Hunter G. Hoffman

Misinformation and Memory: The Creation of New Memories

Misleading information presented after an event can lead people to erroneous reports of that misinformation. Different process histories can be responsible for the same erroneous report in different people. We argue that the relative proportion of times that the different process histories are responsible for erroneous reporting will depend on the conditions of acquisition, retention, and retrieval of information. Given the conditions typical of most misinformation experiments, it appears that misinformation acceptance plays a major role, memory impairment plays some role, and pure guessing plays little or no role. Moreover, we argue that misinformation acceptance has not received the appreciation that it deserves as a phenomenon worthy of our sustained investigation. It may not tell us anything about impairment of memories, but it does tell us something about the creation of new memories.

Virtual reality as an adjunctive pain control during burn wound care in adolescent patients

Abstract For daily burn wound care procedures, opioid analgesics alone are often inadequate. Since most burn patients experience severe to excruciating pain during wound care, analgesics that can be used in addition to opioids are needed. This case report provides the first evidence that entering an immersive virtual environment can serve as a powerful adjunctive, nonpharmacologic analgesic. Two patients received virtual reality (VR) to distract them from high levels of pain during wound care. The first was a 16‐year‐old male with a deep flash burn on his right leg requiring surgery and staple placement. On two occasions, the patient spent some of his wound care in VR, and some playing a video game. On a 100 mm scale, he provided sensory and affective pain ratings, anxiety and subjective estimates of time spent thinking about his pain during the procedure. For the first session of wound care, these scores decreased 80 mm, 80 mm, 58 mm, and 93 mm, respectively, during VR treatment compared with the video game control condition. For the second session involving staple removal, scores also decreased. The second patient was a 17‐year‐old male with 33.5% total body surface area deep flash burns on his face, neck, back, arms, hands and legs. He had difficulty tolerating wound care pain with traditional opioids alone and showed dramatic drops in pain ratings during VR compared to the video game (e.g. a 47 mm drop in pain intensity during wound care). We contend that VR is a uniquely attention‐capturing medium capable of maximizing the amount of attention drawn away from the ‘real world’, allowing patients to tolerate painful procedures. These preliminary results suggest that immersive VR merits more attention as a potentially viable form of treatment for acute pain.

Virtual reality in the treatment of spider phobia: a controlled study

This study explored whether virtual reality (VR) exposure therapy was effective in the treatment of spider phobia. We compared a treatment condition vs. a waiting list condition in a between group design with 23 participants. Participants in the VR treatment group received an average of four one-hour exposure therapy sessions. VR exposure was effective in treating spider phobia compared to a control condition as measured with a Fear of Spiders questionnaire, a Behavioural Avoidance Test (BAT), and severity ratings made by the clinician and an independent assessor. Eighty-three percent of patients in the VR treatment group showed clinically significant improvement compared with 0% in the waiting list group, and no patients dropped out. This study shows that VR exposure can be effective in the treatment of phobias.

Virtual reality and tactile augmentation in the treatment of spider phobia: a case report.

This is the first case report to demonstrate the efficacy of immersive computer-generated virtual reality (VR) and mixed reality (touching real objects which patients also saw in VR) for the treatment of spider phobia. The subject was a 37-yr-old female with severe and incapacitating fear of spiders. Twelve weekly 1-hr sessions were conducted over a 3-month period. Outcome was assessed on measures of anxiety, avoidance, and changes in behavior toward real spiders. VR graded exposure therapy was successful for reducing fear of spiders providing converging evidence for a growing literature showing the effectiveness of VR as a new medium for exposure therapy.

Eye fixations and memory for emotional events

Subjects watched either an emotional, neutral, or unusual sequence of slides containing 1 critical slide in the middle. Experiments 1 and 2 allowed only a single eye fixation on the critical slide by presenting it for 180 ms (Experiment 1) or 150 ms (Experiment 2). Despite this constraint, memory for a central detail was better for the emotional condition. In Experiment 3, subjects were allowed 2.70 s to view the critical slide while their eye movements were monitored. When subjects who had devoted the same number of fixations were compared, memory for the central detail of the emotional slide was again better. The results suggest that enhanced memory for detail information of an emotional event does not occur solely because more attention is devoted to the emotional information.

Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study.

OBJECTIVE The pain experienced by burn patients during physical therapy range of motion exercises can be extreme and can discourage patients from complying with their physical therapy. We explored the novel use of immersive virtual reality (VR) to distract patients from pain during physical therapy. SETTING This study was conducted at the burn care unit of a regional trauma center. PATIENTS Twelve patients aged 19 to 47 years (average of 21% total body surface area burned) performed range of motion exercises of their injured extremity under an occupational therapists direction. INTERVENTION Each patient spent 3 minutes of physical therapy with no distraction and 3 minutes of physical therapy in VR (condition order randomized and counter-balanced). OUTCOME MEASURES Five visual analogue scale pain scores for each treatment condition served as the dependent variables. RESULTS All patients reported less pain when distracted with VR, and the magnitude of pain reduction by VR was statistically significant (e.g., time spent thinking about pain during physical therapy dropped from 60 to 14 mm on a 100-mm scale). The results of this study may be examined in more detail at www.hitL.washington.edu/projects/burn/. CONCLUSIONS Results provided preliminary evidence that VR can function as a strong nonpharmacologic pain reduction technique for adult burn patients during physical therapy and potentially for other painful procedures or pain populations.

Virtual reality exposure therapy for World Trade Center Post-traumatic Stress Disorder: a case report.

Done properly by experienced therapists, re-exposure to memories of traumatic events via imaginal exposure therapy can lead to a reduction of Post-traumatic Stress Disorder (PTSD) symptoms. Exposure helps the patient process and habituate to memories and strong emotions associated with the traumatic event: memories and emotions they have been carefully avoiding. But many patients are unwilling or unable to self-generate and re-experience painful emotional images. The present case study describes the treatment of a survivor of the World Trade Center (WTC) attack of 9-11-01 who had developed acute PTSD. After she failed to improve with traditional imaginal exposure therapy, we sought to increase emotional engagement and treatment success using virtual reality (VR) exposure therapy. Over the course of six 1-h VR exposure therapy sessions, we gradually and systematically exposed the PTSD patient to virtual planes flying over the World Trade Center, jets crashing into the World Trade Center with animated explosions and sound effects, virtual people jumping to their deaths from the burning buildings, towers collapsing, and dust clouds. VR graded exposure therapy was successful for reducing acute PTSD symptoms. Depression and PTSD symptoms as measured by the Beck Depression Inventory and the Clinician Administered PTSD Scale indicated a large (83%) reduction in depression, and large (90%) reduction in PTSD symptoms after completing VR exposure therapy. Although case reports are scientifically inconclusive by nature, these strong preliminary results suggest that VR exposure therapy is a promising new medium for treating acute PTSD. This study may be examined in more detail at www.vrpain.com.

Effectiveness of virtual reality-based pain control with multiple treatments.

ObjectiveThe current study explored whether immersive virtual reality continues to reduce pain (via distraction) with repeated use. SettingThe study was conducted in a burn care unit at a regional trauma center. PatientsSeven patients aged 9–32 years (mean age of 21.9 years; average of 23.7% total body surface area burned [range, 3–60%]) performed range-of-motion exercises of their injured extremity under an occupational therapists direction on at least 3 separate days each. InterventionFor each physical therapy session, each patient spent equal amounts of time in virtual reality and in the control condition (no distraction). The mean duration of physical therapy in virtual reality was 3.5, 4.9, and 6.4 minutes for the first, second, and third session, respectively. Condition order was randomized and counterbalanced. Outcome MeasuresFor each of the three physical therapy sessions, five visual analog pain scores for each treatment condition served as the dependent variables. ResultsPain ratings were statistically lower when patients were in virtual reality, and the magnitude of pain reduction did not diminish with repeated use of virtual reality. The results of this study may be examined in more detail at www.vrpain.com. ConclusionsAlthough the small sample size limits generalizability, results provide converging preliminary evidence that virtual reality can function as a strong nonpharmacological pain reduction technique for burn patients during physical therapy. Results suggest that virtual reality does not diminish in analgesic effectiveness with three (and possibly more) uses. Virtual reality may also have analgesic potential for other painful procedures or pain populations. Practical implications are discussed.

Virtual reality pain control during burn wound debridement in the hydrotank.

ObjectiveMost burn-injured patients rate their pain during burn wound debridement as severe to excruciating. We explored the adjunctive use of water-friendly, immersive virtual reality (VR) to distract patients from their pain during burn wound debridement in the hydrotherapy tank (hydrotank). SettingThis study was conducted on inpatients at a major regional burn center. PatientsEleven hospitalized inpatients ages 9 to 40 years (mean age, 27 y) had their burn wounds debrided and dressed while partially submerged in the hydrotank. InterventionAlthough a nurse debrided the burn wound, each patient spent 3 minutes of wound care with no distraction and 3 minutes of wound care in VR during a single wound care session (within-subject condition order randomized). Outcome MeasuresThree 0 to 10 graphic rating scale pain scores (worst pain, time spent thinking about pain, and pain unpleasantness) for each of the 2 treatment conditions served as the primary dependent variables. ResultsPatients reported significantly less pain when distracted with VR [eg, “worst pain” ratings during wound care dropped from “severe” (7.6) to “moderate” (5.1)]. The 6 patients who reported the strongest illusion of “going inside” the virtual world reported the greatest analgesic effect of VR on worst pain ratings, dropping from severe pain (7.2) in the no VR condition to mild pain (3.7) during VR. ConclusionsResults provide the first available evidence from a controlled study that immersive VR can be an effective nonpharmacologic pain reduction technique for burn patients experiencing severe to excruciating pain during wound care. The potential applications of VR analgesia to other painful procedures (eg, movement or exercise therapy) and other pain populations are discussed.

Creating new memories that are quickly accessed and confidently held.

In two experiments involving a total of 542 subjects, a series of slides depicting a burglary was shown. After the initial event, subjects were exposed to one or more narratives about the event that contained some misinformation or neutral information about four critical details. Finally, subjects were tested on their memories of what they saw, and their reaction times and confidence levels were measured. When subjects took a standard test in which the misinformation item was a possible response option, they responded very quickly and confidently when making this incorrect choice. Misled subjects responded as quickly and confidently to these “unreal” memories as they did to their genuine memories. It does not seem, then, that the misinformation effect arises from a large proportion of subjects who must resolve a conflict between two memories when they are tested, a conflict that would be expected to take time. When subjects took a modified test in which the misinformation item was not a possible response, misled subjects were as accurate as were controls, but they responded more slowly, regardless of whether they ultimately chose the right or wrong option. These findings indicate that misinformation does introduce some form of interference not detected by a simple test of accuracy.