Key elements of social presence psychosocial approach to VR based CBT: an interaction analysis

An effective VR based CBT (Cognitive Behavioural Therapy) requires an explicit knowledge of presence and social presence dynamics fired by virtual reality immersion. Most of the literature suggests that CMC does not have the capacity to support social and affective interaction, however, recent reviews of the social presence literature question the extent to which this literature can be generalised to every communication medium and to every application of these media. In the present contribution, we propose a qualitative method based on a psychosocial approach to investigate different dimensions of the therapeutic experience and interaction. The final objective of the study is the improvement of the VR based therapy system designed by our research unit both from an ergonomic and, consequently, clinical point of view according to a perspective that is strongly ‘context driven’. Social Presence and VR based therapy The genealogy of the social presence construct can be traced back to Mehrabian’s (1969) concept of immediacy: “Immediacy is the directness and intensity of interaction between two entities”. Short et al. (1976) introduced and defined the term social presence as “the salience of the other in a mediated communication and the consequent salience of their interpersonal interactions”. According to Riva (2004) this principle has significant outcomes on design process and ergonomic issues. The VR system used in our study based on the ECT (Experiential Cognitive Therapy) protocol for the treatment of anxiety disorders, recognises in ‘other’ presence an important therapeutic and functional element thus deserving, in our opinion, a careful investigation in order to allow interventions on two fronts: Ergonomic: the design of technical functionalities as they are implemented will have to support, and if necessary reinforce, the perception of the highest levels of social presence with specific reference to intentionality and ‘sense attribution’ that implies the ability to understand the other’s intentions. Clinical-therapeutic: reflections emerging from the study can be at the same time considered relevant aspects from the clinical point of view and consequently lead to a further improvement of the clinical protocol currently in use, stressing other distinctive elements in comparison with non VR based CBT. The research framework: an analysis respectful of the ecological process The study reported is part of the NeuroTIV project “Immersive Virtual Telepresence Managed Care for the Assessment and Rehabilitation in Neuropsychology and Clinical Psychology” (Italian National Research Project 2004-2007, funded by the Italian Ministry of University and Research). The objective of the project is to prove the technical and clinical viability of integrating TIV (Immersive Virtual Telepresence) systems into a managed care platform for neuro-psychological assessment and rehabilitation. Updated treatment protocols and VR based modules to be applied in assessment, therapy and follow up based on controlled clinical trials will be the main outcome of the research. The intervention of the ergonomic research unit, to which the present study refers, consists in the elaboration of ergonomic analysis and in the production and fine-tuning of VR environments for clinical applications. The evolution of the research perspective and of the software design has been marked by a fundamental step compared to previous studies conducted by the same unit. While in the past design and clinical practice were kept separate to a certain extent, in the current project great efforts have been made to overcome this limit by keeping the design phases and the fine-tuning of the environments strictly connected to the clinical applications and requirements’ gathering process. Theoretical approach As stated above, first definitions of ‘social presence’ can be dated back to 1976. More recently, Biocca et al. (2001) propose a clarification of the concept classifying different definitions into three themes respectively centred on co-presence and mutual awareness; on the experience of psychological involvement; on the behavioural interaction through which social presence is realised. Nevertheless the concept is still unclear and mainly used in different ways without specific distinction: with reference both to the medium in mediated communication and to perceptions, behaviours or attitudes of the participants (Rettie, 2003). Related to social presence are the concepts of ‘awareness’, defined as “an understanding of the activities of others, which provides a context for your own activity” (Dourish and Bly, 1992), and more recently the one of “connectedness” (Adler’s 1998) referring to an individual’s attitude and relationship to society and considered as one of the main principles motivating social behaviour (Smith and Mackie, 2000). Schumie et al. (2001), Insko (2003), Riva (2004) propose exhaustive reviews of main methods applied to study the concepts of presence and social presence on the basis of the different theoretical approaches related to the nature of these constructs. This kind of research is generally based on questionnaires or psycho-physiological measures useful to investigate the level of presence and social presence but that aren’t enough to understand what is happening and how interactive context can help the therapist to keep the patient’s “sense of being there” and the patient’s sense of the “other perception” in control. We agree with the approach presented by Spagnolli et al. (2003) that “recognizes that presence is an ambitious concept referring to the user experience in the VE, which is complex, contextualized and dynamic. It stresses the reciprocal contribution of both environment and its inhabitants in configuring each other and the central role of local action in shaping presence”. The authors identify some focuses which must be considered in presence research: the process through which presence is constituted and changed, the problems of the virtual body, of the VE boundaries and of the objects recognised in the simulation, the denial to consider a single perspective on the concept of social presence as the only possibility rather than allowing the coexistence of different configurations. The qualitative methods applied in the study presented are strongly based on perspectives that consider the action as the focus of analysis. In particular, Situated Action Theory (SAT) is an approach developed within the context of socio-cognitive research known as “cognition in practice” and introduces a change of perspective: the action is not considered as the execution of a ready-conceived plan, but as a process of adaptation to the context. Suchman underlines that “instead of separating actions from the circumstances in which occurs as the execution of a carefully thought out plan... [SAT] tries to study how people use circumstances to develop an intelligent course of action” (Galimberti, Riva, 2001, p.167). We think that such a perspective can be generally applied to presence research and to social presence research more specifically.