Geneviève Robillard

Anxiety and Presence during VR Immersion: A Comparative Study of the Reactions of Phobic and Non-phobic Participants in Therapeutic Virtual Environments Derived from Computer Games

Virtual reality can be used to provide phobic clients with therapeutic exposure to phobogenic stimuli. However, purpose-built therapeutic VR hardware and software can be expensive and difficult to adapt to individual client needs. In this study, inexpensive and readily adaptable PC computer games were used to provide exposure therapy to 13 phobic participants and 13 non-phobic control participants. It was found that anxiety could be induced in phobic participants by exposing them to phobogenic stimuli in therapeutic virtual environments derived from computer games (TVEDG). Assessments were made of the impact of simulator sickness and of sense of presence on the phobogenic effectiveness of TVEDGs. Participants reported low levels of simulator sickness, and the results indicate that simulator sickness had no significant impact on either anxiety or sense of presence. Group differences, correlations, and regression analyses indicate a synergistic relationship between presence and anxiety. These results do not support Slaters contention that presence and emotion are orthogonal.

Anxiety increases the feeling of presence in virtual reality

Given previous studies indicating a significant correlation between anxiety and presence, the purpose of this investigation was to explore the direction of the causal relationship between them. The sample consisted of 31 adults suffering from snake phobia. The study featured a randomized within-between design with two conditions and three counterbalanced immersions: (a) a baseline control immersion (BASELINE), (b) an immersion in a threatening and anxiety-inducing environment (ANX), and (c) an immersion in a nonthreatening environment that should not induce anxiety (NOANX). In the NOANX environment, participants were immersed for 5 min in a virtual Egyptian desert. They were told that the environment was safe and contained no snakes. The ANX immersion was identical, except that participants were led to believe that a multitude of hidden and dangerous snakes were lurking in the environment. A period of distraction (reading a text on relaxation) separated the ANX and NOANX immersions. Experimenters recorded presence and anxiety in the middle of and after each VR immersion. These brief measures of presence supported our hypothesis and were significantly higher in the anxious immersion than in the baseline or the nonanxious immersion. This finding was not corroborated by the presence questionnaire, where scores varied significantly in the opposite direction. The results from the brief one-item measures of presence support the significant contribution of emotions felt during the immersion on the subjective feeling of presence. The mixed results with the presence questionnaire are discussed, along with psychological factors potentially involved in presence.

Using biofeedback while immersed in a stressful videogame increases the effectiveness of stress management skills in soldiers.

This study assessed the efficacy of using visual and auditory biofeedback while immersed in a tridimensional videogame to practice a stress management skill (tactical breathing). All 41 participants were soldiers who had previously received basic stress management training and first aid training in combat. On the first day, they received a 15-minute refresher briefing and were randomly assigned to either: (a) no additional stress management training (SMT) for three days, or (b) 30-minute sessions (one per day for three days) of biofeedback-assisted SMT while immersed in a horror/first-person shooter game. The training was performed in a dark and enclosed environment using a 50-inch television with active stereoscopic display and loudspeakers. On the last day, all participants underwent a live simulated ambush with an improvised explosive device, where they had to provide first aid to a wounded soldier. Stress levels were measured with salivary cortisol collected when waking-up, before and after the live simulation. Stress was also measured with heart rate at baseline, during an apprehension phase, and during the live simulation. Repeated-measure ANOVAs and ANCOVAs confirmed that practicing SMT was effective in reducing stress. Results are discussed in terms of the advantages of the proposed program for military personnel and the need to practice SMT.

Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: A three-arm randomised controlled trial

BackgroundPeople with social anxiety disorder (SAD) fear social interactions and may be reluctant to seek treatments involving exposure to social situations. Social exposure conducted in virtual reality (VR), embedded in individual cognitive-behavioural therapy (CBT), could be an answer.AimsTo show that conducting VR exposure in CBT for SAD is effective and is more practical for therapists than conducting exposure in vivoMethodParticipants were randomly assigned to either VR exposure (n = 17), in vivo exposure (n = 22) or waiting list (n = 20). Participants in the active arms received individual CBT for 14 weekly sessions and outcome was assessed with questionnaires and a behaviour avoidance test. (Trial registration number ISRCTN99747069)ResultsImprovements were found on the primary (Liebowitz Social Anxiety Scale) and all five secondary outcome measures in both CBT groups compared with the waiting list. Conducting exposure in VR was more effective at post-treatment than in vivo on the primary outcome measure and on one secondary measure. Improvements were maintained at the 6-month follow-up. VR was significantly more practical for therapists than in vivo exposure.ConclusionsUsing VR can be advantageous over standard CBT as a potential solution for treatment avoidance and as an efficient, cost-effective and practical medium of exposure.

Virtual Reality and the Training of Military Personnel to Cope with Acute Stressors

Virtual reality is used in psychotherapeutic applications, but also as a training tool to practice stress management techniques and, hopefully, in the long term reduce the likelihood of developing posttraumatic stress disorder. This chapter begins with an overview of posttraumatic stress disorder and virtual reality technologies used in clinical research. The core of the chapter is dedicated to review studies using virtual reality to learn and practice stress coping skills or preparing military personnel to deal with stressful situations. Our analyses revealed that virtual reality is a promising training tool but more studies are clearly needed. Issues such as realism and the sense of presence are discussed and their role appears more complicated than initially thought.

Efficacité d'un traitement d'exposition en réalité virtuelle pour le traitement de l'arachnophobie chez l'enfant une étude pilote

Resume Objectif evaluer l’efficacite potentielle de l’exposition par realite virtuelle dans le traitement de l’arachnophobie chez l’enfant. Methode Cette etude repose sur un protocole sans condition temoin, complemente par un devis de cas uniques a niveaux de bases multiples en fonction des individus. L’echantillon se compose de neuf enfants et jeunes adolescents arachnophobes. Les participants se trouvent assignes au hasard a l’un des trois niveaux de bases: trois, quatre ou cinq semaines. Par la suite, ils recoivent six sessions de therapie cognitive-comportementale de 75 minutes suivant un manuel de traitement standardise. Des questionnaires et mesures breves reliees a la phobie et a l’immersion virtuelle sont aussi administres avant, pendant, apres le traitement ainsi qu’au suivi de 6 mois. Resultats les symptomes des participants diminuent de facon significative et les gains se maintiennent a la relance de 6 mois. Conclusion l’exposition virtuelle represente une facon prometteuse pour traiter les phobies chez les enfants, bien que des etudes a plus large echelle demeurent necessaires. Implication Ce nouvel outil donne a la therapie un aspect attractif qui pourrait encourager les enfants a entreprendre et poursuivre une therapie par exposition.

Description of a Treatment Manual for in virtuo Exposure with Specific Phobia

The DSM-IV-TR [1] defines a specific phobia as an intense and persisting fear that is excessive or irrational, usually triggered by the presence or the anticipation of a specific object or situation. The exposure to the fear-provoking object triggers an immediate and almost systematic anxious reaction that can take the form of a panic attack. The individual recognizes the excessive or irrational nature of his fear but avoids the situations that might put him in the presence of the fear-provoking stimulus or experiences these situations with a lot of anxiety. The avoidance and apprehension that are linked to the phobia impair the individual’s daily functioning.

Reliability and validity of a single-item measure of presence in VR

Measuring presence reliably and with minimal intrusion manner is not easy. The present study reports on six studies that have validated a measure of presence consisting of only one item. The content, face validity, test-retest, convergent and divergent validity as well as sensitivity were all confirming reliability and validity of a single-item measure.

Using Virtual Reality in the Treatment of Gambling Disorder: The Development of a New Tool for Cognitive Behavior Therapy

Virtual reality (VR) can be used in the treatment of gambling disorder to provide emotionally charged contexts (e.g., induce cravings) where patients can practice cognitive behavior therapy (CBT) techniques in the safety of the therapist’s office. This raises practical questions, such as whether the cravings are sufficient to be clinically useful but also manageable enough to remain clinically safe. Pilot data are also needed to test the development of a treatment manual and prepare large randomized control trials. This paper reports on three studies describing (a) cravings induced in VR compared to real gambling and a control game of skill with no money involved (N = 28 frequent gamblers and 36 infrequent gamblers); (b) the usefulness of a treatment protocol with only two CBT sessions using VR (N = 34 pathological gamblers); and (c) the safety of a four-session treatment program of CBT in VR (N = 25 pathological gamblers). Study 1 reveals that immersions in VR can elicit desire and a positive anticipation to gamble in frequent gamblers that are (a) significantly stronger than for infrequent gamblers and for playing a control game of skill and (b) as strong as for gambling on a real video lottery terminal. Study 2 documents the feasibility of integrating VR in CBT, its usefulness in identifying more high-risk situations and dysfunctional thoughts, how inducing cravings during relapse prevention exercises significantly relates to treatment outcome, and the safety of the procedure in terms of cybersickness. Results from Study 3 confirm that, compared to inducing urges to gamble in imagination, using VR does not lead to urges that are stronger, last longer, or feel more out of control. Outcome data and effect sizes are reported for both randomized control pilot trials conducted in inpatient settings. Suggestions for future research are provided, including on increasing the number of VR sessions in the treatment program.

Modes of immersion and stress induced by commercial (off-the-shelf) 3D games

Developing a stress-management training (SMT) system and protocol for soldiers can help them cope better with stress experienced in theatre operations. Using 3D horror games in virtual reality (VR) can present an attractive simulation method for soldiers. This study was conducted to find out whether it is possible to stress soldiers moderately using VR and which technology is more efficient to do so. A total of 47 soldiers returning from Afghanistan played two 3D first-person shooter (FPS)/horror games (Killing Floor and Left 4 Dead) on three different types of immersive technologies (a 22-inch stereoscopic monitor, a 73-inch stereoscopic TV and a CAVE™). As a control and reference comparison of induced stress, participants were exposed to the Trier Social Stress Test (TSST), a standardized stress-inducing procedure. Results were supporting of our work, devising an effective low-cost and high-buy-in approach to assist in teaching and practicing stress-management skills. Repeated measures analyses of variance (ANOVAs) revealed statistically significant increases in the soldiers’ respiration rates and heart rates while playing the 3D games and during the TSSTs. No significant interactions were found. Increases in physiological arousal among the soldiers were significant when comparing the baseline to the immersion and to the TSST, but not when comparing both stressors. Immersion in 3D games is proposed as a practical and cost-effective option to create a context that allows practicing SMT.