At the end of the 6th session

At the end of the 6th session Relapse prevention :

what have you learned ? what are your high risk situations ? lapse vs relapse :

a lapse is a source of information about what went wrong… and your reaction could turn a lapse into a relapse.

From virtual to physical reality : Plan self-exposure homework in necessary.

Fostering Presence / Anxiety

Talk in «non virtual» terms.«Walk toward the table and then please close the door».

Highlight useful virtual stimuli.«Ouch, it’s a big spider… its legs are so long… and its looking at you». «Let the spider walk on the wall behind you».

Give the participant some «story line».«Somebody collects spiders in that apartment and we’ll visit it for awhile».

Suggest sensations when you talk.«It feels cold in here … bend over if you don’t want to hit your head on the lamp».

1997: Fear of Flying

Aviophobia: 30 phobics (Wiederhold BK, Wiederhold MD, 1999)

3 groupsVR Exposure with NO physiological

feedbackVR Exposure WITH physiological feedbackImaginal exposure therapy (VIZ)

2 sessions breathing retraining6 sessions of exposure

Behavioral Outcome – 3 month Behavioral Outcome – 3 month follow-upfollow-up

0123456789

10

# of

Par

ticip

ants

Flying without meds

VR + PhysioVR AloneVIZ

Behavioral Outcome – 3 year Behavioral Outcome – 3 year follow-upfollow-up

0123456789

10

# of

Par

tici

pan

ts

Flying without meds

VR + PhysioVR AloneVIZ

VRMC Video Clip: Aviophobia

Airport: Side by Side ShotsAirport: Side by Side ShotsReal Unreal (Tournament)

Fear of Flying: Anticipatory Fear of Flying: Anticipatory AnxietyAnxiety

Controlled Studies: n > Controlled Studies: n > 88

AuthorAuthor CountryCountry YearYear # of Pts# of Pts Tx GrpsTx Grps

WiederholdWiederhold U.S.U.S. 19991999 3030 VR w/Fdbk, VR no Fdbk, VIZVR w/Fdbk, VR no Fdbk, VIZ

RothbaumRothbaum U.S.U.S. 20002000 4949 PC VR, PC VR, In vivo, In vivo, WLCWLC

BotellaBotella SpainSpain 20022002 1111 PC VR w/AnticipatoryPC VR w/Anticipatory

MaltbyMaltby U.S.U.S. 20022002 4545 VRE, VRE, In vivoIn vivo

WiederholdWiederhold U.S.U.S. 20022002 3030 VRGETno, VRGETpm, IETVRGETno, VRGETpm, IET

JangJang KoreaKorea 20022002 1111 Driving vs. FlyingDriving vs. Flying

WiederholdWiederhold U.S.U.S. 20022002 5858 Phobic, non-phobicPhobic, non-phobic

RothbaumRothbaum U.S.U.S. 20022002 4949 VR, SE, WLCVR, SE, WLC

WiederholdWiederhold U.S.U.S. 20032003 3030 VRGETno, VRGETpm, IETVRGETno, VRGETpm, IET

MuhlbergerMuhlberger GermanyGermany 20032003 4545 VRCBT, WLCVRCBT, WLC

BotellaBotella SpainSpain 20042004 99 Multiple baseline Multiple baseline

AviophobiaAviophobia

Controlled Studies: n > 8Controlled Studies: n > 8

Fear of Public SpeakingFear of Public Speaking

AuthorAuthor CountryCountry YearYear # of Pts# of Pts Test GroupsTest Groups

NorthNorth U.S.U.S. 19981998 1616 PC VR, WLCPC VR, WLC

BotellaBotella SpainSpain 20012001 88 Internet-based PC VRInternet-based PC VR

PertaubPertaub U.K.U.K. 20012001 4343 Phobic, non-phobicPhobic, non-phobic

HarrisHarris U.S.U.S. 20022002 1414 VRT, WLCVRT, WLC

SlaterSlater U.K. U.K. 20042004 4040 Phobic, non-phobicPhobic, non-phobic

People React to Avatars’ Behaviors(Pertaub, Slater, & Barker, 2001, 2002)

Static audience

Positive audience

Negative audience

Subjects : 43 fear of public speaking patients - Randomly assigned to one of three

groups, distinguished by the type of virtual audience - Subjects have to talk in front of the virtual audience, at least twice.Scenario : 8 formally dressed avatars, seated around a tableThree variables :

2 designed to assess the degree of self-reported anxiety generated by experienceThe other to measure the speaker’s assessment of their performance.(With a modified form of the Personal Report of Confidence as a Speaker - MPRCS)

Pertaub, Slater & Barker (2001, 2002)

AnovaType of audience, p < .05Neutral > Positive = Negative, p < .05

0102030405060708090

100

Satis

fact

ion

tow

ards

the

perfo

rman

ce

Neutral Positive Negative

Type of audience

0

2

4

6

8

10

12

14

MP

RC

S

Neutral Positive Negative

Type of audience

ANCOVA (estimated from data in the paper)Type of audience, p < .05Negative > positive = neutral.

Public Speaking Virtual Public Speaking Virtual EnvironmentEnvironment

Controlled Studies: n > 8Controlled Studies: n > 8

Needle PhobiaNeedle Phobia

AuthorAuthor CountryCountry YearYear # of Pts# of Pts Test GroupsTest Groups

HamzaHamza South South AfricaAfrica

20002000 1616 Needle phobicNeedle phobic

Virtual Environment

Polar view of the Polar view of the layout of the virtual layout of the virtual student healthstudent health

Virtual ScenarioSimulation of a doctor’s

appointment Two types of exposure to

the injectionInjection lying on the

further end of the doctor’s desk

Simulation of the injecting procedure:Doctor applies a virtual

swab to the avatar's arm and injects the needle

Highest Mean heart rate is when the injection is moving closer to the arm (i.e., situation INJ2 = 95.08 beats per minute)

Decrease in heart rate in INJ3

Mean Heart rate for the first 6 situations did not vary much

Heart Rate at Various StagesHeart Rate at Various Stages140140

120120

100100

6060

4040

8080

Mean Heart Mean Heart RateRate

Various StagesVarious Stages

Desk1 Desk3Desk2

SwabArmUp INJ3INJ1

INJ2

SUDS at Various Stages

Various StagesVarious Stages

Mean Mean

SUDSSUDS

88

77

66

55

44

33

22

11

• As patients moved As patients moved closer to the needle, closer to the needle, mean SUD increasedmean SUD increased

• Mean SUDS Mean SUDS decreased between decreased between when the patient has when the patient has raised his/her arm and raised his/her arm and after swab is applied after swab is applied

3.65

4.6

Desk1Desk1Desk2Desk2

Desk3Desk3ArmUpArmUp

SwabSwabINJ1INJ1

INJ2INJ2INJ3INJ3

5.175.05

4.5

5.716.0

4.41

Scripps Clinic Movie Clip

Controlled Studies: Controlled Studies: n > 8n > 8

AuthorAuthor CountryCountry YearYear # of Pts# of Pts Tx GrpsTx Grps

Hodges, NorthHodges, North U.S.U.S. 19951995 1717 SG VR, WLCSG VR, WLC

LamsonLamson U.S.U.S. 19951995 99 SG VR, WLCSG VR, WLC

BullingerBullinger SwitzerlandSwitzerland 19971997 88 SG VR, SG VR, In vivoIn vivo

HuangHuang U.S.U.S. 19981998 1010 CAVE, CAVE, In vivoIn vivo

EmmelkampEmmelkamp NetherlandsNetherlands 19991999 1010 PC VR, PC VR, In vivoIn vivo

EmmelkampEmmelkamp NetherlandsNetherlands 20022002 3333 PC VR, PC VR, In vivoIn vivo

EmmelkampEmmelkamp NetherlandsNetherlands 20022002 3737 PC VR , CAVE, WLCPC VR , CAVE, WLC

BouchardBouchard CanadaCanada 20022002 88 VideogameVideogame VR VR

SirbuSirbu U.S.U.S. 20042004 3030 Stroop Physio, VR Physio, Stroop Physio, VR Physio, In vivoIn vivo

AcrophobiaAcrophobia

Virtual Reality Research Set-up

Physiological Differentiation in Participants with High and Low Fear Scores Exposed to a VR Heights

Environment (Wiederhold, Wilhelm, Nguyen, Kim, & Gross)

Protocol Participants stood on a platform in a darkened room 5-minute baseline

Viewed neutral film through HMD 15-minute VR exposure Post-exposure, participants completed self-report

questionnaires to identify a number of physiological sensations and emotions

Measures

Self-Reported Anxiety HR: Heart Rate MAP: Mean Arterial Blood

Pressure FPA: Finger Pulse Amplitude FPTT: Finger Pulse Transit

Time EPA: Ear Pulse Amplitude

EPTT: Ear Pulse Transit Time

TEMP: Peripheral Skin Temperature

SCL: Skin Conductance Levels

RR: Respiratory Rate TV: Tidal Volume ACT: Somatic Activity

Acrophobia: Fear of Heights

Self-Reported Anxiety

0

1

2

3

4

5

6

7

8

0 2 4 6 8 10 12 14

Minute

An

xiet

y R

atin

g (

0-10

)

High Acrophobia

Low Acrophobia

70

75

80

85

90

95

100

0 2 4 6 8 10 12 14

Minute

Hea

rt R

ate

High Acrophobia

Low Acrophobia

Heart RateHeart Rate

Acrophobia: Fear of Heights

SUDS = 0-10

Skin Conductance

5

6

7

8

9

10

11

12

0 2 4 6 8 10 12 14

Minute

SC

L

High Acrophobia

Low Acrophobia

Desynchrony/Discordance: HR & Self-Report

0

1

2

3

4

5

6

7

8

0 2 4 6 8 10 12 14

Minute

An

xiet

y R

atin

g (

0-10

)

High Acrophobia

Low Acrophobia

70

75

80

85

90

95

100

0 2 4 6 8 10 12 14

Minute

Hea

rt R

ate

High Acrophobia

Low Acrophobia

Acrophobia: Fear of Heights

Synchrony/Concordance: Skin Conductance & Self-Report

0

1

2

3

4

5

6

7

8

0 2 4 6 8 10 12 14

Minute

An

xiet

y R

atin

g (

0-10

)

High Acrophobia

Low Acrophobia

5

6

7

8

9

10

11

12

0 2 4 6 8 10 12 14

Minute

SC

L

High Acrophobia

Low Acrophobia

Acrophobia: Fear of Heights

Mean Arterial Blood Pressure

80

85

90

95

100

105

0 2 4 6 8 10 12 14

Minute

Mea

n A

rter

ial B

loo

d P

ress

ure

High Acrophobia

Low Acrophobia

190

195

200

205

210

215

220

0 2 4 6 8 10 12 14

Minute

EP

TT

High Acrophobia

Low Acrophobia

Ear Pulse Transit Time

Acrophobia: Fear of Heights

Summary Results

Self-reported Anxiety Blood pressure Skin conductance Somatic activity Respiration rate

(both)

Ear pulse transit time (indicative of greater sympathetic activation)

Heart Rate (result of compensatory changes driven by the blood pressure changes?)

Increased:Increased: Decreased:Decreased:

Acrophobia: Fear of Heights

Side by Side Side by Side PicturesPictures

Real Virtual Reality

Acrophobia: Fear of Heights

Acrophobia: Cable Car

Acrophobia: Fear of Heights