A comparative study of the sense of presence and anxiety in an invisible marker versus a marker Augmented Reality system for the treatment of phobia towards small animals

Phobia towards small animals has been treated using exposure in vivo and virtual reality. Recently, augmented reality (AR) has also been presented as a suitable tool. The first AR system developed for this purpose used visible markers for tracking. In this first system, the presence of visible markers warns the user of the appearance of animals. To avoid this warning, this paper presents a second version in which the markers are invisible. First, the technical characteristics of a prototype are described. Second, a comparative study of the sense of presence and anxiety in a non-phobic population using the visible marker-tracking system and the invisible marker-tracking system is presented. Twenty-four participants used the two systems. The participants were asked to rate their anxiety level (from 0 to 10) at 8 different moments. Immediately after their experience, the participants were given the SUS questionnaire to assess their subjective sense of presence. The results indicate that the invisible marker-tracking system induces a similar or higher sense of presence than the visible marker-tracking system, and it also provokes a similar or higher level of anxiety in important steps for therapy. Moreover, 83.33% of the participants reported that they did not have the same sensations/surprise using the two systems, and they scored the advantage of using the invisible marker-tracking system (IMARS) at 5.19 +/- 2.25 (on a scale from 1 to 10). However, if only the group with higher fear levels is considered, 100% of the participants reported that they did not have the same sensations/surprise with the two systems, scoring the advantage of using IMARS at 6.38 +/- 1.60 (on a scale from 1 to 10). (C) 2011 Elsevier Ltd. All rights reserved.Juan, M.; Joele, D. (2011). A comparative study of the sense of presence and anxiety in an invisible marker versus a marker Augmented Reality system for the treatment of phobia towards small animals. International Journal of Human-Computer Studies. 69(6):440-453. doi:10.1016/j.ijhcs.2011.03.00244045369

Design and Implementation of Markerless Augmented Reality Application for Cockroach Phobia Therapy Using Adaptive Threshold

Augmented reality (AR) technology is useful for treating several psychological problems, including phobias such as fear of flying, agoraphobia, claustrophobia, and phobia to insects and small animals. However, the currently existing applications for therapy of cockroach phobia that uses AR technology are still very dependent towards the presence of markers, which might lessen the feeling of being in an actual scenario from everyday lives. In this paper, we created a system that is able to use everyday things as a replacement for markers for phobia therapy for cockroach. There are five main processes: getting the live streaming feed from camera, preprocessing, extracting the center point of the objects, tracking the marker-substitute objects, and lastly, instantiating cockroaches randomly after user lifts the objects according to the number and mode of the cockroaches, whether it is moving or not, that are predetermined by the user. The evaluation in this paper includes eight participants that are carefully selected based on their Fear of Spiders Questionnaire (FSQ) score that is translated into Indonesian and modified to accommodate cockroaches instead of spiders. The results is that the system can induce anxiety level on participants with the highest score of 10, which is the highest score in Standard Unit of Discomfort scale (SUDs). While the presence and reality judgment of this paper has the highest score of 7 which is also the highest score in Slater-Usoh-Steed Questionnaire (SUS)

Exploratory psychometric validation and efficacy assessment study of social phobia treatment based on augmented and virtual reality serious games and biofeedback

Tese de mestrado integrado em Engenharia Biomédica e Biofísica (Engenharia Clínica e Instrumentação Médica), Universidade de Lisboa, Faculdade de Ciências, 2020Com o tamanho de aproximadamente dois punhos fechados e a aparência de uma enorme noz, o cérebro humano possui um poder inigualável, sendo um dos órgãos mais complexos e importantes do corpo humano. Tem a capacidade de um grande computador, capaz de receber e processar informação para depois enviar mensagens como resposta, e ainda assim é capaz de diferenciar a inteligência humana da de uma máquina – capacitando a espécie humana para muito mais, como é o caso particular dos pensamentos, sentimentos e emoções. No entanto, apesar das suas impressionantes capacidades, o cérebro também é extremamente frágil. De acordo com a Organização Mundial de Saúde, 1 em cada 4 pessoas em todo o mundo irá sofrer de uma determinada doença mental ou neurológica, nalgum ponto das suas vidas. Adicionalmente, doenças do foro mental estão entre as principais causas de incapacidade a nível mundial, visto que afetam atualmente cerca de 450 milhões de pessoas, das quais 300 milhões foram apanhadas pelo maior flagelo da mente do milénio: ansiedade e as doenças que dela derivam. Nos dias que correm, os métodos tradicionais de tratamento de patologias ansiogénicas, nomeadamente fobias, são de uma forma geral insatisfatórios, visto que tipicamente dependem de medicação, não possuem métricas objetivas nem existe uma continuidade casa/clínica. Na União Europeia, cerca de 83 milhões de pessoas sofrem de fobias. A patologia fóbica representa o grupo de perturbações de ansiedade com origem apenas, ou predominantemente, em determinadas situações bem definidas e que não representam qualquer perigo: tipicamente um medo persistente e excessivo de um objeto ou situação. Existem três tipos de fobias: fobias específicas, fobia social e agorafobia – sendo a fobia social a mais predominante. No entanto, os métodos tradicionais de tratamento, que incluem a medicação, a terapia cognitivo-comportamental e a dessensibilização sistemática, possuem bastante limitações. Por um lado, a medicação tem uma atuação relativamente rápida, porém não resolve a raiz do problema e origina tipicamente efeitos secundários fortes e prolongados no tempo. Os métodos terapêuticos, mais seguros e com maior potencial, necessitam de longos períodos de tempo para que se comecem a ver os primeiros resultados e, como tal, exigem um elevado compromisso e dedicação por parte do paciente, de tal forma que nem toda a gente é capaz de levar estes tipos de tratamento até ao fim. Adicionalmente, encontram se com frequência geograficamente distribuídos de forma assimétrica e são ainda objeto de grande estigma e tabu. Por outro lado, outra lacuna inerente à abordagem terapêutica em questão é a falta de métricas objetivas que quantifiquem o estado do paciente e o progresso do tratamento, visto que estão inteiramente dependentes da autoavaliação subjetiva da severidade do que sentem os próprios pacientes, bem como a análise, também esta subjetiva, por parte do terapeuta. Ora, este carácter subjetivo leva a uma eficácia de tratamentos muito variável, tornando estes métodos tradicionais muito pouco fiáveis. O presente trabalho de dissertação focou-se na conceptualização, implementação e teste da eficácia de um mecanismo psicoterapêutico digitalizado, que combina jogos sérios com biofeedback para melhorar o tratamento da fobia social. Jogo sério é a designação dada a experiências gamificadas desenhadas para entreter o jogador, enquanto o educam, treinam ou induzem a alteração de comportamentos, não tendo o entretenimento como objetivo central. A aplicação desta técnica no campo da saúde tem vindo a ser comprovada como uma mais valia, incentivando o envolvimento ativo e dinâmico do paciente. No que diz respeito ao biofeedback, este consiste em protocolos de condicionamento que visam manipular sistemas corporais, arbitrariamente, isto é, treino comportamental através da monitorização de processos fisiológicos específicos. Assim, a abordagem idealizada pretende colmatar as lacunas da técnica de dessensibilização sistemática, recorrendo a jogos sérios para facilitar a recriação do ambiente de exposição fóbica em qualquer lugar e de forma controlada, motivar o paciente ao longo do seu tratamento, personalizar a sua jornada através do biofeedback e, recorrendo aos sinais fisiológicos utilizados para o esse feedback, monitorizar/quantificar objetivamente o progresso do tratamento. Para tal, o estudo realizado nesta dissertação foi dividido em duas grandes fases. Primeiramente, foi concebido um método para classificação emocional, através da análise da atividade fisiológica usando Eletroencefalografia (EEG) e Fotopletismografia (PPG), experienciada aquando da visualização de 7 clips de vídeo que suscitam diferentes emoções. Para a validação desses clips, 100 sujeitos saudáveis foram submetidos à experiência e foram avaliadas as emoções sentidas, reportadas pelos próprios. Posteriormente, os vídeos mais eficazes para suscitar cada emoção foram selecionados e o protocolo repetiu-se para 25 novos sujeitos saudáveis e ambas as respostas relatadas e fisiológicas foram monitorizadas. A partir da informação recolhida, retiraram-se várias conclusões uteis para a próxima fase do estudo: relativamente à definição dos requisitos para seleção dos participantes (género, mão dominante), bem como à obtenção do biomarcador da ansiedade baseado nas métricas fisiológicas exploradas. Em conjunto com a equipa psiquiátrica do Hospital de Beja, selecionaram-se 5 doentes masculinos e destros, com idades compreendidas entre os 26 e 58 anos, para participarem no estudo, sendo divididos em dois grupos: o experimental (3) que participou num total de 8 sessões, e o de controlo (2) que não teve qualquer tipo de interação com a investigadora, sendo que a informação necessária foi transmitida pelo seu médico psiquiatra. As duas primeiras sessões dedicaram-se às apresentações e a última serviu de follow-up para avaliar o progresso do tratamento. Ao longo das 5 sessões restantes, foram aplicados os jogos sérios (com Realidade Aumentada (AR) para a terapia por exposição e com Realidade Virtual (VR) para meditação imersiva) e a avaliação emocional, através dos dados fisiológicos de EEG e PPG e do conhecimento adquirido da fase anterior, permitindo a execução de um biofeedback manual, controlando a intensidade da exposição ao estímulo fóbico. Adicionalmente, os participantes também responderam a questionários universais para avaliar os níveis de ansiedade e de fobia social, de qualidade de vida e a experiência de jogo: Beck Anxiety Inventory (BAI); Liebowitz Social Anxiety Scale (LSAS); World Health Organization Quality of Life (WHOQOL-Bref); and Game Experience Questionnaire (GEQ), respetivamente. Os resultados do grupo experimental relativamente ao grupo de controlo demonstram um decréscimo nas pontuações do BAI 6.06 vezes mais acentuado, um decréscimo nas da LSAS 4.57 vezes mais acentuado e um aumento do domínio das relações sociais da WHOQOL 4.24 vezes mais acentuado. Os jogos sérios foram validados através do GEQ, tanto o AR para estimulação fóbica gradual como VR para relaxamento e recuperação do estado desconfortável suscitado pela referida estimulação. Por fim, as métricas fisiológicas também confirmam tais conclusões, dado que se verificam diferenças significativas entre as tarefas com propósitos distintos. Em particular, o presente estudo exploratório serviu como base para testar a usabilidade e recetividade da solução inovadora, bem como aferir o seu potencial e eficácia. Contudo, os resultados devem ser considerados à luz de algumas limitações, nomeadamente no que diz respeito à amostra populacional. Próximos passos para o projeto passam pela otimização dos jogos, tanto a nível gráfico, como da robustez e autonomia dos algoritmos de biofeedback. Posteriormente, uma prova de conceito com um grupo de pacientes de dimensão significativa para se retirarem as devidas conclusões e etapas consequentes para a obtenção de comprovação/certificação clínica. Uma vez clinicamente comprovado, será possível usufruir do potencial da técnica para translação de parte da terapia para fora do ambiente clínico/hospitalar, tornando todo o processo de tratamento mais expedito e acessível. Em suma, o principal objetivo de desenvolver uma solução de jogos sérios para tratamento de fobia social, centrada no doente, foi alcançado e o estudo sugere a eficácia da aplicação da mesma.Nowadays, traditional anxiety treatment methods, namely for phobias, are overall underperforming as they typically rely on medication, and lack objective metrics and clinical/home treatment continuity. In the European Union alone, there are over 83 million people suffering from phobias, access to treatment methods is geographically asymmetrically distributed, and patients are still object of a lot of stigma and taboo. The present dissertation work focuses on conceptualizing, implementing and testing the efficacy of a digitalized psychotherapeutic approach, combining serious gaming and biofeedback for improving the treatment of one of the most common mental health disorders: social phobia. To do so, the study was divided in two major phases. First, an emotion classifying method was conceived, through the analysis of Electroencephalography (EEG) and Photoplethysmography (PPG) signal collected whilst healthy subjects were watching a set of 7 emotion-eliciting videos excerpts. To validate the videos, 100 healthy subjects underwent the experiment and self-reported the emotions perceived. Subsequently, the most effective video on eliciting each emotion was selected and the protocol was extended to 25 new healthy subjects, and both self-reported and physiological responses were monitored. From the information collected, conclusions were retrieved for the next phase: defining participant selection requirements (genre, dominant hand) as well as obtaining an anxiety biomarker based on the explored physiological metrics. Together with the psychiatric team of the Hospital de Beja, 5 male right-handed social phobia patients, aged from 26 to 58 years old, were selected to partake in the study, divided in two groups: the experimental group (3) that participated in a total of 8 sessions, and the control group (2) that had no interaction with the researcher and whose relevant information was transmitted by their physician. The first two sessions were dedicated to presentations and acquaintance with the research team, and the last served as a follow-up moment to assess the treatment progress. During the remaining 5 sessions, the Serious Gaming technique was applied (Augmented Reality (AR) to perform exposure therapy and Virtual Reality (VR) for immersive meditation) and the physiological emotion assessment, through EEG and PPG knowledge acquired in the previous phase, to perform a manual biofeedback, adapting the intensity of the exposure to the phobic stimuli. Additionally, participants also filled out self-reported questionnaires to assess anxiety and social phobia levels, quality-of-life and the gaming experience: Beck Anxiety Inventory (BAI), Liebowitz Social Anxiety Scale (LSAS), World Health Organization Quality of Life (WHOQOL-Bref) and Game Experience Questionnaire (GEQ), respectively. Results demonstrated a decrease on BAI scores 6.06 times more accentuated in the experimental against the control group, a decrease 4.57 times more accentuated on the overall LSAS traces and an increase 4.24 times more accentuated on the WHOQOL domain of social relationships. The serious games were validated through GEQ, both the AR for stimulating uncomfortable states that trigger social phobia, and the VR for inducing the relaxing state to recover from the previous phobic-stimulating experience. Lastly, the physiological features also confirm said conclusions, since there were significant differences identified between tasks with the described separate purposes. Notably, the present exploratory study served as the basis for testing the usability and receptivity of such an innovative solution, as well as assessing its potential efficacy. There is, however, the need to have an increased sample size under testing to confirm the obtained results. All in all, the primary objective of the developing a patient-oriented serious game solution for social phobia treatment was achieved and the study suggests the effectiveness of its application

Beyond the screen – The potential of smartphone apps and immersive technologies in exposure-based interventions for phobias

Specific phobias are extremely common among adults. They are characterized by strong emotional reactions and avoidance behavior when exposed to the feared stimuli. Specifically fears concerning heights or animals such as spiders are highly prevalent, followed by fear of social situations such as fear of public speaking. The gold standard in treating specific phobias is exposure-based therapy. However, exposure-based therapy is limited in its practicability in clinical routine and poses a high hurdle for affected individuals. Virtual and augmented reality (VR/AR) smartphone apps offer attractive platforms to simulate exposure situations and by that increase the accessibility of mental health services in general. Thus, novel smartphone-based treatments hold the potential to facilitate the dissemination of exposure-based treatments for specific phobias. The studies presented as part of this thesis aimed at investigating three newly developed interventions for fear of heights, fear of public speaking and fear of spiders, using the currently available advanced technologies. In the first study (Bentz et al., 2021), a stand-alone, automated and gamified VR exposure app Easyheights was developed using 360° images. The app’s effectiveness to reduce fear of heights and avoidance behavior was investigated in a randomized controlled trial in an adult population with clinical and subclinical fear of heights. The repeated use of the app led to reduced fear and avoidance behavior in a real-life situation on a tower. For the second study (Müller, Fehlmann et al., 2022), the developed stand-alone, automated and gamified VR exposure app Fearless Speech aimed at reducing public speaking anxiety (PSA) and avoidance of eye contact. A virtual audience with 360° videos was used for the exposure and gaze control for the eye contact training. The app was investigated in a randomized controlled trial in healthy adults with subclinical PSA. After the repeated use of the app, participants showed reduced fear and improved eye contact in a real-life speech situation. The third study (Zimmer et al., 2021) examined the developed stand-alone, automated and gamified AR exposure app Phobys. In comparison to VR, AR has only recently been introduced to clinical research. The app was designed to reduce fear, disgust and avoidance behavior in adults with clinical and subclinical fear of spiders. The results of the randomized controlled trial showed that repeatedly using the app led to reduced fear, disgust and avoidance behavior in a real-life situation with a real spider. The results of these studies support the potential of stand-alone, automated VR and AR interventions delivered through smartphone apps. The developed apps allow for a high-quality user experience with a highly realistic environment, gaze control for an easy navigation as well as the possibility of interaction. In addition, gamification elements foster engagement with the apps. All three investigated apps offer low-threshold and low-cost treatment for individuals affected by specific phobias. Testing the effectiveness of these newly developed apps in real-life settings sets them apart from previous studies. Hence, this thesis highlights the potential of using smartphone apps with immersive technologies to advance and disseminate exposure-based treatments for specific phobias

Augmented Reality

Augmented Reality (AR) is a natural development from virtual reality (VR), which was developed several decades earlier. AR complements VR in many ways. Due to the advantages of the user being able to see both the real and virtual objects simultaneously, AR is far more intuitive, but it's not completely detached from human factors and other restrictions. AR doesn't consume as much time and effort in the applications because it's not required to construct the entire virtual scene and the environment. In this book, several new and emerging application areas of AR are presented and divided into three sections. The first section contains applications in outdoor and mobile AR, such as construction, restoration, security and surveillance. The second section deals with AR in medical, biological, and human bodies. The third and final section contains a number of new and useful applications in daily living and learning

Behavioural responses in uncertain conditions are influenced by the orbital prefrontal cortex

The orbital prefrontal cortex (OPFC) is implicated in generating outcome expectancies and in preventing the over-generalization of fear. Here, I investigate if the OPFC supports associative processes by determining the relevance of cues during behavioural tasks with relatively high levels of uncertainty. Two projects were conducted: one using appetitive and aversive context conditioning and another using a cue/place variant of the Morris water task. I observed that OPFC inactivation resulted in generalized responses on the appetitive and aversive context conditioning tasks. Further, I observed that after OPFC inactivation, rats favour spatial over cue responses in a competition test of the water task. These results support a role for the OPFC in influencing response strategies and suggest this region is critical for constraining responses during uncertain conditions. Through interactions with learning and memory systems, these results suggest the OPFC supports associative processes during uncertainty by mediating between discrimination and generalization

Presence 2005: the eighth annual international workshop on presence, 21-23 September, 2005 University College London (Conference proceedings)

OVERVIEW (taken from the CALL FOR PAPERS) Academics and practitioners with an interest in the concept of (tele)presence are invited to submit their work for presentation at PRESENCE 2005 at University College London in London, England, September 21-23, 2005. The eighth in a series of highly successful international workshops, PRESENCE 2005 will provide an open discussion forum to share ideas regarding concepts and theories, measurement techniques, technology, and applications related to presence, the psychological state or subjective perception in which a person fails to accurately and completely acknowledge the role of technology in an experience, including the sense of 'being there' experienced by users of advanced media such as virtual reality. The concept of presence in virtual environments has been around for at least 15 years, and the earlier idea of telepresence at least since Minsky's seminal paper in 1980. Recently there has been a burst of funded research activity in this area for the first time with the European FET Presence Research initiative. What do we really know about presence and its determinants? How can presence be successfully delivered with today's technology? This conference invites papers that are based on empirical results from studies of presence and related issues and/or which contribute to the technology for the delivery of presence. Papers that make substantial advances in theoretical understanding of presence are also welcome. The interest is not solely in virtual environments but in mixed reality environments. Submissions will be reviewed more rigorously than in previous conferences. High quality papers are therefore sought which make substantial contributions to the field. Approximately 20 papers will be selected for two successive special issues for the journal Presence: Teleoperators and Virtual Environments. PRESENCE 2005 takes place in London and is hosted by University College London. The conference is organized by ISPR, the International Society for Presence Research and is supported by the European Commission's FET Presence Research Initiative through the Presencia and IST OMNIPRES projects and by University College London