ArticlePDF Available

Some Practical Considerations of Ethical Issues in VR Research



As scientific laboratories are an important domain of application of VR technology, ethical issues of VR have to be discussed with respect to research and the treatment of research subjects. Exposing participants to VR systems may raise ethical problems due to motion sickness, information overload, intensification of experience, and difficulties with reentry into the real world. The ethical guidelines which are typically applied to psychological research do not cover all of these problems in detail and have to be reconsidered, since they have not been developed with regard to the use of VR systems. Therefore, practical strategies to cope with the addressed ethical problems in VR research are recommended.
Katharina-Maria Behr
Andreas Nosper
Christoph Klimmt*
Tilo Hartmann
Department of Journalism and
Communication Research
Hanover University of Music
and Drama
Hanover, Germany
*Correspondence to
Presence, Vol. 14, No. 6, December 2005, 668 676
©2005 by the Massachusetts Institute of Technology
Some Practical Considerations
of Ethical Issues in VR Research
As scientific laboratories are an important domain of application of VR technology,
ethical issues of VR have to be discussed with respect to research and the treat-
ment of research subjects. Exposing participants to VR systems may raise ethical
problems due to motion sickness, information overload, intensification of experi-
ence, and difficulties with reentry into the real world. The ethical guidelines which
are typically applied to psychological research do not cover all of these problems in
detail and have to be reconsidered, since they have not been developed with re-
gard to the use of VR systems. Therefore, practical strategies to cope with the ad-
dressed ethical problems in VR research are recommended.
1 Some Practical Considerations on Ethical Issues
in VR Research
The advent of virtual reality (VR) technologies and their diverse applica-
tions has raised numerous legal and ethical questions. In this paper, we focus
on the specific ethical problems involved in scientific research with high perfor-
mance VR systems and discuss strategies to cope with them. Most often, high-
end VR systems can be found in research laboratories, so when it comes to
ethical issues in the domain of Presence: Teleoperators and Virtual Environ-
ments, it is reasonable to discuss ethical implications of VR with respect to how
scientists treat the participants of their virtual reality studies.
Social scientists are proud of a long tradition of considering ethical issues in
research whenever humans (and animals) are intended to participate in an in-
vestigation. In general, ethical theories are divided into teleological and deon-
tological approaches (Smith, 2000; Patry, 2002). According to teleological the-
ories (and specifically the utilitarian approach), actions are judged by their
consequences, that is, the end justifies the means. Consequently, an action is
appraised as good or at least acceptable, whenever its outcomes serve the soci-
ety. Thus, according to a strict teleological approach, employing humans or
animals as subjects in an experiment is legitimate as long as the outcome of the
research serves society’s purposes.
In contrast, deontological theories appraise actions by themselves and re-
gardless of their consequences, that is, the result of an action does not justify
the means. Actions are judged as right or wrong in the light of higher princi-
ples, such as the untouchable dignity of all humans. Such a deontological view
is reflected by Kant’s imperative “Act in such a way that you treat humanity,
whether in your own person or in the person of another, always at the same
time as an end and never simply as a means.” From this perspective, any suffer-
ing of humans as participants in scientific experiments is
intolerable, even if the results would be of outstanding
interest to society (Smith, 2000; Patry, 2002).
Today’s ethical frameworks that guide scientific re-
search are based on conceptual hybrids of teleological
and deontological theories. In general, the participation
of humans in experiments is seen as a kind of agreement
between the participant and the researcher that imposes
obligations on each of the contractual partners. Thereby
some basic ethical principles are deduced from the su-
perordinated ethical framework. According to Patry
(2002) these principles are (1) autonomy, (2) nonma-
leficence and beneficence, and (3) justice. Concerning
research, autonomy means respecting humans and their
privacy and obtaining the informed consent of individu-
als participating. Thus, autonomy can be regarded as
securing the subject’s self-determination, her/his free-
dom of decision, and purposeful considerations. Non-
maleficence and beneficence mean to carefully consider
detriments and benefits or risks and benefits, respec-
tively that the subject may encounter throughout the
investigation. The third basic principle, justice, stands
for equality, that is, the equal choice of participants and
fair allocation of risks. Summarizing the shared aim of
all three principles, the participant’s well-being turns
out to be the superordinated aspect that primarily has to
be ensured by researchers, which reflects the specifica-
tions’ strong deontological orientation. Similar princi-
ples as the ones noted above have been proposed by
Smith (2000), who mentions (1) respect for persons
and their autonomy, (2) beneficence and nonmalefi-
cence, (3) justice, (4) trust and fidelity, and (5) scientific
Building on these fundamental considerations of ethi-
cal theory, various codices of conduct have been elabo-
rated which guide scientists with respect to the design
of studies, for instance, the Nuremberg Code (1954),
the Declaration of Helsinki (1964) or the Belmont Re-
port (1979). The American Psychological Association
has released a code of conduct that is relevant to today’s
research in psychology and communication (APA,
2002). It is suited for research on presence and VR as
well, since the experiences investigated in studies using
VR systems often target phenomena such as presence
experiences (Steuer, 1992; Lombard & Ditton, 1997;
Draper, Kaber, & Usher, 1998) and the behavior and
reaction of people in virtual environments (Fencott, van
Schaik, Ling, & Shafiullah, 2003; Mager, Bullinger,
Mueller-Spahn, Kuntze, & Stoermer, 2001). VR re-
search caused various innovations in psychological ex-
perimental research, for example in studies on human
perception and on data processing (Huber, Krist, &
Wilkening, 2003; Zyss, 1997). VR systems are more-
over useful tools in diagnosis and therapy, therefore
many studies have investigated the role of virtual reality
for medicine and psychotherapy, for example, for the
development of psychological treatments (Riva, 2003;
Botella, Perpina, Banos, & Garcia-Palacios, 1998;
Strickland, Hodges, North, & Weghorst, 1997).
Due to this link between psychology and VR re-
search, the well-established APA code of conduct seems
to be an appropriate starting point for reconsidering
ethical guidelines for research in VR systems. The APA
code of conduct is as well as most of the codices based
on fundamental principles of how to treat participants in
scientific investigations. It is based on five principles: (1)
Beneficence and Nonmaleficence states that researchers
should take care of their participants and safeguard their
welfare. (2) Fidelity and Responsibility reminds re-
searchers to deal with any established relationship to the
participants in a professional and businesslike manner
and not to exploit the social situation for their own in-
dividual purposes. (3) Integrity stands for the research-
er’s general accuracy, honesty, and truthfulness, for ex-
ample when it comes to the interpretation of observed
data. (4) Justice means that researchers need to be free
from biases in order to ensure proper investigations. (5)
Respect for People’s Rights and Dignity finally refers to
the necessity to “respect the dignity and worth of all
people, and the rights of individuals to privacy, confi-
dentiality, and self-determination” (APA, 2002, p.
1164). In sum, the APA Ethics Code aims at the “wel-
fare and protection of the individuals and groups with
whom psychologists work” (p. 1163). Similar principles
and recommendations are put forward in textbooks on
research ethics (e.g., Smith, 2000; Patry, 2002).
VR systems are designed to induce rich, authentic
experiences of spatial environments which can be per-
Behr et al. 669
ceived through multiple sensory channels. While VR
technology holds the potential for numerous scientific
experimental applications, these capabilities should dis-
pose scientists to reconsider the ethical guidelines they
previously applied before the days of VR, because the
new technologies may induce forms of experience which
are in some way novel and unique (Kallman, 1993). As
a consequence of the requirement to secure the well-
being of participants of studies, it should be discussed
whether specific ethical recommendations have to be
formulated with respect to the employment of VR sys-
tems in empirical (experimental) investigations. For this
purpose, we identify four major potential risks that may
occur during participating in scientific investigations
that employ VR technology: (1) motion sickness, (2)
information overload, (3) intensification of experience,
and (4) reentry into the real world. These phenomena
are capable of causing conflicts during investigations
and therefore ways to avoid ethical problems are dis-
2 Effects of Peculiarities of VR Systems
on Subjects’ Well-Being
2.1 Motion Sickness
Throughout evolution the senses of human beings
have adapted to the occurrences and physical circum-
stances of the terrestrial environment through the pro-
cess of natural selection. If a VR system is intended to
imitate the natural surrounding, it might fall short on
fidelity, number, and coherence of different physical
stimuli that are involved in a natural experience (e.g., in
terms of visual presentation, cf. Barfield, Hendrix,
Bjorneseth, Kaczmarek, & Lotens, 1995). If subjects of
a VR experiment are confronted with such limited, con-
strained, or incoherent sensory inputs, they may experi-
ence some sort of confusion or impairment. The most
prominent phenomenon of this kind is motion sickness,
which has also been labeled cybersickness (DiZio &
Lackner, 1992; McCauley & Sharkey, 1992; Kennedy,
Lanham, Drexler, & Massey, 1997; So, Ho, & Lo,
2001). Symptoms of motion sickness include “nausea
and vomiting, cold sweating, pallor, salivation, drowsi-
ness, dizziness, headache, eye strain, lethargy, lack of
initiative and chronic fatigue” (DiZio & Lackner, p.
319). In general, it is caused by a mismatch between the
feedback which the users’ perceptual system expects
from the environment, for example during body move-
ment (afferent, cf. von Holst & Mittelstaedt, 1950),
and the efferent feedback provided by the VR system
(DiZio & Lackner, 1992). Motion sickness typically
occurs due to errors in position tracking, optical distor-
tion, flicker, insufficient refresh rate or resolution, trans-
port delays, or low update rates (Kennedy, Stanney, &
Dunlap, 2000). Given the adverse implications of mo-
tion sickness for users’ health and experiential state, re-
search ethics demands its prevention due to conflicts
with the non-maleficence principle.
2.2 Information Overload
Highly vivid virtual environments emit a huge
amount of information in the visual, aural, tactile
and/or even olfactory modality. The according output
devices are often very obtrusive, that is, they are directly
attached to the user’s senses throughout the process of
reception. For instance, headphones almost inevitably
induce sound into the users’ ears. It is virtually impossi-
ble to shut down the auditory channel and filter out the
information. The same is true for visual displays such as
head mounted displays, which almost force the users to
receive the presented visual stimuli. The amount of in-
formation and its pushing and pervasive presentation
may cause the problem of information overload. It can
be defined as “the moment when the amount of avail-
able information exceeds the user’s ability to process it”
(Klapp, 1982, p. 63). However, information overload is
not only caused by the sheer volume of information, but
also because of the complexity or confusing structure of
information that might overtax the user’s cognitive skill
to focus on relevant information (Helmersen, Jalalian,
Moran, & Norman, 2001). Therefore Helmersen et al.
(p. 2) characterize information overload as “difficulties
in locating, retrieving, processing, storing and/or re-
retrieving information due to the volume of available
information.” Information overload may lead to stress,
health problems, frustration, disillusionment, depres-
sion, as well as impaired judgment and bad decision
making (Helmersen et al.; Edmunds & Morris, 2000).
From an ethical perspective, these consequences of in-
formation overload are problematic, because they un-
dermine several basic principles, especially the require-
ment of participants’ autonomy/self-determination and
the nonmaleficence principle.
2.3 Intensification of Experience
VR technology allows the researcher to create
whole laboratory settings that can be reshaped, modi-
fied, controlled, and reused very easily and with much
less effort than a real research facility. VR can be used to
simulate stimulus materials that have proved to be use-
ful in conventional experiments, for example spatial sur-
roundings, social situations, or tasks of any kind. Such
VR environments do not induce radically new experi-
ences to participants compared to conventional stimulus
presentations. However, they may foster more intense
experiences, because they are connected very closely to
the subjects’ perceptual system and allow for high de-
grees of immersion, for instance with respect to the field
of view the stimulus material can cover (Biocca &
Delaney, 1995). Any experience induced in a real labo-
ratory, such as feelings of disorientation, fear, anger,
superiority, or joy, may reach higher degrees of intensity
when the according stimulus materials are converted
into a VR environment. Such intensifications of experi-
ence may strain the subjects’ coping abilities and cause
undesirable responses (cf. Whitbeck, 1993). For in-
stance, it has been demonstrated that people suffer harm
and stress when deprived of control and in some cases
perceived loss of control may cause people to react ag-
gressively (Baumeister, 1999; Brehm, 1966). If depriva-
tion of control occurred during exposure to a highly
vivid VR system, the intensified experience could se-
verely endanger the participants’ well-being. From an
ethical perspective, the experimental evocation of per-
ceived loss of control may be acceptable if performed
within a less immersive (or real) environment, but the
application of the same stimulus material under the con-
dition of exposure to a highly immersive VR system may
exceed the tolerable limits of psychological burden.
2.4 Reentry into the Real World
Subjects who are exposed to a highly immersive
VR environment often display some familiarization to
the system’s content and adapt to its perceptual and
physical parameters (Biocca, 1997). If the participants
of a VR study have gotten used to the virtual environ-
ment, they may face some difficulties during and after
the transition into the real world. Such difficulties have
been labeled reentry problems. They refer to the tasks of
leaving the virtual environment after participation in an
experiment, readapting to reality and its physical and
social parameters, and differentiating between VR and
reality. If reentry problems occur, cognitive, emotional,
and behavioral disturbances may arise.
Cognitive disturbances may include difficulties in de-
tecting differences between knowledge gained in the
virtual environment and knowledge acquired in real life.
People tend to forget the sources where they have ob-
tained information, even when they remember the in-
formation itself (Shapiro & Lang, 1991; Appel &
Schreier, 2001). As a result, participants may feel some
confusion about their real world knowledge, as they
might base some real-world actions on information they
received in the VR, which in turn may result in inappro-
priate behavior.
Emotional disturbances may occur because affective
states that have been induced during exposure to a VR
environment may outlast the reentry process. After leav-
ing the VR, the participants cannot erase their emo-
tions. They take them back over into the real world. In
the real world, however, the causes of the emotional
state of the participants no longer exist. This mismatch
between the emotional state and the absence of its
causes can lead to confusion and misattributions.
Behavioral problems can result from the alteration of
the individual body schema that is caused by the repre-
sentation of one’s own body in a VR environment (cf.
Biocca, 1997). According to Biocca (p. 22), “in virtual
and augmented reality systems, changes in the location
of the represented head or hands can significantly dis-
tort [the perception of] the body.” Consequently,
hand-eye coordination or other coordination abilities
may be compromised after the subjects have left an ex-
Behr et al. 671
perimental VR environment. Such adaptation problems
may occur, for example, if subjects drive a car shortly
after the reentry process. Their perception of speed and
distances may be biased, which would be connected to
an increased accident risk.
Reentry problems do not occur during the exposure
to the VR system, but when returning to reality. The
fact that reentry problems occur after the actual experi-
ment does not release researchers from their responsibil-
ity for the subjects, however. As a possible consequence
of participation in experimental research, reentry prob-
lems have to be considered from an ethical point of
view. They may conflict with various basic principles,
primarily with autonomy/self-determination (e.g., in
case of limited mobility after participation) and non-
3 Coping with Specific Ethical Problems
in VR Research Practice
3.1 Strategies that Refer to VR
Technology and Experimental
Some techniques to overcome VR-specific ethical
aspects in practical research are related to the employed
technology and the way it is used in the experiment. To
avoid motion sickness, for example, McCauley and
Sharkey (1992, p. 316) suggest a variety of provisions:
Exposure time should be limited until adaptation to
the VR has occurred.
Tasks that require high rates of linear or rotational
acceleration should be avoided, or kept brief, until
the individual has fully adapted to the altered envi-
Users of VR should be considered on an individual
basis when determining an adaptation program.
Self-movement through a VR should be at high
altitudes above the terrain and/or at low speeds
because the rate that objects flow through a visual
scene is related to motion sickness.
Unusual and extraordinary movement maneuvers
should be avoided in VRs.
Users of VR systems should be informed about the
potential negative interactions between the inges-
tion of pharmacological agents and “cybertravel”
through a VR. A list of pharmacological agents
which are capable of inducing negative side effects
in interaction with “cybertravel” should be com-
piled. Participants should be asked whether they
ingest pharmacological agents and should be ex-
cluded from participating, if they are likely to expe-
rience motion sickness due to such ingestion.
Users of VR systems should be informed of the pos-
sible adverse effects including motion sickness, per-
ceptual aftereffects, decreased postural stability,
and, in rare cases, delayed onset of symptoms.
In addition, a careful test of the employed VR tech-
nology with respect to undesirable side effects of expo-
sure (such as physical discomfort and efference-afference
mismatches) should be performed before each experi-
mental session, as situation-based variations of system
parameters may occur (e.g., due to accidental changes
in the software configuration). Participants should be
instructed how to quit the VR experience and to deposit
the equipment in case of too intense emotions or the
feeling of being stressfully overwhelmed by the virtual
environment. During the procedure, an experimenter
should be available in the laboratory who can assist the
participants to terminate exposure and reenter reality if
severe discomfort, information overload, or anxiety
3.2 Strategies that Refer to VR
The intensity of possible experiences that virtual
environments can produce suggests a consideration of
the kind and explicitness of the content that subjects are
confronted with. With respect to the type of content,
experimenters should avoid any depictions that might
induce negative emotions such as fear, disgust, or anger.
If negative emotions are enforced by the experience of
immersion during VR usage, the probability of unde-
sired responses is increased. High levels of positive emo-
tions like joy are, in contrast, less problematic, as they
are normally not connected to any risks or harm. Emo-
tionally neutral stimuli may be, however, the experi-
menter’s best choice to avoid critical effects.
Some research designs inevitably require the imposi-
tion of negative emotions on subjects or will present
content to participants that cannot be purged of its
problematic aspects. If the experimenter’s freedom to
select neutral VR content is limited, the degree of ex-
plicitness of the material has to be assessed very care-
fully. For example, a mood manipulation technique that
has been established for standard laboratory research
may turn out to be very powerful and effective when
ported into a VR system. As a result, some participants
may enter emotional or cognitive conditions that cannot
be justified from the perspective of research ethics. In
such a case, a mild variant of the stimulus materials
should be generated, and careful pretests of the appro-
priate level of stimulus intensity should be implemented.
An exception from the recommendation to avoid in-
tensifications of experience through vivid VR presenta-
tions is necessary for e-therapy applications (e.g., Roy et
al., 2003). A successful therapy often requires the in-
duction of fear or other intense and inconvenient emo-
tions, and VR systems are useful tools to evoke such
responses in clients and can therefore lead to a thera-
peutic effect (Riva, 2003). Such effects have been
shown for many different phobias, such as the fear of
heights (Hodges et al., 1995; Kuntze, Stoermer, Mager,
Mueller-Spahn, & Bullinger, 2003), the fear of flying
(Klein, 2000; Rothbaum, Hodges, Smith, Lee, & Price,
2000), arachnophobia (Carlin, Hoffman, & Weghorst,
1997; Garcia-Palacios, Hoffmann, Carlin, Furness, &
Botella, 2002), or driving phobia (Wald & Taylor,
2000). Besides the positive effects of virtual reality ex-
posure therapy, negative effects like sickness symptoms
were found to be serious for five percent of participants
(Cobb, Nichols, Ramsey, & Wilson, 1999). Therefore
researchers (and therapists) also should avoid too strong
(affective) consequences of client VR exposure when-
ever possible in such exceptional settings. The ethical
discussion of VR exposure therapy is somewhat different
from the ethical discussion of the use of VR systems in
research. The use of VR systems in therapy is first of all
directed to the client and not to superordinate conse-
quences for society. So from a deontological and from a
teleological point of view the use of VR systems is justi-
fiable, since the subject is not used as a means to an end,
but is treated for the subject’s own health. Nevertheless
therapists have to exercise caution since stimuli provided
in VR may evoke very strong experiences and, more-
over, clients might be more vulnerable than other sub-
jects. Consequently, cybertherapists will have to recon-
sider their standard ethical guidelines (e.g., Barnes &
Murdin, 2001) in the light of chances and risks of high
performance VR just as VR investigators do with respect
to research ethics.
3.3 Strategies that Refer to Selection,
Preparation, and Dismissal of
If the potential power of an experimental VR stim-
ulus has to be taken into account, subjects should be
screened carefully for susceptibility to possible problems
connected to participation. For example, individual dif-
ferences have been reported in the liability to motion
sickness (cf. McCauley & Sharkey 1992). Highly sensi-
tive individuals should not participate in VR studies in
which occurrence of motion sickness cannot be ruled
out in advance. Similarly, participants should be tested
for phobias that may be related to the content of the
stimulus materials. Claustrophobia (Febbraro & Clum,
1995) and agoraphobia (Franklin, 1991) may be espe-
cially relevant, because most VR systems depict spatial
environments and some may trigger incidents of panic
in people with space-related phobias. Moreover, the
participants should possess a sufficient degree of general
media literacy (Groeben & Hurrelmann, 2002) which
includes knowledge about VR systems or allows for a
good understanding of VR-specific information that is
provided by the experimenter.
Once suitable participants have been selected, they
should be carefully instructed and prepared for what they
are going to experience during VR exposure, both in
terms of depicted content and level of immersion. Subjects
should be enabled to make a well-informed decision about
whether they are ready to participate or not. Moreover,
instructions should empower subjects to cope with all as-
Behr et al. 673
pects of the presented stimulus with respect to technical
handling, cognitive processing, and emotional coping.
During the reentry stage, participants have to be accom-
panied and should be assisted to readapt to the physical
and social rules of reality. In order to prevent serious adap-
tation problems, subjects should not be dismissed immedi-
ately after the end of the experiment, but should be ob-
served until the experimenter has made sure that
readaptation is completed. For safety reasons, subjects
should be strongly recommended not to drive a car or
handle other complex technical or mechanical devices im-
mediately after VR exposure. The easiest way to avoid re-
entry problems and risks may be to hand out some distrac-
tion tasks to participants after the actual experiment.
Finally, the participants’ debriefing should include infor-
mation about the potential side effects of the VR system.
In addition to clarifications about the purpose of the study,
the experimenter should talk to the subjects about their
experience during exposure and their physical condition
after exposure. Individuals who felt high levels of intensity
during participation may need additional information and
an opportunity to communicate their experiences in order
to cope with the situation. Moreover, the debriefing
should address the differences between the VR system and
reality to assist subjects in the cognitive and behavioral
transition to the real world. The debriefing, then, may be-
come a part of a guided reentry procedure that ensures the
subjects’ safety and well-being after the treatment has been
4 Conclusion
Although we are still exploring the powerful capa-
bilities of VR to induce various kinds and degrees of
experiences, researchers must be aware of the fact that
many VR systems hold such power and should consider
these capabilities carefully when they design experi-
ments. The advent of VR in the laboratories of presence
researchers and other scientists who utilize VR for basic
and applied research in their domains does not demand
whole new codes of conduct for the treatment of sub-
jects. However, it appears to be necessary to reconsider
those ethical aspects of research, because the presenta-
tion of stimuli through VR technology may cause new
and unique experiential states that might be problematic
from an ethical perspective (Kallman, 1993). If re-
searchers are attentive to those peculiarities, potential
ethical problems can be avoided, and subjects’ well-
being can be secured in spite of the new experiential
dimensions VR technology allows to enter. The sug-
gested techniques to cope with the discussed problems
may function as a tool for the day-to-day practice of VR
research that may help to ensure that beneficence, re-
sponsibility, integrity, justice, and dignity will guide fu-
ture VR research.
This review is based upon work supported by the European
Commission, Information, Society and Technology Program,
within the research project “Presence: Measurement, Effects,
Conditions (MEC),” IST-2001-37661 (http://www.ijk. We thankfully acknowledge the
Commission’s support.
American Psychological Association (APA). (2002). Ethical
principles of psychologists and code of conduct 2002.
American Psychologist, 57(12), 1060–1073.
Appel, M., & Schreier, M. (2001). The role of presence in dis-
tinguishing between fact and fiction. Poster presented at the
European Presence Research Conference, October 9–10,
2003, Eindhoven, The Netherlands.
Barfield, W., Hendrix, C., Bjorneseth, O., Kaczmarek, K. A.,
& Lotens, W. (1995). Comparison of human sensory capa-
bilities with technical specifications of virtual environment
equipment. Presence: Teleoperators and Virtual Environ-
ments, 4(4), 329–356.
Barnes, F. P., & Murdin, L. (Eds.). (2001). Values and ethics
in the practice of psychotherapy and counseling. Buckingham,
UK: Open University Press.
Baumeister, R. F. (1999). The nature and structure of the self:
An overview. In R. F. Baumeister (Ed.), The self in social
psychology (pp. 1–20). Philadelphia: Psychology Press.
Biocca, F. (1997). The cyborg’s dilemma: Progressive em-
bodiment in virtual environments. Journal of Computer-
Mediated Communications, 3(2), [Online]. Available:
[July 14, 2003].
Biocca, F., & Delaney, B. (1995). Immersive virtual reality
technology. In F. Biocca & M. Levy (Eds.), Communica-
tion in the age of virtual reality (pp. 15–32). Hillsdale, NJ:
Lawrence Erlbaum.
Botella, C., Perpina, C., Banos, R. M., & Garcia-Palacios, A.
(1998). Virtual reality: A new clinical setting lab. Studies in
Health Technology and Informatics, 58, 73–81.
Brehm, J. W. (1966). A theory of psychological reactance. New
York: Academic Press.
Carlin, A. S., Hoffman, H. G., & Weghorst, S. (1997). Virtual
reality and tactile augmentation in the treatment of spider
phobia: A case study. Behaviour Research and Therapy,
35(2), 153–162.
Cobb, S. V. G., Nichols, S., Ramsey, A., & Wilson, J. R.
(1999). Virtual reality-induced symptoms and effects
(VRISE). Presence: Teleoperators and Virtual Environments,
8(2), 169–186.
DiZio, P., & Lackner, J. R. (1992). Spatial orientation, adap-
tion and motion sickness in real and virtual environments.
Presence: Teleoperators and Virtual Environments, 1(3),
Draper, J. V., Kaber, D. B., & Usher, J. M. (1998). Telepres-
ence. Human Factors, 40(3), 354–375.
Edmunds, A., & Morris, A. (2000). The problem of informa-
tion overload in business organisations: A review of the lit-
erature. International Journal of Information Management,
20, 17–28.
Febbraro, G. A. R., & Clum, G. A. (1995). A dimensional
analysis of claustrophobia. Journal of Psychopathology & Be-
havioral Assessment, 17(4), 335–351.
Fencott, C., van Schaik, P., Ling, J., & Shafiullah, M. (2003).
The effects of movement of attractors and pictorial content
of rewards on users’ behaviour in virtual environments: An
empirical study in the framework of perceptual opportuni-
ties. Interacting with Computers, 15(1), 121–140.
Franklin, J. A. (1991). Agoraphobia. International Review of
Psychiatry, 3(2), 151–162.
Garcia-Palacios, A., Hoffman, H., Carlin, A., Furness, T. A.,
& Botella, C. (2002). Virtual reality in the treatment of spi-
der phobia: A controlled study. Behaviour Research and
Therapy, 40(9), 983–993.
Groeben, N., & Hurrelmann, B. (2002). (Hrsg.), Medien-
kompetenz. Voraussetzungen, Dimensionen, Funktionen [Me-
dia literacy. Conditions, dimensions, functions.]. Weinheim,
Germany: Juventa.
Helmersen, P., Jalalian, A., Moran, G., & Norman, F. (2001).
Impacts of information overload [On-line]. Available at
P947/D1/p947d1.pdf [July 15, 2003].
Hodges, L. F., Kooper, R., Meyer, T. C., Rothbaum, B. O.,
Opdyke, D., de Graaff, J. J., et al. (1995). Virtual environ-
ments for treating the fear of heights. Computer, 28(7), 27–
Huber, S., Krist, H., & Wilkening, F. (2003). Judgement and
action in speed adjustment tasks: Experiments in virtual en-
vironments. Developmental Science 6(2), 197–210.
Kallman, E. A. (1993). Ethical evaluation: A necessary ele-
ment in virtual environment research. Presence: Teleoperators
and Virtual Environments, 2(2), 143–146.
Kennedy, R. S., Lanham, D. S., Drexler, J. M., & Massey,
C. J. (1997). A comparison of cybersickness incidences,
symptom profiles, measurement techniques, and sugges-
tions for further research. Presence: Teleoperators and Vir-
tual Environments, 6(6), 638 644.
Kennedy, R. S., Stanney, K. M., & Dunlap, W. P. (2000).
Duration and exposure to virtual environments: Sickness
curves during and across sessions. Presence: Teleoperators
and Virtual Environments, 9(5), 463–472.
Klapp, O. (1982). Meaning lag in the information society.
Journal of Communication, 32(2), 56 66.
Klein, R. A. (2000). Virtual reality exposure therapy in the
treatment of fear of flying. Journal of Contemporary Psycho-
therapy, 30(2), 195–207.
Kuntze, M. F., Stoermer, R., Mager, R., Mueller-Spahn, F., &
Bullinger, A. H. (2003). Die Behandlung der Ho¨henangst
in einer virtuellen Umgebung (The treatment of fear of
heights in a virtual environment). Der Nervenarzt [The
Neurologist], 74(5), 428 435.
Lombard, M., & Ditton, T. (1997). At the heart of it all: The
concept of presence. Journal of Computer-Mediated Com-
munication, 3(2). Available at
jcmc/vol3/issue2/lombard.html [June 10, 2003].
Mager, R., Bullinger, A. H., Mueller-Spahn, F., Kuntze,
M. F., & Stoermer, R. (2001). Real-time monitoring of
brain activity in patients with specific phobia during expo-
sure therapy, employing a stereoscopic virtual environment.
CyberPsychology & Behavior, 4(4), 465–469.
McCauley, M. E., & Sharkey, T. J. (1992). Cybersickness:
Perception of self-motion in virtual environments. Presence:
Teleoperators and Virtual Environments, 1(3), 311–318.
Behr et al. 675
Patry, P. (2002). Experimente mit Menschen: Einfu¨hrung in
die Ethik der psychologischen Forschung [Experiments with
human participants: Introduction into the ethics of psychologi-
cal research]. Bern, Switzerland: Huber.
Riva, G., (2003). Applications of virtual environments in med-
icine. Methods of Information in Medicine, 42(5), 524–534.
Rothbaum, B. O., Hodges, L., Smith, S., Lee, J. H., & Price,
L. (2000). A controlled study of virtual reality exposure
therapy for the fear of flying. Journal of Consulting and
Clinical Psychology, 68(6), 1020–1026.
Roy, S., Klinger, E., Le´geron, P., Lauer, F., Chemin, I., &
Nugues, P. (2003). Definition of a VR-based protocol to
treat social phobia. Cyberpsychology & Behavior, 6(4), 411–
So, R. H. Y., Ho, A., & Lo, W. T. (2001). A metric to quan-
tify virtual scene movement for the study of cybersickness:
Definition, implementation, and verification. Presence: Tele-
operators and Virtual Environments, 10(2), 193–215.
Shapiro, M. A., & Lang, A. (1991). Making television reality.
Unconscious processes in the construction of social reality.
Communication Research, 18(5), 685–705.
Smith, M. B. (2000). Moral foundations in research with hu-
man participants. In B. Sales & S. Folkman (Eds.), Ethics in
research with human participants (pp. 2–10). Washington,
DC: American Psychological Association.
Steuer, J. (1992). Defining virtual reality: Dimensions deter-
mining telepresence. Journal of Communication, 42, 73–93.
Strickland, S., Hodges, L., North, M., & Weghorst, S.
(1997). Overcoming phobias by virtual exposure. (Phobia
treatment by virtual reality technology) [On-line]. Available
at [February 21, 2005].
von Holst, E., & Mittelstaedt, H. (1950). Das Reafferenzprin-
zip (The Reafference-principle). Die Naturwissenschaften
[The Sciences], 37, 464 476.
Wald, J., & Taylor, S. (2000). Efficacy of virtual reality exposure
therapy to treat driving phobia: A case report. Journal of Behavior
Therapy and Experimental Psychiatry, 31(3–4), 249 –257.
Whitbeck, C. (1993). Virtual environments: Ethical issues and
significant confusions. Presence: Teleoperators and Virtual
Environments, 2(2), 147–152.
Zyss, T. (1997). The use of virtual reality techniques in neuro-
science and psychiatry. European Psychiatry, 12(2), 219.
... Therefore, depending on the aim of the study, researchers should define appropriate exclusion criteria by using specialized questionnaires to assess whether the user has previously exhibited or currently exhibits signs and symptoms (e.g., dissociative experiences, psychotic episodes, suicidal ideation) of certain disorders that may get aggravated by the experience. Behr et al. [146] suggest screening participants for space-related phobias (e.g., claustrophobia, agoraphobia), as well as other phobias specifically related to the test material. ...
... These prescreening guidelines may also be utilized for non-clinical studies involving VR exposure. In general, it is often advised that people who show high levels of sensitivity to cybersickness should not be exposed to VR [146] even in a research setting. However, from the perspective of product developers, including more vulnerable participants allows for a deeper level of insight, which can then be utilized to improve the application or system. ...
... Virtual environments (VEs) differ from other types of media based on two main characteristics [159]: saliency (i.e., VEs provide a more salient/vivid experience by combining multiple sensory stimuli) and agency (i.e., VEs allow the user to interact with their surroundings). The information overload during VR use [146] is a result of high levels of saliency, enabled by the inherent multimodality of VR systems which expose the user to various sensory stimuli (predominantly audio-visual, often haptic) at the same time, combined with the system's intrusiveness. Unlike hand-held or desktop displays, VR HMDs are strapped onto the user's head and often equipped with integrated headphones or used with external earphones. ...
User acceptance of virtual reality (VR) applications is dependent on multiple aspects, such as usability, enjoyment, and cybersickness. To fully realize the disruptive potential of VR technology in light of recent technological advancements (e.g., advanced headsets, immersive graphics), gaining a deeper understanding of underlying factors and dimensions impacting and contributing to the overall end-user experience is of great benefit to hardware manufacturers, software and content developers, and service providers. To provide insight into user behaviour and preferences, researchers conduct user studies exploring the influence of various user-, system-, and context-related factors on the overall Quality of Experience (QoE) and its dimensions. When planning and executing such studies, researchers are faced with numerous methodological challenges related to study design aspects, such as specification of dependant and independent variables, subjective and objective assessment methods, preparation of test materials, test environment, and participant recruitment. Approaching these challenges from a multidisciplinary perspective, this paper reviews different aspects of performing perception-based QoE assessment for interactive VR applications and presents options and recommendations for research methodology design. We provide an overview of different influence factors and dimensions that may affect the overall QoE, with a focus on presence, immersion, and discomfort. Furthermore, we address ethical and practical issues regarding participant choice and test material, present different assessment methods and measures commonly used in VR research, and discuss approaches to choosing study duration and location. Lastly, we provide a concise analysis of key challenges that need to be addressed in future studies centered around VR QoE.
... negative experiences with reality-enhancing technologies. Initial research in this area identifies information overload as an important psychological mechanism that leads to stress, frustration, and impaired judgment on the part of the consumer (Behr et al., 2005). Furthermore, some consumers find the immersive and realistic virtual environment too confronting, while up to 80% of consumers experience cybersickness during or after using VR (Kim et al., 2021). ...
... Special attention should also be given to potential negative outcomes that occur after consumers stop using these technologies and "re-enter the real world." Very little is known about emotional, cognitive, and behavioral disturbances that consumers experience during and after the transition from immersive virtual environments to nonvirtual ones (Behr et al., 2005). Prior research warns that the use of AR mirrors, which allows virtual try-on of products such as make-up, can make some consumers (e.g., those with low selfesteem) more prone to self-change and esthetic procedures (Javornik et al., 2022). ...
Full-text available
Reality‐enhancing technologies such as augmented reality and virtual reality are rapidly becoming a part of everyday life. Seizing this moment, we set out a research agenda for studying the psychological mechanisms underpinning consumer experiences with these new technologies, structured around four application areas: (1) delivering innovative offerings, (2) supporting sustainability and consumer well‐being interventions, (3) balancing value cocreation and privacy concerns, and (4) achieving new modes and means of impact. For each area, we identify research directions that can guide the development and use of reality‐enhancing technologies for the realization of next‐generation consumer experiences. We explicitly balance potential advantages and disadvantages, thus encouraging researchers and practitioners to prioritize developing the “purpose” of these technologies, by focusing on the psychological mechanisms that underlie their use, over the technological development of their “pixels.” In this way, we guide the impactful development of reality‐enhancing technologies for applications with significance for consumers and firms.
... Due to its outstanding advantages of multimodal perception and immersive experience, virtual reality environment has greatly contributed to the construction of embodied cognitive environment and learners' deep cognitive processing. Therefore, it is regarded as an important way to explore whether and how the combination of technology and embodied cognition can effectively promote learning [15][16][17][18] . In addition, with the wide application of various modern information technologies such as virtual reality and augmented reality in learning situations, learning behavior and its psychological mechanism based on immersive virtual reality fusion environment have become the frontier issues concerned in the field of educational psychology. ...
Full-text available
p align="justify">Metaverse is a hot topic recently, which has aroused widespread concern from all walks of life. The possible impact of the metaverse on the field of psychology includes creating a new field of panoramic learning process by creating an educational metaverse, creating a more scientific and novel teaching model by creating a MOOC metaverse, breaking the “magic circle” to alleviate interpersonal avoidance and promote individual social behavior, fostering individual self-identity by shaping the metaverse cyberpunk culture, improving the effectiveness of school mental health education by building a metaverse psychological experience center, creating a metaverse psychological intervention system based on traditional behavioral therapy to improve the effectiveness of psychological counseling, etc. However, the emerging technology represented by the metaverse is a double-edged sword. It is not only necessary to pay attention to this opportunity to create a perfect world or to create miracles, but also to guard against potential harm to the development of human society. </p
... A promising direction is to consider the concept of productive engagement as the level of engagement that maximizes learning Nasir et al. (2021). Lastly, these educational tools should consider the ethical issues surrounding virtual reality research (e.g., risks related to information overload, intensification of arousal with virtual environments and re-entry into the real world, Behr et al., 2005) or human-computer interaction (usefulness in the light of the purpose, Grinbaum et al., 2017;Wullenkord and Eyssel, 2020), and also protection of the user's data and privacy (e.g., audio/video recording of the learner, see Parsons, 2021). ...
Full-text available
Clinician-patient communication is essential to successful care and treatment. However, health training programs do not provide sufficient clinical exposure to practice communication skills that are pivotal when interacting with patients exhibiting mental health or age-related disorders. Recently, virtual reality has been used to develop simulation and training tools, in particular through embodied virtual patients (VP) offering the opportunity to engage in face-to-face human-like interactions. In this article, we overview recent developments in the literature on the use of VP-simulation tools for training communicative skills in psychiatry and geriatrics, fields in which patients have challenging social communication difficulties. We begin by highlighting the importance of verbal and non-verbal communication, arguing that clinical interactions are an interpersonal process where the patient’s and the clinician’s behavior mutually shape each other and are central to the therapeutic alliance. We also highlight the different simulation tools available to train healthcare professionals to interact with patients. Then, after clarifying what communication with a VP is about, we propose an overview of the most significant VP applications to highlight: 1) in what context and for what purpose VP simulation tools are used in psychiatry (e.g. depression, suicide risk, PTSD) and geriatrics (e.g., care needs, dementia), 2) how VP are conceptualized, 3) how trainee behaviors are assessed. We complete this overview with the presentation of VirtuAlz, our tool designed to train health care professionals in the social skills required to interact with patients with dementia. Finally, we propose recommendations, best practices and uses for the design, conduct and evaluation of VP training sessions.
... Therefore, as both realities get mixed, VR users experience ''consensual hallucinations'' 6 that sometimes culminate in significant dissociative symptoms, such as prolonged difficulty in readjusting to the real world and a feeling that the outside world is not real, upon completion of a VR session. 7 This feeling of detachment from the real world, as if one is in a dream, is scientifically known as ''Derealization'' (DR). ...
Objective: The use of virtual reality (VR) has been increasing worldwide, as devices are becoming more sophisticated and provide an escape from reality during the COVID-19 lockdown. This recent rise in the use of VR leads to new side effects being reported, such as dissociative symptoms that may or may not constitute a mental health concern. This retrospective study investigated the prevalence and intensity of dissociative symptoms in VR users, as well as some potential predisposing conditions that may trigger them, and their impact on the subjects' wellbeing. Materials and Methods: We conducted a survey (n = 358) that was posted on VR Facebook groups. This survey was approved by the University of Lisbon Medical Faculty's IRB, and comprised a modified version of the Clinician-Administered Dissociative State Scale (CADSS) and questions regarding potential risk factors known to induce dissociative disorders or experiences. Results: Data analysis revealed that 83.9% participants reported dissociative symptoms, with varying intensity according to CADSS (X̄=7.62;s=7.89). Significant correlations were found between CADSS score and the time spent playing, the use of software applications (apps) that involve virtual hands or hand tracking, history of previous dissociative experiences, traumatic childhood events, avoidant coping strategies, and psychiatric disorders. Nonetheless, most participants categorized the symptoms as nonanxiogenic (85.8%) and minute lasting (77.4%). Conclusion: In conclusion, this study revealed that although VR can induce dissociative experiences, they seem to be short lasting and nonthreatening to the individual's wellbeing and might be predicted or attenuated by managing other known risk factors for dissociative phenomena.
... VR induces strong sensory feedback on our perception. Previous work discussed the ethical implications of conducting VR research [5,35] and of realism in VR and Augmented Reality (AR) [56]. In our work, we focus on uses of VR that are highly persuasive for benefits (e.g., training), but could also be used for malicious purposes. ...
... VR induces strong sensory feedback on our perception. Previous work discussed the ethical implications of conducting VR research [5,35] and of realism in VR and Augmented Reality (AR) [56]. In our work, we focus on uses of VR that are highly persuasive for benefits (e.g., training), but could also be used for malicious purposes. ...
Full-text available
"Virtual-Physical Perceptual Manipulations" (VPPMs) such as redirected walking and haptics expand the user's capacity to interact with Virtual Reality (VR) beyond what would ordinarily physically be possible. VPPMs leverage knowledge of the limits of human perception to effect changes in the user's physical movements, becoming able to (perceptibly and imperceptibly) nudge their physical actions to enhance interactivity in VR. We explore the risks posed by the malicious use of VPPMs. First, we define, conceptualize and demonstrate the existence of VPPMs. Next, using speculative design workshops, we explore and characterize the threats/risks posed, proposing mitigations and preventative recommendations against the malicious use of VPPMs. Finally, we implement two sample applications to demonstrate how existing VPPMs could be trivially subverted to create the potential for physical harm. This paper aims to raise awareness that the current way we apply and publish VPPMs can lead to malicious exploits of our perceptual vulnerabilities.
The bands are experiencing a change in the consumers' brand preferences pattern, where consumers are more prone to experience the product virtually using Metaverse. This descriptive study examined the antecedents (novelty, Interactivity, Vividness) of a brand's gamification marketing activities in the Metaverse and the impact on consumers' affective brand engagement. Also, this study explored the consumers' anticipated satisfaction and brand advocacy in the Metaverse. The conceptual model was analysed using SMART-PLS. The collected from more 9 countries were used to do the descriptive analysis. The finding suggests that brands can have more consumers' affective brand engagement and increase their virtual brand experience if they use gamification-based marketing activities in Metaverse © 2022. Journal of Content, Community and Communication.All Rights Reserved.
Most applications of virtual reality and technology used in counseling occur in the context of client intervention and treatment. This article presents how virtual enhanced education tools such as virtual reality, augmented reality, and 360° videos provide a stage for constructing creative opportunities for experiential learning in counselor education.
Technological advances, lower cost, and greater availability of extended reality (XR) have led to more widespread applications and uptake of these technologies. Simulated environments can be used to study, measure, and influence human behavior in a variety of situations, and there are many examples of application in education, training, and rehabilitation, among others. However, the quality of the user experience and effectiveness of these applications are influenced by a variety of factors including the design of, and interaction with, the technology. This chapter presents an overview of human factors/ergonomics (HF/E) issues associated with XR with reference to user experience models defined in early virtual reality research. Using case examples that show how multisensory and multimodal interaction techniques can enhance the realism and efficacy of the user experience, and how XR technology can be used to deliver engaging and effective rehabilitation programs for older users, the importance of HF/E considerations are highlighted. Recommendations for future research include: the need for deeper understanding regarding optimum design of simulation content and multimodal user interaction; cost/benefit analysis taking into account user characteristics and the context of use; a provision of guidelines to aid technology producers during the design process for development of new XR applications; and standardized protocols for the evaluation of user experiences.
Objectives: This paper intends to investigate the role of virtual reality (VR) in medicine. In particular it outlines the current state of research and technology that is relevant to the development of effective virtual environments in medicine. Methods: After describing the two different visions of VR we can find in medicine – the presentation of virtual objects to all of the human senses in a way identical to their natural counterpart, and a new human-computer interaction paradigm in which users are active participants within a computer-generated three-dimensional virtual world – the paper presents some of the most interesting applications actually developed in the area. Finally, it discusses the clinical principles, technological devices and safety issues associated with the use of VR in medicine. Results: With more than 1,000 VR papers already indexed in Medline, VR is a reality health care. Even if the number of controlled studies is still limited, its merging with emerging technologies like Ambient Intelligence and wireless communication will further improve its diffusion. Conclusions: The possible impact of VR on health care could be even higher than the one offered by the new communication technologies like Internet. In fact, VR is at the same tima technology, a communication interface and an experience: a communication interface based on interactive 3D visualization, able to collect and integrate in single real-like experience different inputs and data sets. However, significant efforts are still required to move VR into commercial success and therefore routine clinical use.
Conference Paper
The widespread use of virtual environment (VE) systems in a variety of applications has serious implications for the user. Users with access to these sophisticated interactive "immersions" in multisensory, three-dimensional (3D) synthetic environments have been shown to experience motion sickness-like symptoms (i.e., eyestrain, ataxia, fatigue, drowsiness) and aftereffects such as visual flashbacks, disorientation, and balance disturbances occasionally occurring up to 12 hours after VE exposure. This is a significant health and safety concern. Technical improvements of VE systems need to be initiated to reduce these potential aftereffects that could result in adverse legal, economic, individual, and social consequences. Many different types of symptoms have been reported that appear-to make up the cybersickness syndrome. From our extensive database of virtual environment and flight simulator exposures, we offer examples of these symptoms profiles along with suspected mechanisms and origins. We discuss these issues as well as various assessment techniques and methods used to determine the presence of VE sickness in individuals.
A new and innovative approach to treating fear of flying has been developed using Virtual Reality Exposure Therapy. This article discusses the development of Virtual Reality Exposure Therapy and reviews a case study of a fear of flying patient seen in our practice. Early results are very promising and may indicate that Virtual Reality Exposure Therapy may also lead to creative interventions with other anxiety disorders.
One psychological mechanism that people may use to construct social reality is a reality-monitoring procedure with which they may relatively automatically and unconsciously select relevant event memories in constructing a picture of the world. Contextual information stored with the event memories is one element used to determine the relevance of a memory. Both preattentive psychophysiological responses and higher-order cognitive responses to the stream of television events are likely to be stored with television event memories. Both psychophysiological and cognitive processing of television events are examined to see what kinds of contextual information might be stored as a result of both real and fictional television events and mediated and unmediated television events. Then the decision processes that use this information are examined. It seems likely that television may result in contextual information that is potentially confusing to the reality-monitoring process. The resulting reality-monitoring errors may explain how memories of some fictional or irrelevant television events come inadvertently to influence a person's judgments about the real world. Several suggestions for testing this theory are made.