Social Environment Simulation in VR Elicits a Distinct Reaction in Subjects with Different Levels of Anxiety and Somatoform Dissociation

ABSTRACT Virtual reality has taken many great strides in the recent years. It is increasingly used and is an accepted means of delivering behavioral therapy for phobias and anxiety disorders. In this paper, we examine methods of virtual reality stress induction for use in treatment of somatoform and anxiety disorders, as well as the adequate measures of the evoked stress response. In total, 42 healthy subjects took part in testing as part of this study. The results show that electrodermal activity is more sensitive in capturing a subject reaction to non-interactive social environment simulation while cardiovascular parameters better reflect task-related stress. Furthermore, our results suggest a distinct relationship between electrodermal activity and anxiety and cardiovascular parameters and somatoform dissociation. These results can point to a possibility of virtual reality utilization in the research and treatment of disorders in which anxiety and somatization are important features.

[1]  Chris Barker,et al.  An Experiment on Public Speaking Anxiety in Response to Three Different Types of Virtual Audience , 2002, Presence: Teleoperators & Virtual Environments.

[2]  J. Ridley Studies of Interference in Serial Verbal Reactions , 2001 .

[3]  J. Stroop Studies of interference in serial verbal reactions. , 1992 .

[4]  Chris Barker,et al.  An Experimental Study on Fear of Public Speaking Using a Virtual Environment , 2006, Cyberpsychology Behav. Soc. Netw..

[5]  T. Hothorn,et al.  Simultaneous Inference in General Parametric Models , 2008, Biometrical journal. Biometrische Zeitschrift.

[6]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[7]  Xueni Pan,et al.  Socially Anxious and Confident Men Interact with a Forward Virtual Woman: An Experimental Study , 2012, PloS one.

[8]  Fotis Liarokapis,et al.  A Model for Eye and Head Motion for Virtual Agents , 2018, 2018 10th International Conference on Virtual Worlds and Games for Serious Applications (VS-Games).

[9]  José Gutiérrez-Maldonado,et al.  The role of presence in the level of anxiety experienced in clinical virtual environments , 2011, Comput. Hum. Behav..

[10]  Mika P. Tarvainen,et al.  Kubios HRV - Heart rate variability analysis software , 2014, Comput. Methods Programs Biomed..

[11]  Christopher G. Courtney,et al.  Validity of the Virtual Reality Stroop Task (VRST) in active duty military , 2013, Journal of clinical and experimental neuropsychology.

[12]  E. Nijenhuis Somatoform Dissociation , 2001 .

[13]  Helmut Hlavacs,et al.  Is virtual reality emotionally arousing? Investigating five emotion inducing virtual park scenarios , 2015, Int. J. Hum. Comput. Stud..

[14]  François Bernier,et al.  Selection of Key Stressors to Develop Virtual Environments for Practicing Stress Management Skills with Military Personnel Prior to Deployment , 2010, Cyberpsychology Behav. Soc. Netw..

[15]  Brent Lance,et al.  Optimal Arousal Identification and Classification for Affective Computing Using Physiological Signals: Virtual Reality Stroop Task , 2010, IEEE Transactions on Affective Computing.

[16]  Robert S. Kennedy,et al.  Simulator Sickness Questionnaire: An enhanced method for quantifying simulator sickness. , 1993 .

[17]  D. Levac,et al.  When is virtual reality "therapy"? , 2013, Archives of physical medicine and rehabilitation.

[18]  Heloir,et al.  The Uncanny Valley , 2019, The Animation Studies Reader.

[19]  M. Bareš,et al.  Processing of Emotion in Functional Neurological Disorder , 2018, Front. Psychiatry.

[20]  B. Rockstroh,et al.  Somatoform dissociation and posttraumatic stress syndrome – two sides of the same medal? A comparison of symptom profiles, trauma history and altered affect regulation between patients with functional neurological symptoms and patients with PTSD , 2017, BMC Psychiatry.

[21]  Frank Bretz,et al.  Simultaneous Inference , 2020, Biostatistics Decoded.

[22]  Li Li,et al.  Virtual Reality Exposure Therapy of Anxiety Disorders , 2012 .

[23]  Mel Slater,et al.  Place illusion and plausibility can lead to realistic behaviour in immersive virtual environments , 2009, Philosophical Transactions of the Royal Society B: Biological Sciences.

[24]  Mark Grimshaw,et al.  Facial expression of emotion and perception of the Uncanny Valley in virtual characters , 2011, Comput. Hum. Behav..

[25]  A. Rizzo,et al.  Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis. , 2008, Journal of behavior therapy and experimental psychiatry.

[26]  K. Roelofs,et al.  Trauma, stress, and preconscious threat processing in patients with psychogenic nonepileptic seizures , 2009, Epilepsia.

[27]  V. Voon,et al.  Disrupted avoidance learning in functional neurological disorder: Implications for harm avoidance theories☆ , 2017, NeuroImage: Clinical.

[28]  Bernard D. Adelstein,et al.  Demand Characteristics of a Questionnaire Used to Assess Motion Sickness in a Virtual Environment , 2006, IEEE Virtual Reality Conference (VR 2006).

[29]  M. North,et al.  Virtual reality therapy: an effective treatment for psychological disorders. , 1997, Studies in health technology and informatics.

[30]  Richard J. Brown,et al.  Psychological and psychiatric aspects of psychogenic non-epileptic seizures (PNES): A systematic review. , 2016, Clinical psychology review.

[31]  P. Nolin,et al.  Development and initial assessment of a new paradigm for assessing cognitive and motor inhibition: The bimodal virtual-reality Stroop , 2012, Journal of Neuroscience Methods.

[32]  C. Kirschbaum,et al.  The 'Trier Social Stress Test'--a tool for investigating psychobiological stress responses in a laboratory setting. , 1993, Neuropsychobiology.

[33]  Emily M. O’Bryan,et al.  The Role of Emotion Reactivity in Health Anxiety , 2017, Behavior modification.

[34]  Christian Wolff,et al.  Potential of virtual reality as a diagnostic tool for social anxiety: A pilot study , 2017, Comput. Hum. Behav..

[35]  Todd Bowerly,et al.  A Virtual Reality Scenario for All Seasons: The Virtual Classroom , 2009, CNS Spectrums.

[36]  M. Kempton,et al.  Virtual reality in the psychological treatment for mental health problems: An systematic review of recent evidence , 2016, Psychiatry Research.

[37]  B. Rothbaum,et al.  The Use of Virtual Reality Exposure in the Treatment of Anxiety Disorders , 1999, Behavior modification.

[38]  Pierre Nolin,et al.  Assessment of executive function in adolescence: A comparison of traditional and virtual reality tools , 2013, Journal of Neuroscience Methods.

[39]  J. A. Häusser,et al.  The Trier Social Stress Test as a paradigm to study how people respond to threat in social interactions , 2015, Front. Psychol..

[40]  Thomas D. Parsons,et al.  Adaptive virtual environments for neuropsychological assessment in serious games , 2012, IEEE Transactions on Consumer Electronics.

[41]  Karl F. MacDorman,et al.  The Uncanny Valley [From the Field] , 2012, IEEE Robotics Autom. Mag..

[42]  B. Rothbaum,et al.  Virtual Reality-Enhanced Extinction of Phobias and Post-Traumatic Stress , 2017, Neurotherapeutics.

[43]  Debra A. Dunstan,et al.  Screening for anxiety and depression: reassessing the utility of the Zung scales , 2017, BMC Psychiatry.

[44]  P. Spinhoven,et al.  The Development and Psychometric Characteristics of the Somatoform Dissociation Questionnaire (SDQ‐20) , 1996, The Journal of nervous and mental disease.

[45]  Mark B. Powers,et al.  Virtual reality exposure therapy for anxiety disorders: A meta-analysis. , 2008, Journal of anxiety disorders.

[46]  K. Roelofs,et al.  The effect of stress induction on working memory in patients with psychogenic nonepileptic seizures , 2010, Epilepsy & Behavior.

[47]  José Gutiérrez-Maldonado,et al.  Validity of virtual reality as a method of exposure in the treatment of test anxiety , 2007, Behavior research methods.

[48]  M. Benedek,et al.  A continuous measure of phasic electrodermal activity , 2010, Journal of Neuroscience Methods.

[49]  Daniel David,et al.  New Directions in Virtual Reality-Based Therapy for Anxiety Disorders , 2013 .

[50]  Brenda K. Wiederhold,et al.  Lessons Learned from 350 Virtual-Reality Sessions with Warriors Diagnosed with Combat-Related Posttraumatic Stress Disorder , 2010, Cyberpsychology Behav. Soc. Netw..

[51]  W W Zung,et al.  A rating instrument for anxiety disorders. , 1971, Psychosomatics.

[52]  Henrik M. Peperkorn,et al.  The impact of perception and presence on emotional reactions: a review of research in virtual reality , 2015, Front. Psychol..

[53]  C. Botella,et al.  Virtual reality exposure therapy in anxiety disorders: a quantitative meta‐analysis , 2012, Depression and anxiety.

[54]  Owen Kelly,et al.  Psychosocial Stress Evoked by a Virtual Audience: Relation to Neuroendocrine Activity , 2007, Cyberpsychology Behav. Soc. Netw..

[55]  T. Dinan,et al.  The Trier Social Stress Test: Principles and practice , 2016, Neurobiology of Stress.

[56]  M. Muñoz,et al.  adapTaTion of The Trier soCial sTress TesT To VirTual realiTy : psyCho-phsyiologiCal and neuroendoCrine modulaTion , 2011 .

[57]  B. Kudielka,et al.  Trier Social Stress Test , 2007 .

[58]  Matthew Price,et al.  Does engagement with exposure yield better outcomes? Components of presence as a predictor of treatment response for virtual reality exposure therapy for social phobia. , 2011, Journal of anxiety disorders.