Interfaces That Heal: Coupling Real and Virtual Objects to Treat Spider Phobia

Tactile augmentation is a simple, safe, inexpensive interaction technique for adding physical texture and force feedback cues to virtual objects. This study explored whether virtual reality (VR) exposure therapy reduces fear of spiders and whether giving patients the illusion of physically touching the virtual spider increases treatment effectiveness. Eight clinically phobic students were randomly assigned to one of 3 groups-(a) no treatment, (b) VR with no tactile cues, or (c) VR with a physically "touchable" virtual spider-as were 28 nonclinically phobic students. Participants in the 2 VR treatment groups received three 1-hr exposure therapy sessions resulting in clinically significant drops in behavioral avoidance and subjective fear ratings. The tactile augmentation group showed the greatest progress on behavioral measures. On average, participants in this group, who only approached to 5.5 ft of a live spider on the pretreatment Behavioral Avoidance Test (Garcia-Palacios, 2002), were able to approach to 6 in. of the spider after VR exposure treatment and did so with much less anxiety (see www.vrpain.com for details). Practical implications are discussed.     

Virtual reality and mobile phones in the treatment of generalized anxiety disorders: a phase-2 clinical trial

Several studies have demonstrated that exposure therapy—in which the patient is exposed to specific feared situations or objects that trigger anxiety—is an effective way to treat anxiety disorders. However, to overcome a number of limitations inherent in this approach—lack of full control of the situation, costs and time required, etc.—some therapists have started to add virtual reality (VR) to the in vivo exposure-based therapy, providing in-office, controlled exposure therapy. Compared to the in vivo exposure, VR Exposure Therapy (VRET) is completely controlled: the quality, the intensity and the frequency of the exposure are decided by the therapist, and the therapy can be stopped at any time if the patient does not tolerate it. Moreover, the flexibility of a virtual experience allows the patient to experience situations that are often much worse and more exaggerated than those that are likely to be encountered in real life. However, a critical issue underlying the use of VRET in the treatment of anxiety-related disorders is the lack of a virtual reality system in the patient’s real-life context. In this paper, we present a clinical protocol for the treatment of Generalized Anxiety Disorders (GAD) based on the ubiquitous use of a biofeedback-enhanced VR system. The protocol includes the use of a mobile exposure system allowing patients to perform the virtual experience in an outpatient setting. A between-subjects study, involving 25 GAD patients, was carried out to verify the efficacy of the proposed approach. The clinical data in this pilot study seemed to support the efficacy of the ubiquitous approach.     

VRMosaic: Web access from within a virtual environment

For the foreseeable future, users of virtual reality systems will likely spend more time in the “real” environment than in a virtual environment. In the “real” environment, users access much of their data using flat screen applications, which include tools such as authoring and analysis programs and even hyperlinked browsers. We believe that users will find VEs more appealing if they can import their flat screen applications. We also believe that the World Wide Web infrastructure, and supporting tools such as NCSA Mosaic, Netscape's Navigator, and Sun's HotJava, have become a de facto standard both for making data available and allowing limited interaction with that data. These beliefs motivated us to develop a technology for porting flat screen applications based on the 3.1 version of the InterViews toolkit into VR. NCSA Mosaic provided us with a real application that would: (1) test our infrastructure effectively; and (2) provide a compelling application example. We used our “2D interface in VR” infrastructure to port Mosaic into RealEyes, our VR system. Dubbed “VRMosaic”, this application lets users familiar with Mosaic access the Web from within an immersive VE. But VRMosaic is not just an embedded version of NCSA Mosaic-it also allows for VR specific features such as navigation within the VE     

Viability of virtual reality exposure therapy as a treatment alternative

Virtual reality (VR) has garnered the interest of many scientific communities over the last decade. One promising track of research lies in VR exposure therapy (VRET), where gradual exposure to a negative stimulus is used to reduce anxiety. Virtual exposure is desirable in many situations, as it can be less intimidating and less expensive than traditional in vivo treatment with much the same success. Examining the benefits and drawbacks of VRET is an important first step toward an accurate assessment of its viability as a treatment alternative. This paper will review current literature on the topic of VRET and answer several questions regarding the viability of the treatment. It will also provide some additional research direction for improving the case for mainstreaming VRET.     

Perceiving interpersonally-mediated risk in virtual environments

Using virtual reality (VR) to examine risky behavior that is mediated by interpersonal contact, such as agreeing to have sex, drink, or smoke with someone, offers particular promise and challenges. Social contextual stimuli that might trigger impulsive responses can be carefully controlled in virtual environments (VE), and yet manipulations of risk might be implausible to participants if they do not feel sufficiently immersed in the environment. The current study examined whether individuals can display adequate evidence of presence in a VE that involved potential interpersonally-induced risk: meeting a potential dating partner. Results offered some evidence for the potential of VR for the study of such interpersonal risk situations. Participants’ reaction to the scenario and risk-associated responses to the situation suggested that the embodied nature of virtual reality override the reality of the risk’s impossibility, allowing participants to experience adequate situational embedding, or presence.     

Virtual reality (VR) and psychotherapy: opportunities and challenges

Virtual reality technology is now being used to provide exposure and desensitization for a number of phobic conditions. In this paper, we first review these current applications and discuss the work needed to refine and expand these applications to phobias. We then comment briefly on some preliminary applications of VR technology to mental-health problems outside the domain of phobias. Finally, we consider ways in which VR might be used to further enhance psychotherapy and assist in the treatment of a wide variety of disorders. Various possible interventions are discussed, along with the technological developments needed to make them possible.     

Using augmented reality to treat phobias

Virtual reality (VR) is useful for treating several psychological problems, including phobias such as fear of flying, agoraphobia, claustrophobia, and phobia to insects and small animals. We believe that augmented reality (AR) could also be used to treat some psychological disorders. AR and VR share some advantages over traditional treatments. However, AR gives a greater feeling of presence (the sensation of being there) and reality judgment (judging an experience as real) than VR because the environment and the elements the patient uses to interact with the application are real. Moreover, in AR users see their own hands, feet, and so on, whereas VR only simulates this experience. With these differences in mind, the question arises as to the kinds of psychological treatments AR and VR are most suited for. In our system, patients see their own hands, feet, and so on. They can touch the table that animals are crossing or seeing their feet while the animals are running on the floor. They can also hold a marker with a dead spider or cockroach or pick up a flyswatter, a can of insecticide, or a dustpan.     

Through-Walls Collaboration

Through-walls collaboration lets users in the field work in real time with users indoors. The users in the field have first-hand knowledge and context of the current problem, whereas the indoor users have access to reference materials, a global picture, and more advanced technology. This article presents the overall concept and the following working projects: Hand of God, tabletop collaboration technologies, distributive VR/AR, remote active tangible interactions, mobile AR X-ray vision, and input devices for wearable computers.     

How level of realism influences anxiety in virtual reality environments for a job interview

This study describes how the level of graphical realism required in a virtual social simulation setting can be therapeutically useful in reducing job interview anxiety through exposure. We developed a virtual job interview simulation at a university career service to help student populations faced with the prospect of their first job interview. The virtual job interview simulation can deliver a realistic mock job interview within a high-quality immersive system that is similar to professional virtual reality (VR) systems. We conducted two experimental studies with a common theme: the role of graphical reality of the virtual interviewer and the immersive visual display in the virtual job interview simulation. The results are presented in this study based on a psycho-physiological approach, revealing variation in the distribution of participants′ anxiety state across various VR conditions. The overall conclusion of this study is that the sense of anxiety is less correlated to the graphical realism in VR environment even though the more graphically detailed the virtual human was, the more it provoked a sense of presence. In addition, at least some degree of physical immersion is needed to maintain anxiety levels over the course of VR exposure.     

Virtual and interactive environments for work of the future

Virtual reality (VR) systems and the virtual environments (VEs) experienced within them have presented challenges to human computer interaction over many years. The sheer range of different interfaces which might be experienced and of different behaviours which might be exhibited have caused difficulties in general understanding of participants’ performance within VR/VE and in providing coherent guidance for designers. We have recently completed a European Information Society Technologies (IST) project, Virtual and Interactive Environments for Workplaces of the Future (VIEW of the Future), which has made great strides in developing improved VR systems and interaction concepts and devices, based upon good understanding of participation in VEs. Particular emphasis in the VIEW of the Future project has been upon mobility and multiple active collaboration in use of VR/VE. This paper introduces a special issue devoted to this project and overviews the project as a whole. In doing so it also reviews some of the human factors issues defined for VR/VE over the years and the contribution of VIEW of the Future to addressing these.     

Physical ergonomics of virtual environment use

This paper describes an investigation of the types of problems that may be experienced by Virtual Reality (VR) users. Initial concerns have been voiced about various issues concerning the design of VR equipment, particularly the physical ergonomics of head-mounted displays (HMDs) and hand-held input devices, and the problems associated with display resolution and lags. This study investigated a number of VR users' perceptions of the types of physical ergonomics issues that they were aware of when participating in a number of different virtual environments (VEs), using different VR systems. Several different methods were employed, including questionnaires, body mapping, user observation and interviews. Issues highlighted as either causing participants discomfort or interfering with their experience of the VE were: discomfort from static posture requirements, general discomfort from wearing the HMD, difficulty becoming accustomed to 3D hand held input devices, dissatisfaction with deficits in the visual display and fear of getting 'tangled' in connecting cables. The implications of these findings for developers, implementers and users of VR are discussed.     

Attaching context-aware services to moving locations

User information and communication resources - such as precise location information and direction, altitude, light, and humidity measurements (via sensors) - are becoming more available in end devices. This increasing range of information can enable context-aware informational services as well as linking digital objects to physical objects a user is observing. Thus, mobile users can obtain relevant information about real-world objects while simultaneously staying in touch with other users. The author describes an open, scalable service architecture in which context-aware service negotiation lets entities establish communication and negotiate services without a third party's assistance and without advance knowledge of either party's features. Context information can help hide data complexity from users until they need to make choices regarding such things as payments or object interactions.     

Virtual reality in vestibular assessment and rehabilitation

Previous experiences on vestibular compensation showed that multisensorial stimulations affect postural unbalance recovery. Virtual Environment (VE) exposure seems very useful in vestibular rehabilitation, since the experience gained during VE exposure is transferable to the real world. The rearrangement of the hierarchy of the postural cues was evaluated in 105 patients affected by visual, labyrinthic and somatosensory pathology in normal conditions and during sensorial deprivation. They were divided into five groups according to pathology and compared to 50 normal controls. Our data show that VE exposure is a reliable method to identify the deficient subsystem and the level of substitution. Moreover, Virtual Reality (VR) would accelerate the compensation of an acute loss of labyrinthine function, related to adaptive modifications of the vestibulo-ocular and vestibulo-spinal reflexes, overstimulating the residual labyrinthine function. The residual labyrinthine function is poor in chronic bilateral vestibular deficit and VE exposure should provide sensory substitution or sensory motor reorganisation, thereby modulating the external spatial reference and promoting the reorganisation of the multiple sensory input. The potential for VE exposure perspectives seems very promising when dealing with the vestibular system where there is a continuous rearrangement of different sensorial informations as a result of environmental and age-related changes.     

Multiple decoupled interaction: An interaction design approach for groupware interaction in co-located virtual environments

Interactive visualizations such as virtual environments and their associated input and interface techniques have traditionally focused on localized single-user interactions and have lacked co-present active collaboration mechanisms where two or more co-located users can share and actively cooperate and interact with the visual simulation. VR facilities such as CAVEs or PowerWalls, among many others, seem to promise such collaboration but due to the special requirements in terms of 3D input and output devices and the physical configuration and layout, they are generally designed to support an active controlling participant—the immersed user—and a passive viewing only audience. In this paper we explore the integration of different technologies, such as small handheld devices and wireless networks with VR/VEs in order to develop a technical and conceptual interaction approach that allows creation of a more ad hoc, interaction rich, multimodal and multi-device environment, where multiple users can access certain interactive capabilities of VE and support co-located collaboration.     

Perceiving affordances in virtual reality: influence of person and environmental properties in perception of standing on virtual grounds

We evaluated the perception of affordances in virtual environments (VE). In our work, we considered the affordances for standing on a virtual slanted surface. Participants were asked to judge whether a virtual slanted surface supported upright stance. The objective was to evaluate whether this perception was possible in virtual reality (VR) and comparable to previous works conducted in real environments. We found that the perception of affordances for standing on a slanted surface in virtual reality is possible and comparable (with an underestimation) to previous studies conducted in real environments. We also found that participants were able to extract and to use virtual information about friction in order to judge whether a slanted surface supported an upright stance. Finally, results revealed that the person’s position on the slanted surface is involved in the perception of affordances for standing on virtual grounds. Taken together, our results show quantitatively that the perception of affordances can be effective in virtual environments and influenced by both environmental and person properties. Such a perceptual evaluation of affordances in VR could guide VE designers to improve their designs and to better understand the effect of these designs on VE users.     

Postural instability induced by virtual reality exposure: development of a certification protocol

Exposure to virtual environments often causes users to experience symptoms of motion sickness. An accessory manifestation of motion sickness symptoms is postural disequilibrium. If the postural disequilibrium that occurs persists beyond the time an individual is within the confines of the laboratory or system site, user safety could be compromised and products liability issues could be forthcoming. In this study, a portable, automated postural assessment system is developed that can be employed before and after exposure to a virtual reality (VR) system in order to certify that a user's balance on exiting the system is at least demonstrably as good as it was on entering. It is argued that if the "coming out" balance performance is sufficiently poorer than the "going in" balance, then the user should be retained until the pretest balance performance is regained. The results from a set of normative and validation experiments on postural equilibrium identified several reliable measures of stance that could serve as a basis for certification. Furthermore, a new automated video-based measure using only head movement showed that performance over sessions is stable and reliable. The head movement changes that occur with stimuli, such as alcohol and simulator exposure, are well behaved, predictable, and significant even with small samples. The implication is that the proposed objective measure of postural stability, in conjunction with procedures for obtaining self-reports of symptoms, can afford some measure of certification that exposure to a given VR system is without harm.     

Mild stress stimuli built into a non-immersive virtual environment can elicit actual stress responses

The experience of Virtual Reality (VR) can lead to unwanted or wanted psychological stress reactions. Highly immersive VR games for instance utilise extreme, life-threatening, or dangerous situations to achieve those responses from their players. There is also sufficient evidence that in clinical settings and specific situations, such as fear of heights or post-traumatic stress, virtual stimuli can lead to perceived stress for clients. However, there is a gap in research targeting everyday, mild emotional stimuli, which are neither extreme nor specific and which are not presented in an immersive system. To what extent can common stimuli in a non-immersive virtual environment elicit actual stress reactions for its users? We developed a desktop VR system and evaluated it in a study with 54 participants. We could show that virtual stimuli in a common, domestic family environment led to a significant increase in perceived stress as measured by quantitative (self-reports) and qualitative (semi-structured interviews analysed with a General Inductive Approach (GIA)) responses. The results also showed that the introduction of virtual stimuli induced significantly higher levels of perceived workload and sense of presence and led to different physiological reactions. These findings have implications for the design and implementation of non-immersive VR systems.     

Development and evaluation of BCI for operating VR flight simulator based on desktop VR equipment

Advancement of brain-computer interface (BCI) has shown its applications in various scenarios, including flight control. Flight simulator is a crucial part for aircraft design or experiment. Desktop virtual reality (VR)-based flight is a perfect choice for overcoming existing problems in head-mounted VR flight simulations, such as dizziness and isolation, which make interaction and sharing very difficult. In this paper, a BCI based on the steady-state visual evoked potential paradigm and a VR flight simulator were developed and integrated. The performance of the developed system was evaluated quantitatively for comparative studies. Experimental results show that the developed system is very convenient and suitable for VR flight simulations. The average operating accuracies with plane and VR visual stimuli are 81.6% and 86.8%, respectively. The VR visual stimuli can improve the average operating accuracy by 5.2% compared with the plane visual stimuli.     

The role of presence in the level of anxiety experienced in clinical virtual environments

Recent reviews point towards that Virtual Reality Exposure Therapy (VRET) can be an effective medium to provide exposure therapy for anxiety disorders. The concept of presence, usually defined as the sense of being inside the virtual environment, has been considered the principal mechanism that leads to the experience of anxiety in clinical virtual environments. The present study sought to examine the relationship between sense of presence and in-session anxiety in a sample of 210 students showing high and low test anxiety when exposed to both clinical and non-stressful virtual environments. This is the largest study conducted to date with the aim of examining the relationship between presence and anxiety in clinical virtual environments, and the first to explore separately the relationship between presence and state-anxiety in phobic and non-phobic participants. The results suggest that presence was not related to anxiety in a non-stressful environment. It was also found that although presence is related to anxiety in both groups of students when exposed to clinical virtual environments, this relationship was clearly stronger for high test anxiety students. This line of research will broaden our understanding of the mechanisms that lead to the efficacy of VRET.     

Virtual hell: a trip through the flames

In immersive virtual environments, our eyes and ears are usually the most important channels of perception. However, you might expect that their creators would include other senses in VEs so as to represent the largest range of stimuli. After all, humans are creatures of many senses and rely upon all of them in day-to-day living. In crafting virtual worlds for exploration, VE developers usually aim for as much realism as possible given the constraints of equipment and cost. Unfortunately, force and tactile feedback still have a long way to go, although tactile feedback models can simulate local geometry, texture reproduction, and heat flux and temperature for replicating collision detection. To investigate the latter options, I developed a complete thermal feedback system, the VR Thermal Kit, which includes different components to model, control, and physically generate stimuli on the operator's skin (usually the hand and exposed parts of the body). The results of my study concentrate on interaction paradigms and haptic rendering. They also enhance the level of immersion