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| Bird's eye view on the tower's top-level platform (50 m). The heatmap shows differences in group movement behavior comparing low height anxious (LHA, blue) and high height anxious (HHA, red) participants. Participants started on a solid platform and had the task to walk over a metal mesh as close to the railing as they wanted. Blue areas indicate that more LHA participants walked there, whereas red areas indicate that more HHA participants were there. The more intense a color is, the greater the relative difference between both groups.
Source publication
Acrophobia is characterized by intense fear in height situations. Virtual reality (VR) can be used to trigger such phobic fear, and VR exposure therapy (VRET) has proven effective for treatment of phobias, although it remains important to further elucidate factors that modulate and mediate the fear responses triggered in VR. The present study asses...
Context in source publication
Context 1
... behavior on the tower's top-level platform was analyzed by comparing the covered distance from the starting position to the railing between groups. The independent samples t-test returned that the LHA group (M = 2.47, SD = 0.53) was able to move significantly closer to the railing than the HHA group (M = 2.01, SD = 0.81), t (97) = 3.22, p = 0.002, d = 0.65 (see Figure 3). ...
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Citations
... However, the definitions of presence and its subcomponents have varied across studies, creating ambiguities as researchers seek to understand presence in the interactive marketing (Cummings & Bailenson, 2016;Kim & Biocca, 1997;Lombard & Ditton, 1997;Schubert et al., 2001;Wirth et al., 2007;Witmer & Singer, 1998). For instance, some research has suggested that presence is one dimension of immersion (Deng et al., 2020;Grinberg et al., 2014;Naul & Liu, 2020) or an indication that immersion has been experienced (Georgiou et al., 2019;Gromer et al., 2018). Cummings and Bailenson's (2016) meta-analysis further added evidence supporting this view. ...
... In contrast, potentially negative consequences of presence, such as negative feelings coming from branded experience and side effects of the system design, may receive less attention (Feng, 2018;Li et al., 2002). In the meantime, evidence has mounted from other fields suggesting that a stronger sense of presence may also trigger and amplify negative emotions, such as anger (Miyahira et al., 2010;van Gelder et al., 2019), anxiety (Renaud, 2002), and fear (Gromer et al., 2018). There have also been concerns related to the role of presence in system-induced nausea, sickness, and disorientation (Baños et al., 2004;Chowdhury et al., 2017;Ling et al., 2013). ...
... In addition, the review suggested paying more attention to the contentinduced negative affective responses (Chowdhury et al., 2017). Research from other fields found that presence amplifies negative emotions, such as anxiety and fear (Gromer et al., 2018;Renaud et al., 2002). However, another line of research proposed that the effect of presence followed the prediction of the transportation imagination model and suggested that users who feel a higher level of presence should produce less critical thoughts and counterarguments, resulting in better affective responses and persuasive outcomes (Breves, 2021;Oh & Jin, 2018;Oh et al., 2020). ...
Interactive marketing has greatly benefited from advances in immersive technologies, like virtual reality, as they provide consumers with marketing experiences that transcend the constraints associated with more traditional media. Consumers’ feelings of being “there” in a mediated environment further increase the effectiveness of the immersive experience, making the concept of “presence” a central process of interest to researchers and practitioners in interactive marketing. In this chapter, the authors conduct a systematic review of presence within the interactive marketing literature, focusing on its conceptual development and empirical outcomes. This review revealed key components in a theoretical framework of presence, including its technological antecedents (e.g., sensory breadth), associated subdimensions (e.g., ecological validity), and cognitive processes (e.g., self-location and action possibilities). This review also suggests that the cognitive processes associated with presence are relatively understudied, including the impact of presence on consumers’ positive and negative affective responses toward the system, marketing content, and self-perception, as well as inconsistent findings concerning memory and the influence of presence on behavioral outcomes. These suggestions provide valuable insights given the importance of cognitive and affective responses in driving evaluations of marketing messages, facilitating future research investigating presence within interactive marketing.
Keywords: Immersive experience; Interactive Marketing; Presence; Systematic review; Telepresence; Metaverse
... The complexity of these stimuli comes with the costs of a resource-intensive development process to individualize the virtual environment. In addition to audiovisual content, haptic feedback might provide a promising domain for further sensory-motor contingencies of VR systems (Gall and Latoschik 2018;Gromer et al. 2018). However, to date, technical limitations impede the widespread use of haptic feedback in VR, except for simulated floor Fig. 1 Overview of the number of studies applying VR for studying emotional responding. ...
... Some studies suggest that HMDs and CAVEs produce similar effects, depending on the study's specific requirements (Bouchard and Rizzo 2019). (a) Participants can be located within a CAVE and by means of a gamepad they can freely move within a virtual environment including, for example, a tower inducing fear of height (Gromer et al. 2018). (b) Protocols of animal studies can be easily translated to VR settings as demonstrated with the elevated plus maze (EPM; Biedermann et al. 2017;Madeira et al. 2021). ...
... Although VR users are fully aware of the fact that they are in their living room, a laboratory, or a therapist's office when entering an immersive virtual environment, they start to react to the virtual world as if it is real. For example, a height fearful person visiting the terrace of a virtual skyscraper might show the same emotional, physiological, and behavioral reactions as when visiting a real height situation, including fear, sweating, going weak at the knees, and keeping distance from the railing (Gromer et al. 2018(Gromer et al. , 2019. In short, users react to and behave in virtual environments as if they were really there, i.e. they show indications of a "(suspension of dis-)belief, that they are in a world other than where their real bodies are located" (Slater and Usoh 1993, p. 222). ...
Emotions are frequently considered as the driving force of behavior, and psychopathology is often characterized by aberrant emotional responding. Emotional states are reflected on a cognitive-verbal, physiological-humoral, and motor-behavioral level but to date, human research lacks an experimental protocol for a comprehensive and ecologically valid characterization of such emotional states. Virtual reality (VR) might help to overcome this situation by allowing researchers to study mental processes and behavior in highly controlled but reality-like laboratory settings. In this chapter, we first elucidate the role of presence and immersion as requirements for eliciting emotional states in a virtual environment and discuss different VR methods for emotion induction. We then consider the organization of emotional states on a valence continuum (i.e., from negative to positive) and on this basis discuss the use of VR to study threat processing and avoidance as well as reward processing and approach behavior. Although the potential of VR has not been fully realized in laboratory and clinical settings yet, this technological tool can open up new avenues to better understand the neurobiological mechanisms of emotional responding in healthy and pathological conditions.KeywordsApproachAvoidanceEmotionsPresenceVirtual reality
... We found that the EPM environments were able to reliably test anxiety-related behaviors as well as their underlying physiological and subjective correlates. Therefore, our results are in line with other studies which showed that virtual heights consistently evoke subjective, behavioral, and psychological fear responses across different setups (Asjad et al., 2018;Biedermann et al., 2017;Gromer et al., 2018Gromer et al., , 2019Kisker et al., 2019a). The feeling of presence together with immersivity is considered to be crucial for inducing affect and thus for the real-life experience in VR (Felnhofer et al., 2015;Kisker, Gruber, & Schöne, 2021b;Kisker, Lange, et al., 2021a;Slater & Wilbur, 1997). ...
... Thus, it does not seem to be crucial how interesting and captivating a VR is for it to evoke the feeling of presence. Instead, the feeling of presence might be a prerequisite for any emotional affect to occur in VR (Felnhofer et al., 2014), although experimental evidence is inconclusive (Gromer et al., 2018(Gromer et al., , 2019. Similarly, it has been suggested that a VE should be as realistic as possible to create an advanced simulation of reality, e.g., by using 3D photos and videos instead of computer-generated VEs, which are easily recognized as unreal (Schöne et al., 2021). ...
... This may also be facilitated by the mixed-reality design of both EPM versions. An increase in immersion achieved by adding tactile cues (i.e., wind simulation) was found to enhance VR-triggered fear responses in a virtual height scene (Gromer et al., 2018). Increasing immersion by using haptic cues in a virtual spider simulation (Hoffman et al., 2003;Peperkorn & Mühlberger, 2013) or stereoscopy in a virtual height simulation (Mühlberger et al., 2012) resulted in an increased feeling of presence and fear. ...
Approach–avoidance conflicts are a hallmark of anxiety-related behaviors. A gold standard for assessing anxiety-related behaviors in rodents is the elevated plus-maze (EPM), which was recently translated to humans using immersive virtual reality. Repeated behavioral testing is particularly interesting for clinical and pharmacological research in humans but could be limited by habituation effects. Here, we tested whether comparable strategies that are used in rodents (different environments and inter-trial interval of 28 days) are sufficient to avoid habituation or sensitization effects on the EPM, making it possible to perform repeated measurement of anxiety-related behavior in humans. Moreover, we developed two novel virtual environments for repeated testing to explore whether a scenario resembling the real world is superior to a video game-like EPM in terms of lifelike physiological, emotional, and behavioral responses. On a behavioral level, no significant differences but a high correlation between first and repeated exposure to the human EPM independent of EPM version were found. On a psychophysiological level, salivary alpha-amylase, skin-conductance, and respiratory frequency increased at first and second exposure independent of EPM version. However, at repeated exposure, skin-conductance and heart rate showed indicators for anticipatory anxiety and a small sensitization effect, while no effect of real-world resemblance on these physiological measures was found. This was also reflected in slightly higher subjective anxiety levels at second exposure, although subjective anxiety still correlated strongly between first and second exposure. In conclusion, the human EPM can be used for longitudinal assessments of human anxiety-related behavior when strategies to avoid habituation and sensitization are considered.
... It is important to note that these technologies (e.g., Oculus) can also be used for MR experiences where the virtual environment is superimposed on the real environment, which is possible through the frontal camera. Such an approach can be found in a recently developed immersive VR experience called Cave Automatic Virtual Environment (CAVE), a room-sized immersive 3D visualization system developed to overcome the problems of HMDs, such as limited mobility, especially for movement-related research applications (Gromer et al., 2018). According to many authors (Mütterlein and Hess, 2017;Mazikowski, 2018), CAVE systems offer the most immersive installations of VR. ...
Efficient movements require intact motor and cognitive function. There is a growing literature on motor-cognitive interventions to improve the overall quality of life of healthy or diseased older people. For such interventions, novel technological advances are crucial not only in terms of motivation but also to improve the user experience in a multi-stimuli world, usually offered as a mixture of real and virtual environments. This article provides a classification system for movement-related research dealing with motor-cognitive interventions performed in different extents of a virtual environment. The classification is divided into three categories: (a) type of digital device with the associated degree of immersiveness provided; (b) presence or absence of a human-computer interaction; and (c) activity engagement during training, defined by activity >1.5 Metabolic Equivalent of task. Since virtual reality (VR) often categorizes different technologies under the same term, we propose a taxonomy of digital devices ranging from computer monitors and projectors to head-mounted VR technology. All immersive technologies that have developed rapidly in recent years are grouped under the umbrella term Extended Reality (XR). These include augmented reality (AR), mixed reality (MR), and VR, as well as all technologies that have yet to be developed. This technology has potential not only for gaming and entertainment, but also for research, motor-cognitive training programs, rehabilitation, telemedicine, etc. This position paper provides definitions, recommendations, and guidelines for future movement-related interventions based on digital devices, human-computer interactions, and physical engagement to use terms more consistently and contribute to a clearer understanding of their implications.
... The experiment was performed in a five-sided Cave Automatic Virtual Environment system (CAVE) at Würzburg University, which is described in detail by Gromer et al. (2018). The CAVE measures 4 × 3 × 2.95 m and uses a stereoscopic image projection technique in which the participants wear interference-filtering glasses (Infitec Premium, Infitec, Ulm, Germany). ...
Approach and avoidance of positive and negative social cues are fundamental to prevent isolation and ensure survival. High trait social anxiety is characterized by an avoidance of social situations and extensive avoidance is a risk factor for the development of social anxiety disorder (SAD). Therefore, experimental methods to assess social avoidance behavior in humans are essential. The social conditioned place preference (SCPP) paradigm is a well-established experimental paradigm in animal research that is used to objectively investigate social approach–avoidance mechanisms. We retranslated this paradigm for human research using virtual reality. To this end, 58 healthy adults were exposed to either a happy- or angry-looking virtual agent in a specific room, and the effects of this encounter on dwell time as well as evaluation of this room in a later test without an agent were examined. We did not observe a general SCPP effect on dwell time or ratings but discovered a moderation by trait social anxiety, in which participants with higher trait social anxiety spent less time in the room in which the angry agent was present before, suggesting that higher levels of trait social anxiety foster conditioned social avoidance. However, further studies are needed to verify this observation and substantiate an association with social anxiety disorder. We discussed the strengths, limitations, and technical implications of our paradigm for future investigations to more comprehensively understand the mechanisms involved in social anxiety and facilitate the development of new personalized treatment approaches by using virtual reality.
... Several other studies found higher levels of anxiety (Gromer et al., 2018;Peperkorn, Alpers, & Mühlberger, 2014;Robillard, Bouchard, Fournier, & Renaud, 2003;Suied, Drettakis, Warusfel, & Viaud-Delmon, 2013;Taffou, Guerchouche, Drettakis, & Viaud-Delmon, 2013;Wilhelm et al., 2005), stronger physiological fear responses (Mühlberger, Bülthoff, Wiedemann, & Pauli, 2007;Wilhelm et al., 2005), or avoidance behavior (Gromer et al., 2018;Rinck et al., 2016), and a better fear discrimination (Mosig et al., 2014) in phobic participants compared to non-phobic participants. Moreover, in acrophobic patients, movement (Coelho et al., 2008) and wind simulation (Gromer et al., 2018) in VR were associated with higher fear. ...
... Several other studies found higher levels of anxiety (Gromer et al., 2018;Peperkorn, Alpers, & Mühlberger, 2014;Robillard, Bouchard, Fournier, & Renaud, 2003;Suied, Drettakis, Warusfel, & Viaud-Delmon, 2013;Taffou, Guerchouche, Drettakis, & Viaud-Delmon, 2013;Wilhelm et al., 2005), stronger physiological fear responses (Mühlberger, Bülthoff, Wiedemann, & Pauli, 2007;Wilhelm et al., 2005), or avoidance behavior (Gromer et al., 2018;Rinck et al., 2016), and a better fear discrimination (Mosig et al., 2014) in phobic participants compared to non-phobic participants. Moreover, in acrophobic patients, movement (Coelho et al., 2008) and wind simulation (Gromer et al., 2018) in VR were associated with higher fear. ...
... Several other studies found higher levels of anxiety (Gromer et al., 2018;Peperkorn, Alpers, & Mühlberger, 2014;Robillard, Bouchard, Fournier, & Renaud, 2003;Suied, Drettakis, Warusfel, & Viaud-Delmon, 2013;Taffou, Guerchouche, Drettakis, & Viaud-Delmon, 2013;Wilhelm et al., 2005), stronger physiological fear responses (Mühlberger, Bülthoff, Wiedemann, & Pauli, 2007;Wilhelm et al., 2005), or avoidance behavior (Gromer et al., 2018;Rinck et al., 2016), and a better fear discrimination (Mosig et al., 2014) in phobic participants compared to non-phobic participants. Moreover, in acrophobic patients, movement (Coelho et al., 2008) and wind simulation (Gromer et al., 2018) in VR were associated with higher fear. Additionally, both in individuals with acrophobia (Gromer, Reinke, Christner, & Pauli, 2019) and arachnophobia (Peperkorn & Mühlberger, 2013), sense of presence and the experience of fear in a virtual scenario were associated. ...
Background
Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders.
Objective
To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders.
Data source
Systematic literature searches via PubMed (last literature update: 9th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders.
Eligibility criteria
To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology.
Study evaluation
For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria.
Results
Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder.
Conclusion
While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application.
Review registration
PROSPERO register CRD42020188436.
Funding
The review was funded by budgets from the University of Bonn. No third party funding was involved.
... In this paper, "immersion" is defined as the combination of the experienced presence and the immersive design aspects. It is hypothesized that increased immersion will lead to a stronger emotional response during VRET which subsequently increases the efficacy of this intervention (Waterworth and Waterworth, 2003;Gromer et al., 2018). Adjustment of the immersion provides the opportunity to modify the dosage and depth of exposure to moderate the emotional responses a participant may experience. ...
... Finally, another investigative need concerns the effect of immersion on emotional responses. Clarity surrounding this relationship would be valuable for the future development of tailored immersion (Krijn et al., 2004;Visch et al., 2010;Gromer et al., 2018;van Gelderen et al., 2020c). ...
Introduction
With the application of virtual reality (VR), tailored interventions can be created that mirror the traumatic experiences of veterans with post-traumatic stress disorder (PTSD). Visual elements can be mimicked, and auditory and other senses stimulated. In doing so, the degree of immersion can be adjusted to optimize the therapeutic process. Objectively measuring the sensory immersion is key to keep subjects within their personal window of tolerance. Based on this information the therapist can decide manipulate the sensory stimulation embedded in the treatment.
Objectives
The objectives of this study are to explore the different immersive design aspects of VRET that can be modified to influence the experienced presence in veterans with PTSD, and to discuss possible methods of measuring the emotional response facilitated by immersive design aspects and experienced presence.
Methods
Four design aspects are discussed: system, sensory cues, narrative and challenge. We also report on a user experiment in three veterans that informed on quality and depth of immersion.
Results
Believability of the neutral virtual environment was important for maintaining the veterans’ presence within the VR experience. The immersive design aspects that were personalized and supportive in the narrative of the veteran such as music and self-selected images appeared to have a strong influence on recall and reliving of the traumatic events.
Conclusions
Finally, in order to increase the therapeutic effect in veterans with PTSD, the highlighted design aspects should be recognized and tailored to maximize immersion in virtual reality exposure therapy.
Disclosure
No significant relationships.
... While questionnaires with many items can provide a detailed assessment of multiple dimensions of presence, single-item questionnaires, such as the test presented by Bouchard et al. [16], allow a rapid assessment and are less prone to memory impairment after exposure to the experience. The Bouchard test has been used successfully in previous works [17,18,19]. In this work, since the user must perform as many trials as possible (see section 4.1), we required a questionnaire that was easy to understand and quick to complete. ...
Technological advances in recent years have promoted the development of virtual reality systems that have a wide variety of hardware and software characteristics, providing varying degrees of immersion. Immersion is an objective property of the virtual reality system that depends on both its hardware and software characteristics. Virtual reality systems are currently attempting to improve immersion as much as possible. However, there is no metric to measure the level of immersion of a virtual reality system based on its characteristics. To date, the influence of these hardware and software variables on immersion has only been considered individually or in small groups. The way these system variables simultaneously affect immersion has not been analyzed either. In this paper, we propose immersion metrics for virtual reality systems based on their hardware and software variables, as well as the development process that led to their formulation. From the conducted experiment and the obtained data, we followed a methodology to find immersion models based on the variables of the system. The immersion metrics presented in this work offer a useful tool in the area of virtual reality and immersive technologies, not only to measure the immersion of any virtual reality system but also to analyze the relationship and importance of the variables of these systems.
... However, due to time and monetary constraints, exposure is rarely offered during treatment [32]. VR technology is a promising tool to address this issue [33,34]. By providing the possibility to encounter fear-provoking situations or sensations that are otherwise avoided while at the same time being in a safe environment, VR-based exposure therapy can be carefully executed step by step, responding to the client's progress. ...
Background: Cognitive behavioral therapy is the first-line treatment for patients with panic disorder (PD) and agora-phobia (AG). Yet, many patients remain untreated due to limited treatment resources. Digital self-guided short-term treatment applications may help to overcome this issue. While some therapeutic applications are already supported by health insurance companies, data on their efficacy is limited. The current study investigates the effect of self-guided digital treatment comprising psychoeducation and virtual reality exposure therapy (VRET).
Methods: Thirty patients diagnosed with PD, AG, or panic disorder with agoraphobia (PDA) will be randomly assigned to either the experimental group (EG) or the control group (CG). Participants of both groups will undergo baseline diagnostics in the first two sessions. The subsequent treatment for the EG consists of a self-guided 6-week phase of application-based psychoeducation, one therapy session preparing for the VRET, and 4 weeks of application-based self-guided VRET. To control for the potential effects of the therapy session with the therapist, the CG will receive relaxation and stress-reduction training instead. All patients will then undergo a closing session which terminates with the post-assessment (~ 10 weeks after baseline assessment) and a follow-up assessment 6 weeks following the closing session. Symptom severity (primary outcome) will be assessed at baseline, interim, post-treatment, and follow-up. Additionally, remission status (secondary outcome) will be obtained at follow-up. Both measures will be compared between the groups.
Discussion: The current study aims at providing insights into the efficacy of short-term treatment applications including psychoeducation and self-guided VRET. If successful, this approach might be a feasible and promising way to ease the burden of PD, AG, and PDA on the public health system and contribute to a faster access to treatment.
... Presence, measured by IPQ, has shown to be an important factor that contributes to provoke anxiety in virtual reality exposure therapy in participants who met criteria for anxiety-related disorders (Ling, Nefs, Morina, Heynderickx, & Brinkman, 2014). Immersion significantly increased fear responses triggered by a height simulation in a cave automatic virtual environment in participants very afraid of heights (Gromer et al., 2018). The foregoing shows the importance of having a valid and reliable sense of presence measure for a finer analysis of our findings, and the need to have a Spanish version of the IPQ to enhance the sense of presence, which could be relevant to improve the experience of fear. ...
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Virtual Reality (VR) is a promising tool for the study of cued fear conditioning in humans because it allows the use of complex and realistic experimental situations. The present study aims to validate a task for the acquisition and extinction of cued fear learning through VR with ecologically relevant Unconditional Stimuli (USs). In a first experiment (n = 69), we evaluated the effectiveness of six USs specially created to be presented in a virtual environment and to provoke physiological and affective reactions of fear. The two stimuli that evoked significantly higher than baseline electromyographic responses during three trials were then selected to be used as the USs in a second experiment. Experiment 2 (n = 51) aimed to determine if the previously selected US could generate a conditioned response (CR) when associated with another visual stimulus (Conditioned Stimulus; CS) in a differential conditioning paradigm, and subsequently go through extinction. We measured physiological, subjective and behavioral responses of fear, and evaluated their relationship to trait anxiety. This study showed that visual CSs in a VR environment can potentiate a startle reflex during acquisition, but we observed no discrimination between stimuli that signaled the US (fear cues CS+) and stimuli that signaled the absence of the US (safety cue CS-). Nevertheless, differential learning was observed in subjective measures (US expectancy and retrospective anxiety ratings) during acquisition, where participants responded differently to fear and safety cues. Subjective CRs, but not physiological, were reduced during extinction. No changes were observed in response suppression presented with CS, and no relationship was found between trait anxiety and fear responses. We conclude that VR is an appropriate model to elicit valid unconditioned fear responses (URs). The results of the present experiments are particularly important given that subjective CRs (observed in Experiment 2) account for an important part of the clinical experience of anxiety-related disorders, which may help to translate the use of VR to exposure therapy. Future research could improve the task to effectively generate differential physiological and behavioral responses with greater sensitivity to individual differences.
