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Effectiveness of virtual reality exposure in the treatment of arachnophobia using 3D games
Abstract
Buying or creating a virtual reality (VR) software is very costly. A less expensive alternative could be to modify already existing 3D computer games. The goal of this study is to assess the effectiveness of in virtuo exposure in the treatment of arachnophobia using modified 3D games. Participants were 10 women and 1 man. Virtual worlds were created using the game editor of a 3D computer game (Half-Life), modified to offer graduals hierarchies of fearful stimuli (spiders). Analyses revealed significant improvement between pre and post results on the behavioral avoidance test, the Spider Beliefs Questionnaire, and perceived self-efficacy. These promising results suggest that therapy using virtual reality exposure via a modified computer game is useful in the treatment of arachnophobia.
... Zooplankton samples were obtained at 10 stations by a Multinet [59] opening/closing net system (0.25 m 2 aperture) equipped with five nets of 150 µm mesh-size. Additionally, larger and rarer taxa were collected by a pelagic Double Square net (DSN) (505 µm mesh, 1.0 m 2 inlet area) [60] equipped with a pterygoid deepener weighing 24 kg (Hydrobios, Altenholz, Germany) by performing oblique tows from 200 m to the surface or from near-bottom to the surface at depths <200 m at an average speed of 1.5 knots. The DSN net was equipped with a water flow counter (Hydrobios, Altenholz, Germany). ...
The aim of this study is to trace how the fine-thermohaline and kinematic structure, formed over a section along 45.8° S in the interaction zone of the outer Patagonian Shelf (PS) and Malvinas (Falkland) Current (MC) System waters, affect the spatial distribution of bio-optical characteristics, phyto/zooplankton, birds, and marine mammals. For the first time, simultaneous multidisciplinary observations at high spatial resolution (~2.5 km) were performed in this region during the cruise of the R/V “Akademic Mstislav Keldysh” in February 2022. A fine structure of alternating upwelling and downwelling zones over the PS and slope was identified, which resulted from the interaction between the MC inshore branch (MCi), bottom topography, and wind. This interaction significantly affects all the physical, and optical characteristics analyzed in the work, as well as the biota of the region. It was found that the euphotic zone is larger in the downwelling zones than in the upwelling zones, and all spatially local maxima of phytoplankton photosynthetic efficiency are observed in the zones between upwelling and downwelling. Phytoplankton along the section were represented by 43 species. A total of 30 zooplankton species/taxa were identified. Three species of marine mammals and 11 species of birds were recorded in the study site. Most of the phytoplankton species list were formed by dinoflagellates, and picoplankton Prasinoderma colonial quantitatively dominated everywhere. Two floristic and three assemblage groups were distinguished among the analyzed phytoplankton communities. High phytoplankton biodiversity was observed above the PS and low above the PS edge and in the MCi core. Copepods mostly dominated in zooplankton. Subantarctic species/taxa of zooplankton concentrated in the nearshore waters of the PS, while Antarctic species/taxa were most abundant in the zone between the MCi and the MC offshore branch (MCo). The relative abundance of birds in the PS was several times higher than in the MCo. The minimum abundance of birds was in the MCi in the zone of the strongest upwelling identified above the PS edge.
... Arachnophobia: Four studies reported positive effects of VRET in arachnophobia (Botella et al., 2008;Bouchard, Côté, St-Jacques, Robillard, & Renaud, 2006;Piercey, Charlton, & Callewaert, 2012;Shiban et al., 2016) but lacked any control interventions. Supporting this preliminary evidence, two interventional studies found that VRET induced a stronger symptom reduction than no treatment (Garcia-Palacios, Hoffman, Carlin, Furness 3rd, & Botella, 2002) or neutral VR exposure (Minns et al., 2018). ...
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.
... Macrozooplankton and ichthyoplankton samples were obtained at 23 complex stations (+stn. 7303) using a Bongo net (505 μm mesh, 0.6 m mouth diameter) [41] by performing oblique tows from 200 m to the surface and by using a pelagic double square micronekton net (DSN) (505 μm mesh, 1.0 m 2 inlet area) [42] (Figure 1) equipped with a pterygoid deepener weighing 24 kg (Hydrobios, Altenholz, Germany), as well as by performing oblique tows from 600 m to the surface at an average speed of 1.5 knots. DNS and Bongo nets were equipped with a water flow counter (Hydrobios, Altenholz, Germany). ...
In recent decades, the waters off the Antarctic Peninsula and surrounding region have undergone a significant transformation due to global climate change affecting the structure and distribution of pelagic fauna. Here, we present the results of our study on the taxonomic composition and quantitative distribution of plankton communities in Bransfield Strait, Antarctic Sound, the Powell Basin of the Weddell Sea, and the waters off the Antarctic Peninsula and South Orkney Islands during the austral summer of 2022. A slight warming of the Transitional Zonal Water with Weddell Sea influence (TWW) and an increase in its distribution area was detected. Among the pelagic communities, three groups were found to be the most abundant: copepods Calanoides acutus, Metridia gerlachei, and Oithona spp., salpa Salpa thompsoni, and Antarctic krill Euphausia superba. Eu-phausiids were found in cases of low abundance, species diversity, and biomass. In the studied region, an increase in the amount of the salpa S. thompsoni and the euphausiid Thysanoessa macrura and the expansion of their distribution area were observed. Significant structural shifts in phyto-plankton communities manifested themselves in changes in the structure of the Antarctic krill forage base. The composition and distribution of pelagic fauna is affected by a combination of environmental abiotic factors, of which water temperature is the main one. The obtained results have allowed us to assume that a further increase in ocean temperature may lead to a reduction in the number and size of the Antarctic krill population and its successive replacement by salps and other euphausiids that are more resistant to temperature fluctuations and water desalination.
... It has been proven in many studies that serious games can support the acquisition of skills and knowledge while keeping the players engaged [4,26,30,38]. The players may also benefit from a positive change in attitude towards a subject [6], increased motivation and confidence, and situational awareness [7,10,42,49,54]. Playing such games has additionally been shown to promote problem recognition, problem solving, decision-making, and self-monitoring [15,27]. ...
Privacy Policies inform users about how their personal data is managed while fulfilling the obligatory requirements. Past studies have shown that users often do not read privacy policies, cannot comprehend the long and complex policy documents, and resort to providing their consent without knowledge. To enable users to make an informed decision, we explored serious games as a new medium to improve their understanding of privacy policies. In a mobile escape room game, users engage with the data collection and processing by solving different puzzles. We validated the game concept in a user study by comparing it to a conventional textual policy. Our findings show that the game promoted greater information recall in users. However, a trade-off seems to exist between frustration, duration and understanding. We show strategies for turning a privacy policy into game elements for a mobile escape room game and incorporating privacy information into different puzzles. We recommend that the choice of a privacy policy format should vary in a case-by-case scenario and should accommodate different target audiences.
... VR has been the focus of international interest for the last 20 years or so. Virtual applications are used, in particular, in psychotherapeutic interventions for the treatment of post-traumatic stress disorder (22), social anxiety (23,24), paranoia (25), specific phobias, such as acrophobia (26), aerophobia (27,28) and arachnophobia (29,30). Recent literature has also recently pointed to the usefulness of VR in the treatment of GD (31)(32)(33)(34), since VR is a methodological approach that allows to recreate a realistic ecological representation of craving situations (35)(36)(37). ...
Cognitive behavioral therapy (CBT) is the most successful protocol in gambling disorder (GD) treatment. However, it presents some weaknesses, especially concerning relapse prevention (RP). RP is one of the most important therapeutic steps, aiming at managing cravings and to avoid future relapse increasing perceived self-efficacy. Encouraging results come from the blending of psychotherapy and virtual reality (VR), containing gambling cues. The goal of Alter Game (approved by the Ethical Commission, Prot. No. 69346) is verifying the efficacy of an innovative psychological treatment for GD based on the integration of traditional CBT therapy and an immersive VR cue exposure therapy using a serious virtual game, which is a game designed for purposes other than entertainment. RP in virtual cue-exposure therapy allows pathological gamblers to manage the urge to gamble and to avoid relapse by becoming aware of which internal and external triggers are related to craving. We hypothesize that the integrated intervention will be more effective than simple CBT with regard to self-efficacy, craving, and gambling-related distortions. Four virtual ecological environments were developed, and a virtual app, Exludo, interfaced with a computerized multiparametric acquisition system for biofeedback, was created. A sample of about 60 patients aged between 18 and 65 with GD referring to the Addiction Medicine Unit of Verona (Rossi Hospital) will be recruited. Patients will be randomly assigned to the CBT group (16 CBT sessions) or the CBT + VR group (8 CBT sessions + 8 VR cue-exposure therapy sessions). The MCMI-III, the BIS-11, and the SOGS will be used to evaluate inclusion and exclusion criteria, while the Gambling Related Cognitions Scale and the Multidimensional Gambling Self-Efficacy Scale will be used to verify changes as a function of the treatment. Craving will be evaluated through VAS, and psychophysiological variables will be assessed through biofeedback. A pre-test/post-test experimental design with a 1-month follow-up will be conducted. This study will examine an innovative psychotherapeutic protocol for GD treatment, and it will help in identifying new virtual tools to increase the efficacy of traditional therapeutic approaches that could also be applied to treat other addictions.
... Patients were also asked to sit in a chair and interact with the virtual environment through the mouse, whose interactive actions were captured through the InterSense 3D. Besides, Jarrell Pair et al. [17] proposed a serious game for the treatment of spider phobia, and Jessica et al. [18] proposed a serious game used to treat driving phobia. They all use Iglasses as VR display device. ...
Phobia is a widespread mental illness, and severe phobias can seriously impact patients daily lives. One-session Exposure Treatment (OST) has been used to treat phobias in the early days,but it has many disadvantages. As a new way to treat a phobia, virtual reality exposure therapy(VRET) based on serious games is introduced. There have been much researches in the field of serious games for phobia therapy (SGPT), so this paper presents a detailed review of SGPT from three perspectives. First, SGPT in different stages has different forms with the update and iteration of technology. Therefore, we reviewed the development history of SGPT from the perspective of equipment. Secondly, there is no unified classification framework for a large number of SGPT. So we classified and combed SGPT according to different types of phobias. Finally, most articles on SGPT have studied the therapeutic effects of serious games from a medical perspective, and few have studied serious games from a technical perspective. Therefore, we conducted in-depth research on SGPT from a technical perspective in order to provide technical guidance for the development of SGPT. Accordingly, the challenges facing the existing technology has been explored and listed.
... Meta-analytic studies have proved clinical efficacy of the VR for the anxiety disorder spectrum in adults, children and adolescents [12,13,14,15]. The use of VR as an exposure technique in anxiety disorders covers claustrophobia [16], flying phobia [17,18,19], acrophobia[] 20,21], fear of small animals [22,23,24], panic [8], agoraphobia [8], posttraumatic stress disorder [3 ]and stage fright [25], among many others. ...
The current study was performed to assess the phenomenon known as Presence, to measure Anxiety responses, simulator sickness and autonomic activation in subjects of the general population. The sample consisted in 37 Argentine participants (15 male, 22 female) between ages 20 and 40; who were exposed to 3 virtual environments designed to research and treat phobias. Instruments utilized for this study were the Symptom Checklist 90-R, Acrophobia Questionnaire, Fear of Spiders Questionnaire, The Claustrophobia Questionnaire, Igroup Presence Questionnaire, Simulator Sickness Questionnaire and the State-Trait Anxiety Inventory. All virtual environments generated sufficient feeling of presence. Cybersickness was only registered in the Elevator scenario. The Apartment and Spiders environments have shown not to be anxiety triggers within this population. As for Elevator, a significant increase in the level of state anxiety was generated. A possible hypothesis to account for this fact might be that reported anxiety responds to movement simulated in the virtual scenario while on the other two scenarios the subjects remained static. The existence of a correlation between HRV and state anxiety has been analyzed and no significant relation has been found between the variables. Even though there is a relation between anxiety and presence, no significant relation has been found between anxiety and presence. Regarding sensory conflict, a follow up study in the Elevator environment should be done, eliminating movement and exposing subjects to the stimuli while static at different heights. Future studies should consider broadening the size of the sample and studying clinical population to compare results.
Background:
Coronavirus Disease 2019 has spread worldwide and generated tremendous stress on human beings. Unfortunately, it is often hard for distressed individuals to access mental health services under conditions of restricted movement or even lockdown. In this research, we developed an online coloring game and tested its effectiveness as an accessible and engaging instrument for maintaining subjective well-being (SWB) as well as for reducing anxiety during the pandemic.
Objective:
The study first aims to develop an online digital intervention package on a commercial released coloring game. The second aim is to test the effectiveness of difference interventions package for players to maintain SWB and reduce anxiety during the pandemic.
Methods:
An evidence-based coloring intervention package was developed and uploaded to an online coloring game covering almost 1.5 million players worldwide in January 2021. Global players participated to color either four rounds of images characterized by awe, pink, nature, and blue or four rounds of irrelevant images. Participants' subjective well-being (SWB), anxiety, and perceived effectiveness of the game in reducing anxiety (subjective effectiveness, SE) were assessed one week before the intervention (T1), after completing pictures in each round (T2-T5), and after the intervention (T6). Independent t-tests were used to examine the general intervention effect and the intervention effect of each round. One-way ANOVA was used to examine whether these outcome variables were influenced by the number of rounds completed.
Results:
In total, 1390 global players responded and completed at least one assessment. Overall, the general intervention group showed a statistical significantly greater increase in SWB than the general control group (N=164, t=3.59, Cohen's d 0.58[95% CI 0.36 to -1.24], P<0.001). Compared to the control group, the best effectiveness of intervention group showed in the Awe round, in which the increasing of SWB is significant (N=171, t=2.51, Cohen's d 0.39[95% CI 0.10 to -0.82], P=0.013), and players who colored all four pictures had nearly significant improvement in SWB (N=171, F(4,170)=2.34, ŋ2=0.053, P=0.058) and a significant decrease in anxiety(N=171, F(4,170)=3·39, ŋ2=0·075, P=0.011).
Conclusions:
These data suggest that the effectiveness of online psychological interventions, such as coloring game, for mental health in the special period. It shows the feasibility of applying existing commercial games embedded scientific psychological interventions that can fill the gap of mental crises and services for a wider group of people during the pandemic. The result would inspire the innovations of against the psychological problems caused by public emergencies, and encourages more games, especially most popular ones, to take more positive action for the common crisis of mankind.
Clinicaltrial:
Diaphragmatic breathing and progressive muscle relaxation (PMR) are an effective way for relaxation training and anxiety control, but their use is not common to the general public. Today, as the need for non-face-to-face contact increases, virtual reality (VR)-based self-training is gaining attention in public health. This study aimed to evaluate the feasibility of the newly developed VR-based relaxation training program. Both diaphragmatic breathing and PMR can be trained without an assistant using this VR application in three steps: 1) learning in a virtual clinic, 2) review in a comfortable virtual environment, and 3) practice in outdoor virtual environments. Self-training is recommended on a 3-weeks schedule with a total of 4–6 trials per day for 4 days a week. Thirty-one healthy volunteers were divided into the VR ( n = 15) and worksheet ( n = 16) groups, and participated in self-training under similar conditions as much as possible. Multiple evaluations were performed before, during, and after self-training. The change rates of all psychological and psychophysiological measures before and after self-training did not significantly differ between the two groups. The levels of tension after breathing practices showed no group difference, whereas those after PMR practices were significantly lower in the VR group than in the worksheet group. In the VR group, trials of outdoor practices tended to induce a decrease of the tension level, particularly after outdoor breathing trials. The VR group gave a practicable score of 70 points or more, average 43.5, and average 180.3 for usability, cybersickness, and presence of this program, respectively. These results suggest that the VR-based relaxation self-training program can be used by healthy people as a means of relaxation. In the use of this program, diaphragmatic breathing may be used more easily, but the benefit of using VR is higher in PMR. These findings provide justification for a randomized controlled study of whether this program can be used for stress relief in the general population and, furthermore, treatment of patients with anxiety disorders.
Beliefs held by spider phobics about a confrontation with a spider are investigated. Study 1 explores the content of thoughts and images which spider phobics (N = 44) report to have during a confrontation with a spider and investigates the frequency and strength of the subjective belief in the idea. Spider phobics appear to have an abundance of negative, irrational ideas about the spider and about their own reactions during a confrontation with a spider. A one-session therapistassisted exposure therapy strongly attenuates these beliefs. Study 2 investigates the psychometric properties of the Spider Phobia Beliefs Questionnaire (SBQ), which measures the strength of belief of a large number of ideas derived from Study 1, in a second sample of spider phobics (N = 112). Factor analysis revealed 5 spider-related factors: harm, hunter and prey, unpredictability, territory, and multiplication; and 4 self-related factors: panic, paralysis, incubation, and unrestrained behavior. These factors have good internal consistency and reasonable test-retest reliability. The SBQ discriminates strongly between spider phobics and normals (N = 33) and has good concurrent validity as indicated by positive associations with other indices of spider phobia. It appears that spider phobics have a lot of misconceptions about spiders, e.g., that spiders attack them, take revenge, or are incalculable and about their own reactions about a confrontation with a spider, e.g., they expect to have a heart attack, to die of fear, or to exacerbate their fear. Most self-related ideas resemble those held by panic patients. Both spider-related and self-related ideas can be corrected by a one-session treatment.
Fear of flying (FOF) affects an estimated 10-25% of the population. Patients with FOF (N = 49) were randomly assigned to virtual reality exposure (VRE) therapy, standard exposure (SE) therapy, or a wait-list (WL) control. Treatment consisted of 8 sessions over 6 weeks, with 4 sessions of anxiety management training followed by either exposure to a virtual airplane (VRE) or exposure to an actual airplane at the airport (SE). A posttreatment flight on a commercial airline measured participants' willingness to fly and anxiety during flight immediately after treatment. The results indicated that VRE and SE were both superior to WL, with no differences between VRE and SE. The gains observed in treatment were maintained at a 6-month follow up. By 6 months posttreatment, 93% of VRE participants and 93% of SE participants had flown. VRE therapy and SE therapy for treatment of FOF were unequivocally supported in this controlled study.
Tactile augmentation is a simple, safe, inexpensive interaction technique for adding physical texture and force feedback cues to virtual objects. This study explored whether virtual reality (VR) exposure therapy reduces fear of spiders and whether giving patients the illusion of physically touching the virtual spider increases treat- ment effectiveness. Eight clinically phobic students were randomly assigned to one of 3 groups—(a) no treatment, (b) VR with no tactile cues, or (c) VR with a physically "touchable" virtual spider—as were 28 nonclinically phobic students. Participants in the 2 VR treatment groups received three 1-hr exposure therapy sessions resulting in clinically significant drops in behavioral avoidance and subjective fear ratings. The tactile augmentation group showed the greatest progress on behavioral measures. On average, participants in this group, who only approached to 5.5 ft of a live spider on the pretreatment Behavioral Avoidance Test (Garcia-Palacios, 2002), were able to ap- proach to 6 in. of the spider after VR exposure treatment and did so with much less anxiety (see www.vrpain.com for details). Practical implications are discussed.
This study explored whether virtual reality (VR) exposure therapy was effective in the treatment of spider phobia. We compared a treatment condition vs. a waiting list condition in a between group design with 23 participants. Participants in the VR treatment group received an average of four one-hour exposure therapy sessions. VR exposure was effective in treating spider phobia compared to a control condition as measured with a Fear of Spiders questionnaire, a Behavioural Avoidance Test (BAT), and severity ratings made by the clinician and an independent assessor. Eighty-three percent of patients in the VR treatment group showed clinically significant improvement compared with 0% in the waiting list group, and no patients dropped out. This study shows that VR exposure can be effective in the treatment of phobias.
All the people who have heard virtual reality have their own definition of the technology. As a result, virtual reality has definitions as many as the people who have heard it. In this study, the virtual world is defined as an application that lets users navigate and interact with a three-dimensional, computer-generated environment in real time. Such a system has three basic elements which include interaction, 3D graphics, and immersion. The present study aims to emphasis that the virtual reality is more of an interface concept rather than a single product.
Simulator sickness (SS) in high-fidelity visual simulators is a byproduct of modem simulation technology. Although it involves symptoms similar to those of motion-induced sickness (MS), SS tends to be less severe, to be of lower incidence, and to originate from elements of visual display and visuo-vestibular interaction atypical of conditions that induce MS. Most studies of SS to date index severity with some variant of the Pensacola Motion Sickness Questionnaire (MSQ). The MSQ has several deficiencies as an instrument for measuring SS. Some symptoms included in the scoring of MS are irrelevant for SS, and several are misleading. Also, the configural approach of the MSQ is not readily adaptable to computer administration and scoring. This article describes the development of a Simulator Sickness Questiomaire (SSQ), derived from the MSQ using a series of factor analyses, and illustrates its use in monitoring simulator performance with data from a computerized SSQ survey of 3,691 simulator hops. The database used for development included more than 1,100 MSQs, representing data from 10 Navy simulators. The SSQ provides straightforward computer or manual scoring, increased power to identify "problem" simulators, and improved diagnostic capability.
The Fear of Spiders Questionnaire (FSQ), an 18-item self-report questionnaire assessing spider phobia, was developed in an attempt to complement the information provided by the Spider Phobia Questionnaire (SPQ). Data obtained from 338 undergraduates revealed that the FSQ was able to discriminate phobics from nonphobics, and indicated decrements in phobic responding from pretest to posttest following cognitive therapy. Test-retest data, obtained from non-treatment control groups, indicated that scores on the FSQ are stable over a one month period. The FSQ also demonstrated adequate convergent validity due to its significant correlations with the SPQ and a behavioral avoidance test. Finally, a factor analysis revealed two factors accounting for 55% of the variance. It is argued that, compared to the SPQ, items on the FSQ are more explicit regarding the time period to be assessed, and may be more sensitive to differences between phobics and nonphobics and decrements in phobic responding following treatment.
This is the first case report to demonstrate the efficacy of immersive computer-generated virtual reality (VR) and mixed reality (touching real objects which patients also saw in VR) for the treatment of spider phobia. The subject was a 37-yr-old female with severe and incapacitating fear of spiders. Twelve weekly 1-hr sessions were conducted over a 3-month period. Outcome was assessed on measures of anxiety, avoidance, and changes in behavior toward real spiders. VR graded exposure therapy was successful for reducing fear of spiders providing converging evidence for a growing literature showing the effectiveness of VR as a new medium for exposure therapy.
The aim of the present study was to evaluate the effectiveness of low-budget virtual reality (VR) exposure versus exposure in vivo in a between-group design in 33 patients suffering from acrophobia. The virtual environments used in treatment were exactly copied from the real environments used in the exposure in vivo program. VR exposure was found to be as effective as exposure in vivo on anxiety and avoidance as measured with the Acrophobia Questionnaire (AQ), the Attitude Towards Heights Questionnaire (ATHQ) and the Behavioral Avoidance Test (BAT). Results were maintained up to six months follow-up. The present study shows that VR exposure can be effective with relatively cheap hardware and software on stand-alone computers currently on the market. Further studies into the effectiveness of VR exposure are recommended in other clinical groups as agoraphobics and social phobics and studies in which VR exposure is compared with more emerging virtual worlds as presented in CAVE-type systems.