landscapes from Tsuchiura city and Tsukuba city, Japan. On-site survey data was collected for 17 items related to aesthetic preference and landscape cognition. The same scenes were produced by VR and same survey data as on-site was collected. The agreement of both the overall mean of all landscapes and the ratings of all individuals in each landscape confirmed the high level of concordance of most cognitive attributes between the two stimuli. The findings support immersive VR as a reliable tool for assessing landscape cognition.