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ZusammenfassungHintergrundVirtuelle Realität (VR) wird seit 20 Jahren als Expositionsverfahren in der Verhaltenstherapie von Angststörungen untersucht. Inzwischen liegen mehrere Metaanalysen mit überzeugenden Wirksamkeitsbelegen vor.FragestellungIn den letzten Jahren hat eine enorme Weiterentwicklung der VR-Technologie und der damit verbundenen Möglichkeiten stattgefunden, die weiterhin andauert. Vor diesem Hintergrund wird der aktuelle Stand von VR als Expositionsmethode dargestellt.Material und MethodenWir bieten einen narrativen Überblick über aktuelle Forschung zu VR-Expositionstherapie bei Angststörungen und die wichtigsten Entwicklungen in diesem Bereich.ErgebnisseNach einem anfangs fast ausschließlichen Fokus auf spezifische Phobien nimmt die Zahl der Arbeiten zu komplexeren Angststörungen (v. a. soziale Angststörung) zu. Zudem hat sich VR inzwischen als experimentelle Methode etabliert, um psychopathologische Prozesse zu erforschen und die Wirkmechanismen von (VR-)Exposition zu erhellen.DiskussionNach wie vor besteht Forschungsbedarf zur VR-Expositionstherapie, v. a. bei komplexen Angststörungen (z. B. Panikstörung und Agoraphobie, soziale Phobie) und Traumafolgestörungen. Darüber hinaus hat sich VR als Forschungsmethode inzwischen etabliert. Die rasche technische Entwicklung im VR-Bereich lässt eine weitere Zunahme der Forschungsaktivitäten zu VR erwarten – sowohl in der klinischen als auch in der Grundlagenforschung.AbstractBackgroundVirtual reality (VR) has been investigated as a medium for exposure therapy of anxiety disorders for 20 years. Various meta-analyses have provided convincing evidence of the therapeutic efficacy of exposure therapy in VR.ObjectiveIn recent years VR technology and its applications have considerably improved. Therefore, the current state of the art of VR exposure therapy is presented.Material and methodsThis article provides a narrative review of current research on VR exposure therapy for anxiety disorders and major directions of development in this area.ResultsAfter an almost exclusive focus on specific phobias in the early days, research on more complex anxiety disorders (particularly on social anxiety disorder) is increasing. In addition, VR has become established as an experimental method to probe psychopathological processes and to elucidate the mechanism of action of (VR) exposure therapy.ConclusionThere is still a need for more research into VR exposure therapy, especially in complex anxiety disorders (e. g. panic disorder, agoraphobia and social anxiety disorder) and trauma-related disorders. Furthermore, VR has become established as a research tool. The rapid technological development gives reason to expect a continuing increase in VR research, in clinical as well as basic research.

While studies have increasingly used virtual hands and objects in virtual environments to investigate various processes of psychological phenomena, conflicting findings have been reported even at the most basic level of perception and action. To reconcile this situation, the present study aimed 1) to assess biases in size perception of a virtual hand using a strict psychophysical method and 2) to provide firm and conclusive evidence of the kinematic characteristics of reach-to-grasp movements with various virtual effectors (whole hand or fingertips only, with or without tactile feedback of a target object). Experiments were conducted using a consumer immersive virtual reality device. In a size judgment task, participants judged whether a presented virtual hand or an everyday object was larger than the remembered size. The results showed the same amplitude of underestimation (approximately 5%) for the virtual hand and the object, and no influence of object location, visuo-proprioceptive congruency, or short-term experience of controlling the virtual hand. Furthermore, there was a moderate positive correlation between actual hand size and perception bias. Analyses of reach-to-grasp movements revealed longer movement times and larger maximum grip aperture (MGA) for a virtual, as opposed to a physical, environment, but the MGA did not change when grasping was performed without tactile feedback. The MGA appeared earlier in the time course of grasping movements in all virtual reality conditions, regardless of the type of virtual effector. These findings confirm and corroborate previous evidence and may contribute to the field of virtual hand interfaces for interactions with virtual worlds.

When faced with a personal problem people typically give better advice to others than to themselves. A previous study showed how it is possible to enact internal dialogue in virtual reality (VR) through participants alternately occupying two different virtual bodies – one representing themselves and the other Sigmund Freud. They could maintain a self-conversation by explaining their problem to the virtual Freud and then from the embodied perspective of Freud see and hear the explanation by their virtual doppelganger, and then give some advice. Alternating between the two bodies they could maintain a self-dialogue, as if between two different people. Here we show that the process of alternating between their own and the Freud body is important for successful psychological outcomes. An experiment was carried out with 58 people, 29 in the body swapping Self-Conversation condition and 29 in a condition where they only spoke to a Scripted Freud character. The results showed that the Self-Conversation method results in a greater perception of change and help compared to the Scripted. We compare this method with the distancing paradigm where participants imagine resolving a problem from a first or third person perspective. We consider the method as a possible strategy for self-counselling.

We provide a critical review of digital technologies in evidence-based treatments (EBTs) for mental health with a focus on the functions technologies are intended to serve. The review highlights issues related to clarity of purpose, usability, and assumptions related to EBT technology integration, branding, and packaging. Developers continue to use technology in creative ways, often combining multiple functions to convey existing EBTs or to create new technology-enabled EBTs. Developers have a strong preference for creating and investigating whole-source, branded solutions related to specific EBTs, in comparison to developing or investigating technology tools related to specific components of behavior change, or developing specific clinical protocols that can be delivered via existing technologies. Default assumptions that new applications are required for each individual EBT, that EBTs are best served by the use of only one technology solution rather than multiple tools, and that an EBT-specific technology product should include or convey all portions of an EBT slow scientific progress and increase risk of usability issues that negatively impact uptake. We contend that a purposeful, functions-based approach should guide the selection, development, and application of technology in support of EBT delivery.

Virtual reality exposure therapy (VRET) is a promising approach in treating phobias such as fear of heights (acrophobia). VRET provides an effective, cost-efficient, scalable and individually adaptable alternative to traditional exposure therapy. To further foster the potential of VRET, a novel concept called Playful User-generated Treatment (PUT) was derived from expert interviews and literature review. In this paper, we provide additional insights regarding the applicability of PUT in real therapy scenarios. For that purpose, practicing psychotherapists (n=13) participated in an online survey and shared their assessments regarding PUT. By conducting qualitative content analysis (inductive category formation), we identified opportunities and challenges that should be considered for the design of playful VRET systems. Opportunities were seen for preparatory habituation, increased control and self-efficacy, improved interaction, economic usage and a realistic display of anxiety-inducing environments. Challenges included lack of direct communication and realism as well as pseudo-habituation to virtual environments.

Virtual reality exposure therapy (VRET) can have a significant impact towards assessing and potentially treating various anxiety disorders. One of the main strengths of VRET systems is that they provide an opportunity for a psychologist to interact with virtual 3D environments and change therapy scenarios according to the individual patient’s needs. However, to do this efficiently the patient’s anxiety level should be tracked throughout the VRET session. Therefore, in order to fully use all advantages provided by the VRET system, a mental stress detection system is needed. The patient’s physiological signals can be collected with wearable biofeedback sensors. Signals like blood volume pressure (BVP), galvanic skin response (GSR), and skin temperature can be processed and used to train the anxiety level classification models. In this paper, we combine VRET with mental stress detection and highlight potential uses of this kind of VRET system. We discuss and present a framework for anxiety level recognition, which is a part of our developed cloud-based VRET system. Physiological signals of 30 participants were collected during VRET-based public speaking anxiety treatment sessions. The acquired data were used to train a four-level anxiety recognition model (where each level of ‘low’, ‘mild’, ‘moderate’, and ‘high’ refer to the levels of anxiety rather than to separate classes of the anxiety disorder). We achieved an 80.1% cross-subject accuracy (using leave-one-subject-out cross-validation) and 86.3% accuracy (using 10 × 10 fold cross-validation) with the signal fusion-based support vector machine (SVM) classifier.

Virtual environments will deeply alter the way we conduct scientific studies on human behavior. Possible applications range from spatial navigation over addressing moral dilemmas in a more natural manner to therapeutic applications for affective disorders. The decisive factor for this broad range of applications is that virtual reality (VR) is able to combine a well-controlled experimental environment together with the ecological validity of the immersion of test subjects. Until now, however, programming such an environment in Unity® requires profound knowledge of C# programming, 3D design, and computer graphics. In order to give interested research groups access to a realistic VR environment which can easily adapt to the varying needs of experiments, we developed a large, open source, scriptable, and modular VR city. It covers an area of 230 hectare, up to 150 self-driving vehicles and 655 active and passive pedestrians and thousands of nature assets to make it both highly dynamic and realistic. Furthermore, the repository presented here contains a stand-alone City AI toolkit for creating avatars and customizing cars. Finally, the package contains code to easily set up VR studies. All main functions are integrated into the graphical user interface of the Unity® Editor to ease the use of the embedded functionalities. In summary, the project named Westdrive is developed to enable research groups to access a state-of-the-art VR environment that is easily adapted to specific needs and allows focus on the respective research question.

Virtual Reality has already been proven as a useful supplementary treatment tool for anxiety disorders. However, no specific technological importance has been given so far on how to apply Virtual Reality with a way that properly stimulates the phobic stimulus and provide the necessary means for lifelike experience. Thanks to technological advancements, there is now a variety of hardware that can help enhance stronger emotions generated by Virtual Reality systems. This study aims to evaluate the feeling of presence during different hardware setups of Virtual Reality Exposure Therapy, and, particularly how the user’s interaction with those setups can affects their sense of presence during the virtual simulation. An acrophobic virtual scenario is used as a case study by 20 phobic individuals and the Witmer–Singer presence questionnaire was used for presence evaluation by the users of the system. Statistical analysis on their answers revealed that the proposed full body Motion Recognition Cameras system generates a better feeling of presence compared to the Hand Controllers system. This is thanks to the Motion Recognition Cameras, which track and allow display of the user’s entire body within the virtual environment. Thus, the users are enabled to interact and confront the anxiety-provoking stimulus as in real world. Further studies are recommended, in which the proposed system could be used in Virtual Reality Exposure Therapy trials with acrophobic patients and other anxiety disorders as well, since the proposed system can provide natural interaction in various simulated environments.

Virtual Reality (VR) content production is now a flourishing industry. The specifics of VR, as opposed to videogames or movies, allow for a content format where users experience, at the same time, the narrative richness characteristic of movies and theatre plays with interactive engagement. To create such a content format some technical challenges still need to be solved, the main being the need for a new generation of animation engines that can deliver interactive characters appropriate for narrative-focused VR interactive content. We review the main assumptions of this approach and recent progress in interactive character animation techniques that seems promising to realise this goal.

Virtual Reality (VR) Therapy has emerged in the 90s as an appealing way of delivering exposure treatment. Throughout these years, ample evidence has been published. Although there is an agreed consensus regarding its efficacy, currently a quick shift in the field is being experienced, especially due to the advent of off-the-shelf technology that is greatly facilitating its dissemination. In this context, theoretical discussions of the field appear as an important action in order to take stock of the mounting evidence that has been produced and the main challenges for the coming future. To stimulate the discussion in a burgeoning field, a SWOT analysis is proposed, which may help to map the field of VR therapy for anxiety and stress-related disorders. Overall, it is undoubted that VR appears as a well-established technology for the treatment of ASRD and the main challenges are in line with the possibility of hurdling the same obstacles that the whole field of clinical psychology and psychotherapy has to deal with: How to bridge the gap between research and clinical practice.

This paper presents the design, a pilot implementation and validation of eTher, an assistive virtual agent for acrophobia therapy in a Virtual Reality environment that depicts a mountain landscape and contains a ride by cable car. eTher acts as a virtual therapist, offering support and encouragement to the patient. It directly interacts with the user and changes its voice parameters – pitch, tempo and volume – according to the patient’s emotional state. eTher identifies the levels of relaxation/anxiety compared to a baseline resting recording and provides three modalities of relaxation - by determining the user to look at a favorite picture, listen to an enjoyable song or read an inspirational quote. If the relaxation modalities fail to be effective, the virtual agent automatically lowers the level of exposure. We have validated our approach with a number of 10 users who played the game once without eTher’s intervention and three times with assistance from eTher. The results showed that the participants succeeded to finish the game quicker in the last gameplay session where the virtual agent intervened. Moreover, their biophysical data showed significant improvements in terms of relaxation state.

This is an editorial to a special issue on Consumers and Technology in a Changing World. Appearing in volume 53 issue 6, European Journal of Marketing (2019)

This document describes an interactive virtual reality tool for subjective assessment designed under the scope of ITU-T Study Group 12 and the Video Quality Experts Group in the development of the future ITU-T Recommendation P.360-VR for the subjective assessment of 360 videos using Head-Mounted Displays (HMDs). The tool has been designed under the Unity3D engine to be used on multiple HMDs. Furthermore, it can be configured for a variety of custom or predefined questions while the video sequence is played and/or after its ending. The head tracking is also registered in degrees. The voting method is gaze-based using joysticks keys for confirmation.

The thesis focuses in development of a Virtual Reality based Serious Game platform for overcoming phobia, with special focus on acrophobia i.e., fear of heights. Levels of acrophobic scenarios with gradual exposure to heights is developed. The prototype includes game elements such as motivation, target and set of goals to be achieved. The serious game platform reduces the level of fear by encouraging the individual to use it again since they are challenging and attractive. The degree of fear of heights in people is evaluated using questionnaire and since it showed a significant number of people experience acrophobia, this platform may be used in treatment to overcome the same. Future studies should include the deployment of serious game platform on patients with acrophobia to measure the effectiveness of this system.

Specific phobias are among the most common mental diseases, affecting the lives of millions of people. Yet, many cases remain untreated and even undiagnosed, partly due to entry barriers such as waiting times and inconvenience of therapy. To improve the therapeutic options and convenience for the treatment of specific phobias, we implemented a virtual reality application for treating acrophobia (fear of heights) with in-virtuo exposure therapy. Our concept is based on principles from psychology and interaction design. This concept is then implemented using the game engine Unity and Oculus Rift headset as a target device for VR display. Our application has a wide range of customization options, which enables it to be personalized to individual patients. In addition, a number of motivational methods are integrated, which are intended to increase patient motivation, as motivation is essential for a successful therapy. CCS Concepts • Human-centered computing → Virtual reality; Interactive systems and tools; Visualization; • Applied computing → Health informatics;

Recent research indicates that many post-secondary students feel overwhelming anxiety, negatively impacting academic performance and overall well-being. In this paper, based on multidisciplinary literature analysis and innovative ideas in cognitive science, learning models, and emerging technologies, we introduce a theoretical framework that shows how and when priming activities can be introduced into the experiential learning cycle to reduce anxiety and increase cognitive bandwidth. This framework proposes a Virtual Reality based priming approach that uses games and meditative interventions. Our results show this approach's potential compared to no-priming scenarios for reducing anxiety and significance for VR gaming in improving cognitive bandwidth.

Recent research indicates that a majority of postsecondary students in North America “felt overwhelming anxiety” in the past few years, an effect that is negatively impacting their academic performance and overall well-being. Building on recent technology and cognitive priming research, we propose a theoretical framework and technology solution to address the student anxiety challenge using technologybased priming. As an initial test of our theoretical framework, this study aims to test the effectiveness of Virtual Reality gaming applications to reduce anxiety and increase cognitive bandwidth. In this preliminary, within-subjects study design, N=10, the primed participants showed a marked increase in cognitive test performance subsequent to the priming activity compared to the non-primed test session. The results also showed that highly anxious subjects derived more benefit from the priming activity than less anxious subjects.

Questionnaires are among the most common research tools in virtual reality (VR) user studies. Transitioning from virtuality to reality for giving self-reports on VR experiences can lead to systematic biases. VR allows to embed questionnaires into the virtual environment which may ease participation and avoid biases. To provide a cohesive picture of methods and design choices for questionnaires in VR (inVRQ), we discuss 15 inVRQ studies from the literature and present a survey with 67 VR experts from academia and industry. Based on the outcomes, we conducted two user studies in which we tested different presentation and interaction methods of inVRQs and evaluated the usability and practicality of our design. We observed comparable completion times between inVRQs and questionnaires outside VR (nonVRQs) with higher enjoyment but lower usability for \inVRQs. These findings advocate the application of inVRQs and provide an overview of methods and considerations that lay the groundwork for inVRQ design.

Public speaking anxiety is commonly treated using cognitive behavioral therapy. During the therapy session, the patient is either asked to vividly imagine and describe the feared stimulus or is confronted with it in the real world. Sometimes, however, it can be hard to imagine the object of fear or to create a controllable environment that contains this stimulus. Virtual reality exposure therapy (VRET) can help solve these problems by placing the patient in a simulated 3D environment. While standalone VRET applications have been investigated for more than 25 years, we are analyzing the viability of a cloud-based VRET system. In this paper, we discuss the architectural and technical choices made in order to create a mobile and lightweight solution that can be easily adapted by any psychology clinic. Moreover, we are analyzing data gathered from 30 participants who have undergone a VRET session for public speaking anxiety. Finally, the collected psychophysiological signals including galvanic skin response (GSR) and skin temperature are processed and investigated in order to evaluate our cloud-based VRET system.