Desensitizing Anxiety Through Imperceptible Change: Feasibility Study on a Paradigm for Single-Session Exposure Therapy for Fear of Public Speaking.

BACKGROUND: Exposure therapy (ET) for anxiety disorders involves introducing the participant to an anxiety-provoking situation over several treatment sessions. Each time, the participant is exposed to a higher anxiety-provoking stimulus; for example, in the case of fear of heights, the participant would successively experience being at a greater height. ET is effective, and its counterpart, virtual reality (VR) exposure therapy (VRET), where VR substitutes real-world exposure, is equally so. However, ET is time-consuming, requiring several sessions. OBJECTIVE: This study aimed to compare the results of single-session exposure with those of traditional VRET with regard to reducing public speaking anxiety. METHODS: We introduced a paradigm concerned with public speaking anxiety where the VR exposure occurred in a single session while the participant interacted with a virtual therapist. Over time, the therapist transformed into an entire audience with almost imperceptible changes. We carried out a feasibility study with 45 participants, comparing 3 conditions: single-session exposure (n=16, 36%); conventional multiple-session exposure (n=14, 31%), where the same content was delivered in successive segments over 5 sessions; and a control group (n=15, 33%), who interacted with a single virtual character to talk about everyday matters. A week later, the participants were required to speak on a stage in front of a large audience in VR. RESULTS: Across most of the series of conventional public speaking anxiety measures, the single-session exposure was at least as effective in reducing anxiety as the multiple-session exposure, and both these conditions were better than the control condition. The 12-item Personal Report of Confidence as a Speaker was used to measure public speaking anxiety levels, where higher values indicated more anxiety. Using a Bayesian model, the posterior probabilities of improvement compared to a high baseline were at least 1.7 times greater for single- and multiple-session exposures compared to the control group. The State Perceived Index of Competence was used as a measure of anticipatory anxiety for speaking on a stage in front of a large audience, where lower values indicated higher anxiety. The probabilities of improvement were just over 4 times greater for single- and multiple-session exposures compared to the control group for a low baseline and 489 (single) and 53 (multiple) times greater for a middle baseline. CONCLUSIONS: Overall, the results of this feasibility study show that for moderate public speaking anxiety, the paradigm of gradual change in a single session is worth following up with further studies with more severe levels of anxiety and a larger sample size, first with a randomized controlled trial with nonpatients and subsequently, if the outcomes follow those that we have found, with a full clinical trial with patients.

Using virtual reality to assess gesture performance deficits in schizophrenia patients.

Introduction: Gesture performance deficits are prevalent in schizophrenia patients and are strongly associated with poor social communication skills and community functioning, affecting their overall quality of life. Currently, video-recording technology is widely used in clinical settings to assess gesture production deficits in schizophrenia patients. Nevertheless, the subjective evaluation of video-recordings can encumber task assessment. The present study will aim to use virtual reality to examine its potential use as an alternative tool to objectively measure gesture performance accuracy in schizophrenia patients and healthy controls. Methods: Gesture performance in the virtual reality setting will be based on the well-established Test of Upper Limb Apraxia. Participants will be immersed in a virtual environment where they will experience themselves being embodied in a collocated virtual body seen from a first-person perspective. Motion trackers will be placed on participants' hands and elbows to track upper body movements in real-time, and to record gesture movement for later analysis. Participants will see a virtual agent sitting across from them, with a virtual table in between. The agent will perform various types of gestures and the participants' task will be to imitate those gestures as accurately as possible. Measurements from the tracking devices will be stored and analyzed to address gesture performance accuracy across groups. Discussion: This study aims to provide objective measurements of gesture performance accuracy in schizophrenia patients. If successful, the results will provide new knowledge to the gesture literature and offer the potential for novel therapeutic interventions using virtual reality technologies. Such interventions can improve gesturing and thus advance social communication skills in schizophrenia patients.

The sentiment of a virtual rock concert.

We created a virtual reality version of a 1983 performance by Dire Straits, this being a highly complex scenario consisting of both the virtual band performance and the appearance and behaviour of the virtual audience surrounding the participants. Our goal was to understand the responses of participants, and to learn how this type of scenario might be improved for later reconstructions of other concerts. To understand the responses of participants we carried out two studies which used sentiment analysis of texts written by the participants. Study 1 (n = 25) (Beacco et al. in IEEE Virtual Reality: 538-545, 2021) had the unexpected finding that negative sentiment was caused by the virtual audience, where e.g. some participants were fearful of being harassed by audience members. In Study 2 (n = 26) notwithstanding some changes, the audience again led to negative sentiment-e.g. a feeling of being stared at. For Study 2 we compared sentiment with questionnaire scores, finding that the illusion of being at the concert was associated with positive sentiment for males but negative for females. Overall, we found sentiment was dominated by responses to the audience rather than the band. Participants had been placed in an unusual situation, being alone at a concert, surrounded by strangers, who seemed to pose a social threat for some  of them. We relate our findings to the concept of Plausibility, the illusion that events and situations in the VR are really happening. The results indicate high Plausibility, since the negative sentiment, for example in response to being started at, only makes sense if the events are experienced as actually happening. We conclude with the need for co-design of VR scenarios, and the use of sentiment analysis in this process, rather than sole reliance on concepts proposed by researchers, typically expressed through questionnaires, which may not reflect the experiences of participants. Supplementary Information: The online version contains supplementary material available at 10.1007/s10055-022-00685-9.

Self-observation of a virtual body-double engaged in social interaction reduces persecutory thoughts.

The proportion of the population who experience persecutory thoughts is 10-15%. People then engage in safety-seeking behaviours, typically avoiding social interactions, which prevents disconfirmatory experiences and hence paranoia persists. Here we show that persecutory thoughts can be reduced if prior to engaging in social interaction in VR participants first see their virtual body-double doing so. Thirty non-clinical participants were recruited to take part in a study, where they were embodied in a virtual body that closely resembled themselves, and asked to interact with members of a crowd. In the Random condition (n = 15) they observed their body-double wandering around but not engaging with the crowd. In the Targeted condition the body-double correctly interacted with members of the crowd. The Green Paranoid Thoughts Scale was measured 1 week before and 1 week after the exposure and decreased only for those in the Targeted condition. The results suggest that the observation of the body-double correctly carrying out a social interaction task in VR may lead to anxiety-reducing mental rehearsal for interaction thus overcoming safety behaviours. The results also extend knowledge of the effects of vicarious agency, suggesting that identification with the actions of body-double can influence subsequent psychological state.

Evaluating participant responses to a virtual reality experience using reinforcement learning.

Virtual reality applications depend on multiple factors, for example, quality of rendering, responsiveness, and interfaces. In order to evaluate the relative contributions of different factors to quality of experience, post-exposure questionnaires are typically used. Questionnaires are problematic as the questions can frame how participants think about their experience and cannot easily take account of non-additivity among the various factors. Traditional experimental design can incorporate non-additivity but with a large factorial design table beyond two factors. Here, we extend a previous method by introducing a reinforcement learning (RL) agent that proposes possible changes to factor levels during the exposure and requires the participant to either accept these or not. Eventually, the RL converges on a policy where no further proposed changes are accepted. An experiment was carried out with 20 participants where four binary factors were considered. A consistent configuration of factors emerged where participants preferred to use a teleportation technique for navigation (compared to walking-in-place), a full-body representation (rather than hands only), the responsiveness of virtual human characters (compared to being ignored) and realistic compared to cartoon rendering. We propose this new method to evaluate participant choices and discuss various extensions.

Exploring the Effect of Cooperation in Reducing Implicit Racial Bias and Its Relationship With Dispositional Empathy and Political Attitudes.

Previous research using immersive virtual reality (VR) has shown that after a short period of embodiment by White people in a Black virtual body, their implicit racial bias against Black people diminishes. Here we tested the effects of some socio-cognitive variables that could contribute to enhancing or reducing the implicit racial bias. The first aim of the study was to assess the beneficial effects of cooperation within a VR scenario, the second aim was to provide preliminary testing of the hypothesis that empathy and political attitudes could contribute to implicit bias about race, while the third aim was to explore the relationship between political attitudes and empathy. We had (Caucasian) participants embodied in a Black virtual body and engaged either in a cooperative (Coop group) or in a non-cooperative (Neutral group) activity with a confederate experimenter embodying another Black avatar. Before and after VR, we measured participants' implicit racial bias by means of Implicit Association Test (IAT) and their perceived closeness toward the confederate experimenter. Before VR we also assessed participants' political attitudes and empathy traits. Results revealed that, as compared to the Neutral group, the Coop group showed lower IAT scores after the social interaction. Interestingly, in the Neutral but not the Coop group the perceived closeness toward the confederate experimenter was associated with the initial racial bias: the more the participants reduced their distance, the more they reduced their IAT score. Moreover, reported traits of empathy and political attitudes significantly explained the variance observed in the initial implicit bias, with perspective-taking, empathic concern, and personal distress being significant predictors of the IAT scores. Finally, there was a relationship between political attitudes and empathy: the more participants considered themselves as left-wing voters, the higher their perspective-taking and empathic concern scores. We discuss these findings within the neuroscientific and social cognition field and encourage scholars from different domains to further explore whether and under which conditions a given manipulation for reducing racial bias could be efficiently transposed in VR.

Social Conformity in Immersive Virtual Environments: The Impact of Agents' Gaze Behavior.

Immersive virtual reality (IVR) can induce an experience of "social presence" which can, in turn, increase social influence. Non-verbal behavior such as eye contact is an important component of human communication and, therefore, an important factor in creating social presence. This paper presents an experimental study that elaborates social influence through conformity with a group of virtual agents within an immersive virtual environment (IVE). Specifically, it investigates the impact of the agents' gaze behavior on social presence and influence. An experiment based on the Asch (1951) paradigm using two levels of agents' gaze behavior (Eye Contact condition vs. No-Eye Contact condition) was conducted. The results showed that participants conformed with the agents as they gave significantly more incorrect responses to the trials that the agents also gave an incorrect response, compared to those trials that the agents gave correct answers. However, no impact of the agents' gaze behavior on conformity was observed, even if the participants in the Eye Contact condition reported a higher sense of social presence. In addition, self-reported measures showed a number of social effects that occurred only in the eye contact condition, indicating that the agents' gaze behavior has an impact on participants' experience.

Virtual body ownership and its consequences for implicit racial bias are dependent on social context.

When people hold implicit biases against a group they typically engage in discriminatory behaviour against group members. In the context of the implicit racial bias of 'White' against 'Black' people, it has been shown several times that implicit bias is reduced after a short exposure of embodiment in a dark-skinned body in virtual reality. Embodiment usually leads to the illusion of ownership over the virtual body, irrespective of its skin colour. Previous studies have been carried out in virtual scenarios that are affectively neutral or positive. Here, we show that when the scenario is affectively negative the illusion of body ownership of White participants over a White body is lessened, and implicit bias is higher for White participants in a Black virtual body. The study was carried out with 92 White female participants, in a between-groups design with two factors: BodyType (their virtual body was White or Black) and a surrounding Crowd was Negative, Neutral or Positive towards the participant. We argue that negative affect prevents the formation of new positive associations with Black and distress leads to disownership of the virtual body. Although virtual reality is often thought of as an 'empathy machine' our results suggest caution, that this may not be universally the case.

A mechanistic account of bodily resonance and implicit bias.

Implicit social biases play a critical role in shaping our attitudes towards other people. Such biases are thought to arise, in part, from a comparison between features of one's own self-image and those of another agent, a process known as 'bodily resonance'. Recent data have demonstrated that implicit bias can be remarkably plastic, being modulated by brief immersive virtual reality experiences that place participants in a virtual body with features of an out-group member. Here, we provide a mechanistic account of bodily resonance and implicit bias in terms of a putative self-image network that encodes associations between different features of an agent. When subsequently perceiving another agent, the output of this self-image network is proportional to the overlap between their respective features, providing an index of bodily resonance. By combining the self-image network with a drift diffusion model of decision making, we simulate performance on the implicit association test (IAT) and show that the model captures the ubiquitous implicit bias towards in-group members. We subsequently demonstrate that this implicit bias can be modulated by a simulated illusory body ownership experience, consistent with empirical data; and that the magnitude and plasticity of implicit bias correlates with self-esteem. Hence, we provide a simple mechanistic account of bodily resonance and implicit bias which could contribute to the development of interventions for reducing the negative evaluation of social out-groups.

Virtually Being Einstein Results in an Improvement in Cognitive Task Performance and a Decrease in Age Bias.

The brain's body representation is amenable to rapid change, even though we tend to think of our bodies as relatively fixed and stable. For example, it has been shown that a life-sized body perceived in virtual reality as substituting the participant's real body, can be felt as if it were their own, and that the body type can induce perceptual, attitudinal and behavioral changes. Here we show that changes can also occur in cognitive processing and specifically, executive functioning. Fifteen male participants were embodied in a virtual body that signifies super-intelligence (Einstein) and 15 in a (Normal) virtual body of similar age to their own. The Einstein body participants performed better on a cognitive task than the Normal body, considering prior cognitive ability (IQ), with the improvement greatest for those with low self-esteem. Einstein embodiment also reduced implicit bias against older people. Hence virtual body ownership may additionally be used to enhance executive functioning.

Author Correction: Embodiment in a Child-Like Talking Virtual Body Influences Object Size Perception, Self-Identification, and Subsequent Real Speaking.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

Reducing risk and improving maternal perspective-taking and empathy using virtual embodiment.

The ability to perspective-take (cognitive awareness of another's state) and empathise (emotional/affective response) are important characteristics for sensitive, co-operative and constructive parenting, which assists in developing adaptive functioning for children. For the first time, immersive virtual reality was used to place parents in the position of a child in order to assess impact on perspective-taking and empathy. This novel study was conducted with 20 non-high risk Spanish mothers (a pilot study with 12 mothers is reported in supplementary files). Mothers were virtually embodied as a 4-year-old child, experienced from the first-person perspective and with virtual and real body movements synchronised. They interacted with a 'mother avatar', which responded either in a Positive or Negative way. Participants reported a strong body ownership illusion for the child body that led to cognitive, emotional and physical reactions. Experiencing negative maternal behavior increased levels of empathy. In addition, the Negative mother led to increased feelings of fear of violence. Physiological data indicated greater stress in the Negative than Positive condition. Although further research is required to assess the effectiveness of such methods, any improvement in empathy that leads to a change in parenting behavior has the potential to impact on developmental outcomes for children.

Embodiment in a virtual body that speaks produces agency over the speaking but does not necessarily influence subsequent real speaking.

Previous results have shown that body ownership, induced through first-person perspective (1PP) over a virtual body (VB) that moves synchronously with real body movements, can lead to illusory agency over VB utterances even though the participant does not speak. It was also found that when participants later speak they follow the fundamental frequency (FF) of the voice of their VB, indicating a new motor plan for speaking. To eliminate the contribution of veridical agency over the VB movements, we conducted a study where we induced body ownership using visuotactile (VT) synchrony rather than visuomotor. Participants saw a life-sized VB from 1PP and reflected in a virtual mirror, that spoke with corresponding lip movements. Half of the 36 experimental participants experienced synchronous (Sync) passive VT on their hands and abdomen, and the other half asynchronous (Async). We found that both VT Sync and Async conditions resulted in a strong subjective illusion of body ownership and agency over the VB, but not, however, changes in voice FF in subsequent speaking. This shows that although illusory agency may be associated with body ownership, a change in motor plan is likely to be a generalisation from veridical agency over whole body movements.

Embodiment in a Child-Like Talking Virtual Body Influences Object Size Perception, Self-Identification, and Subsequent Real Speaking.

People's mental representations of their own body are malleable and continuously updated through sensory cues. Altering one's body-representation can lead to changes in object perception and implicit attitudes. Virtual reality has been used to embody adults in the body of a 4-year-old child or a scaled-down adult body. Child embodiment was found to cause an overestimation of object sizes, approximately double that during adult embodiment, and identification of the self with child-like attributes. Here we tested the contribution of auditory cues related to one's own voice to these visually-driven effects. In a 2 × 2 factorial design, visual and auditory feedback on one's own body were varied across conditions, which included embodiment in a child or scaled-down adult body, and real (undistorted) or child-like voice feedback. The results replicated, in an older population, previous findings regarding size estimations and implicit attitudes. Further, although auditory cues were not found to enhance these effects, we show that the strength of the embodiment illusion depends on the child-like voice feedback being congruent or incongruent with the age of the virtual body. Results also showed the positive emotional impact of the illusion of owning a child's body, opening up possibilities for health applications.

Virtual Embodiment of White People in a Black Virtual Body Leads to a Sustained Reduction in Their Implicit Racial Bias.

Virtual reality can be used to visually substitute a person's body by a life-sized virtual one. Such embodiment results in a perceptual illusion of body ownership over the virtual body (VB). Previous research has shown that the form of the VB can influence implicit attitudes. In particular, embodying White people in a Black virtual body is associated with an immediate decrease in their implicit racial bias against Black people. We tested whether the reduction in implicit bias lasts for at least 1 week and whether it is enhanced by multiple exposures. Two experiments were carried out with a total of 90 female participants where the virtual body was either Black or White. Participants were required to follow a virtual Tai Chi teacher who was either Asian or European Caucasian. Each participant had 1, 2, or 3 exposures separated by days. Implicit racial bias was measured 1 week before their first exposure and 1 week after their last. The results show that implicit bias decreased more for those with the Black virtual body than the White. There was also some evidence of a general decrease in bias independently of body type for which possible explanations are put forward.

Body ownership causes illusory self-attribution of speaking and influences subsequent real speaking.

When we carry out an act, we typically attribute the action to ourselves, the sense of agency. Explanations for agency include conscious prior intention to act, followed by observation of the sensory consequences; brain activity that involves the feed-forward prediction of the consequences combined with rapid inverse motor prediction to fine-tune the action in real time; priming where there is, e.g., a prior command to perform the act; a cause (the intention to act) preceding the effect (the results of the action); and common-sense rules of attribution of physical causality satisfied. We describe an experiment where participants falsely attributed an act to themselves under conditions that apparently cannot be explained by these theories. A life-sized virtual body (VB) seen from the first-person perspective in 3D stereo, as if substituting the real body, was used to induce the illusion of ownership over the VB. Half of the 44 experimental participants experienced VB movements that were synchronous with their own movements (sync), and the other half asynchronous (async). The VB, seen in a mirror, spoke with corresponding lip movements, and for half of the participants this was accompanied by synchronous vibrotactile stimulation on the thyroid cartilage (Von) but this was not so for the other half. Participants experiencing sync misattributed the speaking to themselves and also shifted the fundamental frequency of their later utterances toward the stimulus voice. Von also contributed to these results. We show that these findings can be explained by current theories of agency, provided that the critical role of ownership over the VB is taken into account.

Illusory ownership of a virtual child body causes overestimation of object sizes and implicit attitude changes.

An illusory sensation of ownership over a surrogate limb or whole body can be induced through specific forms of multisensory stimulation, such as synchronous visuotactile tapping on the hidden real and visible rubber hand in the rubber hand illusion. Such methods have been used to induce ownership over a manikin and a virtual body that substitute the real body, as seen from first-person perspective, through a head-mounted display. However, the perceptual and behavioral consequences of such transformed body ownership have hardly been explored. In Exp. 1, immersive virtual reality was used to embody 30 adults as a 4-y-old child (condition C), and as an adult body scaled to the same height as the child (condition A), experienced from the first-person perspective, and with virtual and real body movements synchronized. The result was a strong body-ownership illusion equally for C and A. Moreover there was an overestimation of the sizes of objects compared with a nonembodied baseline, which was significantly greater for C compared with A. An implicit association test showed that C resulted in significantly faster reaction times for the classification of self with child-like compared with adult-like attributes. Exp. 2 with an additional 16 participants extinguished the ownership illusion by using visuomotor asynchrony, with all else equal. The size-estimation and implicit association test differences between C and A were also extinguished. We conclude that there are perceptual and probably behavioral correlates of body-ownership illusions that occur as a function of the type of body in which embodiment occurs.