Virtual Viewing Time: The Relationship between Presence and Sexual Interest in Androphilic and Gynephilic Men

A review of published studies on virtual reality in sexuality research

INTRODUCTION

Virtual reality (VR) technology contributes to greater approach of methodological safety to make ecological validity more feasible and a growing interest in sexuality behaviors.

OBJECTIVES

The aim of this study was to show VR in the sexuality area by a comprehensive review of outcomes, offer a synthesis of the studies, and make a methodological quality assessment of finding results. A secondary goal was to investigate the effect of immersion on diverse sexual responses outcomes.

METHODS

We designed a review based on a systematic review strategy describing types of studies, participants, data collection and outcomes; searched in 4 electronic databases (PubMed, EMBASE, PsycINFO, and SciELO), and made a full-text screening process.

RESULTS

The study found 18 articles that met research criteria synthesized within 3 outcome groups: erection measures, level of immersion, and biomarker studies. Synthesis shows a lack of methodological aspects that impair results, such as description of methods from bias protection, randomization, or concealment. The literature still needs to improve its methodology, even though it already shows relevant data for intervention in sexual dysfunction, forensic psychiatry, sexual attraction, orientation, and use of pornography.

CONCLUSION

Current methodological issues need better design to highlight relevant issues in sexuality with stronger quality of design, opening boundaries to new diagnostic or interventional technologies to sexual health.

What can the eyes tell us about atypical sexual preferences as a function of sex and age? Linking eye movements with child-related chronophilias

Visual attention plays a central role in current theories of sexual information processing and is key to informing the use of eye-tracking techniques in the study of typical sexual preferences and more recently, in the study of atypical preferences such as pedophilia (prepubescent children) and hebephilia (pubescent children). The aim of this theoretical-empirical review is to connect the concepts of a visual attention-based model of sexual arousal processing with eye movements as indicators of atypical sexual interests, to substantiate the use of eye-tracking as a useful indirect measure of sexual preferences according to sex and age of the stimuli. Implications for research are discussed in terms of recognizing the value, scope and limitations of eye-tracking in the study of pedophilia and other chronophilias in males and females, and the generation of new hypotheses using this type of indirect measure of human sexual response.

Experiencing an art education program through immersive virtual reality or iPad: Examining the mediating effects of sense of presence and extraneous cognitive load on enjoyment, attention, and retention

Sense of presence and extraneous cognitive load (ECL) are the two psychological effects widely employed to explain the cognitive outcomes caused by high-immersive media (e. g., virtual reality). This study identified the concepts of both technological affordance (i.e., immersion) and the psychological effects of VR learning. It investigated the mechanism by which immersion leads to better or worse communication in the context of art education. We operationalized the concept of immersion into two levels: a high-immersive VR system (HTC VIVE Cosmos) and a low-immersive tablet system (iPad). Through a between-subject experiment, we found that higher immersion not only led to a greater sense of presence but also lowered extraneous cognitive load. Enjoyment and attention increased as a sense of presence rose but were not necessarily predicted by extraneous cognitive load. This study found that sense of presence was a more robust explanatory variable than ECL and that cognitive load could be lower in a high-immersive environment with content specifically designed for VR.

Multimodal Behavioral Cues Analysis of the Sense of Presence and Social Presence During a Social Interaction With a Virtual Patient

User's experience evaluation is a key challenge when studying human-agent interaction. Besides user's satisfaction, this question is addressed in virtual reality through the sense of presence and social presence, generally assessed thanks to subjective post-experience questionnaires. We propose in this article a novel approach making it possible to evaluate automatically these notions by correlating objective multimodal cues produced by users to their subjective sense of presence and social presence. This study is based on a multimodal human-agent interaction corpus collected in a task-oriented context: a virtual environment aiming at training doctors to break bad news to a patient played by a virtual agent. Based on a corpus study, we applied machine learning approaches to build a model predicting the user's sense of presence and social presence thanks to specific multimodal behavioral cues. We explore different classification algorithms and machine learning techniques (oversampling and clustering) to cope with the dimensionality of the dataset and to optimize the prediction performance. We obtain models to automatically and accurately predict the level of presence and social presence. The results highlight the relevance of a multimodal model, based both on verbal and non-verbal cues as objective measures of (social) presence. The main contribution of the article is two-fold: 1/ proposing the first presence and social prediction presence models offering a way to automatically provide a user's experience evaluation and 2/ showing the importance of multimodal information for describing these notions.

Flirting With or Through Media: How the Communication Partners' Ontological Class and Sexual Priming Affect Heterosexual Males' Interest in Flirtatious Messages and Their Perception of the Source

Because technologies are frequently used for sexual gratification it seems plausible that artificial communication partners, such as voice assistants, could be used to fulfill sexual needs. While the idea of sexualized interaction with voice assistants has been portrayed in movies (e.g., "Her"), there is a lack of empirical research on the effect of the ontological class (human versus artificial) on the voice's potential to evoke interest in a sexualized interaction and its perception in terms of sexual attractiveness. The Sexual Interaction Illusion Model (SIIM), which emphasizes influences on sensations evoked by artificial interaction partners, furthermore suggests that there may be contextual influences, especially sexual arousal, that may be crucial for the question of engaging in a sexualized interaction with an artificial entity. To empirically investigate whether the ontological class of the speaker (computer-mediated human in comparison to voice assistants) and the level of sexual arousal affects the heterosexual males' interest in hearing more flirtatious messages and the perception of the communication partner's sexual attractiveness, an online experiment with between subject design was conducted. Two hundred and fifty seven respondents were confronted with at least four, and voluntarily six messages from either a computer-mediated human or a flirtatious voice assistant, in interaction with being previously primed sexually or neutrally. The results demonstrated that the effect of sexual arousal was not prevailing on the interest in further messages and the attractiveness perception of the interaction partners, while the ontological class did so. Here, the voice assistant evoked more interest in further messages and the technology itself, while the computer mediated human was perceived to be more sexually attractive and flirtatious, and evoked more social presence. The communication partners social presence was shown to be the predictor with most explanatory power for the interaction partners perceived sexual attractiveness, regardless of whether it was human or artificial. The results underline differences between artificial and human interaction partners, but also underline that especially social presence and the feeling that the user is addressed (in terms of flirtatiousness) is crucial in digitalized intimacy regardless of the ontological class.

Virtual Reality Erotica: Exploring General Presence, Sexual Presence, Sexual Arousal, and Sexual Desire in Women

Virtual reality (VR) media using a three-dimensional (3D) camera facilitates an immersive experience compared to traditional two-dimensional (2D) formats. In this novel study, we used high quality, women-centered erotica and examined whether stimulus modality (VR vs. 2D) and point of view (POV: first-person vs. third-person) impacted women's feelings of sexual presence (activation of sexual response induced by the perception of being present), sexual arousal, and sexual desire (dyadic and solitary). We also investigated the effects of stimulus modality on feelings of general presence (a sense of "being there"). Results from 38 women indicated that with medium to large effects, general presence, sexual presence, and sexual arousal were significantly higher for VR videos relative to 2D videos. Sexual presence was higher for first-person POV depending on the order of film exposure. A general trend toward increasing dyadic sexual desire over the course of the study was observed. No significant differences were observed for solitary sexual desire. These findings support the adaptability of VR media to sex research and show that it can induce feelings of sexual presence and presence more generally. That sexual arousal was positively impacted by VR erotica may have implications for addressing the limitations that accompany other stimulus modalities used to elicit sexual responses in women.

Welches Potenzial haben virtuelle Realitäten in der klinischen und forensischen Psychiatrie? Ein Überblick über aktuelle Verfahren und Einsatzmöglichkeiten

Virtuelle Realitäten (VR) werden in der Diagnose und Behandlung von Patienten im klinischen Feld bereits seit 20 Jahren erfolgreich eingesetzt und weiterentwickelt. Seit etwas mehr als 5 Jahren gibt es nun auch erste Beispiele über die Anwendung von VR in psychiatrisch-forensischen Kontexten. Für die forensische Psychiatrie ist die Möglichkeit, realistische, sichere und kontrollierbare Diagnostik- und Lernumgebungen zu schaffen, der ausschlaggebende Vorteil der VR-Technologie. So können z. B. Straftäter in Szenarien behandelt oder begutachtet werden, welche im echten Leben risikoreich, unethisch oder ökologisch invalide wären. In diesem Artikel werden unterschiedliche aktuelle Studienbeispiele zu klinischer Behandlung und Diagnose von Patienten sowie der forensischen Prognose und Therapie von Straftätern vorgestellt. Damit zeigt der Überblick, dass VR mittlerweile auch in der forensischen Psychiatrie ein vielversprechendes Werkzeug sein kann, welches bereits etablierte Instrumente ergänzen oder erweitern kann. Auch in der Ausbildung von forensisch-psychiatrischem Fachpersonal können VR-Anwendungen eine Hilfe sein. Hier gibt es bereits erste vielversprechende Einsätze durch das Training mithilfe von virtuellen Patienten, jedoch benötigt es noch umfangreiche Forschungsarbeit auf diesem Feld, um sie im professionellen Alltag einsetzen zu können. Vor dem Einsatz von VR-Anwendungen sollten sich Forscher und Praktiker neben den Vorteilen auch mit den Nachteilen von VR auseinandersetzen und ein besonderes Augenmerk auf die ethischen Richtlinien werfen, welche in den letzten Jahren dazu erarbeitet wurden. Die stetige Weiterentwicklung und der immer breitere Einsatz von VR im klinischen und forensisch-psychiatrischen Feld zeigen, dass VR auch hier das Potenzial hat, ein etabliertes Forschungs- sowie Therapieinstrument zu werden.

Sexual attraction modulates interpersonal distance and approach-avoidance movements towards virtual agents in males

How does sexual attraction alter social interaction behavior? We examined the influence of sexual orientation on locomotor approach-avoidance behavior and interpersonal distance. We immersed androphilic and gynophilic male subjects into a virtual environment and presented various male and female virtual persons. In the first experiment, subjects took a step forward (approach) or backward (avoidance) in response to the sex of the virtual person. We measured reaction time, peak velocity, and step size, and obtained ratings of sexual attractiveness in every trial. In the second experiment, subjects had to approach the virtual person as if they were to engage in a social interaction. Here, we analyzed interpersonal distance and peak velocity of the approaches. Our results suggest that sexual attraction facilitates the approach response and reduces the preferred interpersonal distance. We discuss our findings in terms of proxemics, current findings in sex research, and the applicability of our novel task in other fields of psychological research.

Questionnaire Measures and Physiological Correlates of Presence: A Systematic Review

The published literature has produced several definitions for the sense of presence in a simulated environment, as well as various methods for measuring it. The variety of conceptualizations makes it difficult for researchers to interpret, compare, and evaluate the presence ratings obtained from individual studies. Presence has been measured by employing questionnaires, physiological indices, behavioral feedbacks, and interviews. A systematic literature review was conducted to provide insight into the definitions and measurements of presence in studies from 2002 to 2019, with a focus on questionnaires and physiological measures. The review showed that scholars had introduced various definitions of presence that often originate from different theoretical standpoints and that this has produced a multitude of different questionnaires that aim to measure presence. At the same time, physiological studies that investigate the physiological correlates of the sense of presence have often shown ambiguous results or have not been replicated. Most of the scholars have preferred the use of questionnaires, with Witmer and Singer's Presence Questionnaire being the most prevalent. Among the physiological measures, electroencephalography was the most frequently used. The conclusions of the present review aim to stimulate future structured efforts to standardize the use of the construct of presence, as well as inspire the replication of the findings reported in the published literature.

The Importance of Systematically Reporting and Reflecting on eHealth Development: Participatory Development Process of a Virtual Reality Application for Forensic Mental Health Care

Background

The use of electronic health (eHealth) technologies in practice often is lower than expected, mostly because there is no optimal fit among a technology, the characteristics of prospective users, and their context. To improve this fit, a thorough systematic development process is recommended. However, more knowledge about suitable development methods is necessary to create a tool kit that guides researchers in choosing development methods that are appropriate for their context and users. In addition, there is a need for reflection on the existing frameworks for eHealth development to be able to constantly improve them.

Objective

The two main objectives of this case study were to present and reflect on the (1) methods used in the development process of a virtual reality application for forensic mental health care and (2) development model that was used: the CeHRes Roadmap (the Centre for eHealth Research Roadmap).

Methods

In the development process, multiple methods were used to operationalize the first 2 phases of the CeHRes Roadmap: the contextual inquiry and value specification. To summarize the most relevant information for the goals of this study, the following information was extracted per method: (1) research goal, (2) explanation of the method used, (3) main results, (4) main conclusions, and (5) lessons learned about the method.

Results

Information on 10 methods used is presented in a structured manner. These 10 methods were stakeholder identification, project team composition, focus groups, literature study, semistructured interviews, idea generation with scenarios, Web-based questionnaire, value specification, idea generation with prototyping, and a second round of interviews. The lessons learned showed that although each method added new insights to the development process, not every method appeared to be the most appropriate for each research goal.

Conclusions

Reflection on the methods used pointed out that brief methods with concrete examples or scenarios fit the forensic psychiatric patients the best, among other things, because of difficulties with abstract reasoning and low motivation to invest much time in participating in research. Formulating clear research questions based on a model’s underlying principles and composing a multidisciplinary project team with prospective end users appeared to be important in this study. The research questions supported the project team in keeping the complex development processes structured and prevented tunnel vision. With regard to the CeHRes Roadmap, continuous stakeholder involvement and formative evaluations were evaluated as strong points. A suggestion to further improve the Roadmap is to explicitly integrate the use of domain-specific theories and models. To create a tool kit with a broad range of methods for eHealth development and further improve development models, studies that report and reflect on development processes in a consistent and structured manner are needed.

Virtual Reality and Sex Therapy: Future Directions for Clinical Research

Rapidly growing new technologies are revolutionizing the field of mental health, in terms of both understanding and treating mental disorders. Among these, virtual reality (VR) is a powerful tool providing clients with new learning experiences benefiting their psychological well-being. This article offers an overview of the current literature on VR in psychotherapy, highlighting its relevance to sexual dysfunction (SD) treatment.A literature review of PubMed and Google Scholar databases was used to provide a description of the theoretical frameworks and clinical indications associated with VR use in psychotherapy and SD treatment. The effectiveness of VR exposure-based therapy has been empirically validated for several mental disorders, notably anxiety disorders. The emerging combined use of VR and mindfulness tends to focus on chronic pain treatment. Experimental research examining the use of immersive technologies in the treatment of SDs is lacking.Given the shortcomings of conventional SD treatments, exploring and developing specialized VR interventions may prove beneficial. VR offers promising avenues in sex therapy, particularly for the treatment of genital pain disorders or SDs in which anxiety plays a significant etiological role.

Identifying the Added Value of Virtual Reality for Treatment in Forensic Mental Health: A Scenario-Based, Qualitative Approach

Background: Although literature and practice underline the potential of virtual reality (VR) for forensic mental healthcare, studies that explore why and in what way VR can be of added value for treatment of forensic psychiatric patients is lacking.

Goals: This study aimed to identify (1) points of improvements in existing forensic mental health treatment of in- and outpatients, (2) possible ways of using VR that can improve current treatment, and (3) positive and negative aspects of the use of VR for the current treatment according to patients and therapists.

Methods: Two scenario-based methods were used. First, semi-structured interviews were conducted with eight therapists and three patients to elicit scenarios from them. Based on these results, six scenarios about possibilities for using VR in treatment were created and presented to 89 therapists and 19 patients in an online questionnaire. The qualitative data from both methods were coded independently by two researchers, using the method of constant comparison.

Results: In the interviews, six main codes with accompanying sub codes emerged. Ideas for improvement of treatment were grouped around the unique characteristics of the forensic setting, characteristics of the complex patient population, and characteristics of the type of treatment. For possibilities of VR, main codes were skills training with interaction, observation of situations or stimuli without interaction, and creating insight for others into the patient. The questionnaire resulted in a broad range of insights into potential positive and negative aspects of VR related to the current treatment, the patient, the content of a VR application, and practical matters.

Conclusion: VR offers a broad range of possibilities for forensic mental health. Examples are offering training of behavioral and cognitive skills in a realistic context to bridge the gap between a therapy room and the real world, increasing treatment motivation, being able to adapt a VR application to individual patients, and providing therapists with new insights into a patient. These findings can be used to ground the development of new VR applications. Nevertheless, we should remain critical of when in the treatment process and for whom VR could be of added value.

Visual Attention Patterns Differ in Gynephilic and Androphilic Men and Women Depending on Age and Gender of Targets

Visual attention patterns measured with eye-tracking techniques provide indirect clues about sexual response. This study aimed to test the category specificity of sexual responses to stimuli varying in gender and age by evaluating both early and late attention of gynephilic and androphilic men and women. We simultaneously presented sexually preferred and nonpreferred stimuli and measured time to first fixation and total duration of fixation on four areas of interest: entire body, then face, chest, and pelvis. Androphilic women's early attention patterns were nonspecific, whereas gynephilic women and both groups of men showed a category-specific pattern for the entire body. In contrast, all groups showed gender-specific patterns of late attention for all areas of interest. We also found support for age specificity of early and late visual attention in all four groups, with greater attention to adult than child stimuli. This study supports the usefulness of a competing stimulus eye-tracking paradigm as a method to examine gender specificity in gynephilic women and androphilic and gynephilic men, and as a measure of age specificity in gynephilic and androphilic men and women.

Behavioral Monitoring of Sexual Offenders Against Children in Virtual Risk Situations: A Feasibility Study

The decision about unsupervised privileges for sexual offenders against children (SOC) is one of the most difficult decisions for practitioners in forensic high-security hospitals. Facing the possible consequences of the decision for the society, a valid and reliable risk management of SOCs is essential. Some risk management approaches provide frameworks for the construction of relevant future risk situations. Due to ethical reasons, it is not possible to evaluate the validity of constructed risk situations in reality. The aim of the study was to test if behavioral monitoring of SOCs in high-immersive virtual risk situations provides additional information for risk management. Six SOCs and seven non-offender controls (NOC) walked through three virtual risk situations, confronting the participant with a virtual child character. The participant had to choose between predefined answers representing approach or avoidance behavior. Frequency of chosen answers were analyzed in regards to knowledge of the participants about coping skills and coping skills focused during therapy. SOCs and NOCs behavior differed only in one risk scenario. Furthermore, SOCs showed in 89% of all cases a behavior not corresponding to their own belief about adequate behavior in comparable risk situations. In 62% of all cases, SOCs behaved not corresponding to coping skills they stated that therapists focused on during therapy. In 50% of all cases, SOCs behaved in correspondence to coping skills therapists stated that they focused on during therapy. Therapists predicted the behavior of SOCs in virtual risk situations incorrect in 25% of all cases. Thus, virtual risk scenarios provide the possibility for practitioners to monitor the behavior of SOCs and to test their decisions on unsupervised privileges without endangering the community. This may provide additional information for therapy progress. Further studies are necessary to evaluate the predictive and ecological validity of behavioral monitoring in virtual risk situations for real life situations.

Feasibility of a walking virtual reality system for rehabilitation: objective and subjective parameters

BACKGROUND

Even though virtual reality (VR) is increasingly used in rehabilitation, the implementation of walking navigation in VR still poses a technological challenge for current motion tracking systems. Different metaphors simulate locomotion without involving real gait kinematics, which can affect presence, orientation, spatial memory and cognition, and even performance. All these factors can dissuade their use in rehabilitation. We hypothesize that a marker-based head tracking solution would allow walking in VR with high sense of presence and without causing sickness. The objectives of this study were to determine the accuracy, the jitter, and the lag of the tracking system and its elicited sickness and presence in comparison of a CAVE system.

METHODS

The accuracy and the jitter around the working area at three different heights and the lag of the head tracking system were analyzed. In addition, 47 healthy subjects completed a search task that involved navigation in the walking VR system and in the CAVE system. Navigation was enabled by natural locomotion in the walking VR system and through a specific device in the CAVE system. An HMD was used as display in the walking VR system. After interacting with each system, subjects rated their sickness in a seven-point scale and their presence in the Slater-Usoh-Steed Questionnaire and a modified version of the Presence Questionnaire.

RESULTS

Better performance was registered at higher heights, where accuracy was less than 0.6 cm and the jitter was about 6 mm. The lag of the system was 120 ms. Participants reported that both systems caused similar low levels of sickness (about 2.4 over 7). However, ratings showed that the walking VR system elicited higher sense of presence than the CAVE system in both the Slater-Usoh-Steed Questionnaire (17.6 ± 0.3 vs 14.6 ± 0.6 over 21, respectively) and the modified Presence Questionnaire (107.4 ± 2.0 vs 93.5 ± 3.2 over 147, respectively).

CONCLUSIONS

The marker-based solution provided accurate, robust, and fast head tracking to allow navigation in the VR system by walking without causing relevant sickness and promoting higher sense of presence than CAVE systems, thus enabling natural walking in full-scale environments, which can enhance the ecological validity of VR-based rehabilitation applications.