Being There: Understanding the Feeling of Presence in a Synthetic Environment and its Potential for Clinical Change

Anatom

Immersive Composition for Sensory Rehabilitation: 3D Visualisation, Surround Sound, and Synthesised Music to Provoke Catharsis and Healing

There is a wide range of sensory therapies using sound, music and visual stimuli. Some focus on soothing or distracting stimuli such as natural sounds or classical music as analgesic, while other approaches emphasize the active performance of producing music as therapy. This paper proposes an immersive multi-sensory Exposure Therapy for people suffering from anxiety disorders, based on a rich, detailed surround-soundscape. This soundscape is composed to include the users’ own idiosyncratic anxiety triggers as a form of habituation, and to provoke psychological catharsis, as a non-verbal, visceral and enveloping exposure. To accurately pinpoint the most effective sounds and to optimally compose the soundscape we will monitor the participants’ physiological responses such as electroencephalography, respiration, electromyography, and heart rate during exposure. We hypothesize that such physiologically optimized sensory landscapes will aid the development of future immersive therapies for various psychological conditions, Sound is a major trigger of anxiety, and auditory hypersensitivity is an extremely problematic symptom. Exposure to stress-inducing sounds can free anxiety sufferers from entrenched avoidance behaviors, teaching physiological coping strategies and encouraging resolution of the psychological issues agitated by the sound

Does engagement with exposure yield better outcomes?: Components of presence as a predictor of treatment response for virtual reality exposure therapy for social phobia

Virtual reality exposure (VRE) has been shown to be effective for treating a variety of anxiety disorders, including social phobia. Presence, or the level of connection an individual feels with the virtual environment, is widely discussed as a critical construct both for the experience of anxiety within a virtual environment and for a successful response to VRE. Two published studies show that whereas generalized presence relates to fear ratings during VRE, it does not relate to treatment response. However, presence has been conceptualized as multidimensional, with three primary factors (spatial presence, involvement, and realness). These factors can be linked to other research on the facilitation of fear during exposure, inhibitors of treatment response (e.g., distraction), and more recent theoretical discussions of the mechanisms of exposure therapy, such as Bouton’s (2004) description of expectancy violation. As such, one or more of these components of presence may be more strongly associated with the experience of fear during VRE and treatment response than the overarching construct. The current study (N=41) evaluated relations between three theorized components of presence, fear ratings during VRE, and treatment response for VRE for social phobia. Results suggest that total presence and realness subscale scores were related to in-session peak fear ratings. However, only scores on the involvement subscale significantly predicted treatment response. Implications of these findings are discussed

Applying User-Centered Design in the Development of a Software Application For the Treatment of a Mental Health Disorder

The research that follows will provide a process for applying a user-centered design methodology to the development of a virtual environment software application for the treatment of a mental health disorder, specifically post traumatic stress disorder (PTSD). The goal is to create a screen-based virtual environment product that focuses on the end user rather than the technological aspects of the system. Moreover, past and present treatments in the mental health and healthcare fields and their effectiveness will be analyzed through an extensive literature review

Can rehabilitation through virtual reality improve the quality of the health care communication? = ¿La realidad virtual en rehabilitación puede mejorar la calidad de la comunicación en los servicios sanitarios?

Abstract: Introduction: Exercises on prescription given by physiotherapist are sometimes complex to explain & difficult to remember by the patient. Implementation of virtual reality could maybe improve such communication. Objective: demonstrate the effectiveness of using a VR-based protocol, with a “teaching by example” approach Methods: Total of 6 participants were exposed to two different exercise set: 1- with a 3D agent; 2- with a video of a real person. Each test person was: 1- video recorded to keep track on his/her experience using both programs; 2- tested with Modified PSSUQ & Words questionnaires after each performance; 3- video recorded in an interview with open questions to clarify the participants’ personal experiences. Results: Three of the participants would prefer to use the video: Three preferred the 3D virtual reality application and all participants felt both approach were easy to use & follow. However, from the video recorded observations some participants did not perform the exercises as well as they thought themselves; Conclusions: No difference was found in how well the participants performed with the two approaches or how they perceived the movements of the video instructor compared to the 3D virtual trainer. Improvement of the 3D set up, could potentially show further differences between the two approaches in future studies. Keywords: Virtual rehabilitation, virtual reality, Communications, physiotherapy, exercise on prescription Resumen: Introducción: Los ejercicios prescritos por el fisioterapeuta son a veces difícil de explicar y difícil de recordar por parte del paciente. La aplicación de la realidad virtual (VR) quizás pudiera mejorar dicha comunicación. Objetivo: demostrar la eficacia de la utilización de un protocolo basado en VR , utilizando "enseñanza con ejemplos" Métodos : un total de 6 participantes fueron expuestos a dos programas de ejercicios diferentes: 1 - con un agente de 3D ; 2 - con un video de una persona . Cada participante fue: 1– grabado/a en video para realizar un seguimiento de su experiencia utilizando ambos programas; 2– testeado/a con los cuestionarios modificados de PSSUQ y Words después de cada actuación; 3- grabado/a en video en una entrevista con preguntas abiertas para esclarecer las experiencias vividas. Resultados: Tres de los participantes prefirieron el programa de ejercicios en video, el resto el de realidad virtual, todos los participantes pensaron que los dos programas de ejercicios eran fácil de usar y seguir. Sin embargo, las observaciones registradas en vídeo muestran que algunos de los participantes, a pesar de que creyeron realizar correctamente los ejercicios, no los hicieron como se esperaba; Conclusión: No se encontró diferencia entro los dos enfoques en lo que atiene la perfección del movimiento o cómo los participantes percibieron los movimientos del instructor. El mejoramiento del programa 3D de ejercicios, podrían mostrar mayores diferencias entre los dos enfoques en estudios futuros. Palabras clave: Rehabilitación virtual, realidad virtual, comunicación, fisioterapia, prescripción de ejercicio

Wreading, Performing, and Reflecting: The Application of Narrative Hypertext and Virtual World Experiences to Social Work Education

In this dissertation I propose the use of a new media composition of narrative hypertext, performances in a virtual world, and a dialogic process of writing to provide a continuum of learning opportunities in social work education. I suggest that the structure of the hypertext narrative, embedded with hypermedia, mirrors the dissociative aspects of traumatic memory. I argue that work with the multivocality and multisequentiality of narrative hypertext emulates the process of discovery in the clinical interview. The immersive component of work in a virtual world deepens the realism and affective impact of simulations and creates opportunities to practice and demonstrate engagement, assessment, and intervention skills. The writing component of the new media composition actively engages students in a dialogic process that hones the development of self-reflexive practice and a professional social work identity. In developing the project, I enlisted the input of two groups of key informants. Content experts provided background that informed the narrative and scripts. A second group of faculty, students, and practitioners provided input on project design and identified potential barriers to success and anticipated outcomes. Informants suggest that the continuum of media engages students with a variety of learning styles, offers safe ways to practice skills as a precursor to interviews with actual clients, and allows for exploration of diverse identities as an avatar. Potential barriers include the time and resources required to learn new technologies and the potential for students to be triggered by trauma content. Informants offered recommendations to address the barriers. Three changes were immediately incorporated into the structure and content of the project to address these concerns

Designing virtual environments for brain injury rehabilitation

Virtual Reality (VR) has shown great potential in various training applications. In the field of cognitive rehabilitation it has been shown that VR technology can become a useful complement to conventional rehabilitation techniques (e.g. Rizzo et al. (2002), Brown et al. (2002) and Kizony et al. (2002)). An important part of a brain injury patient’s rehabilitation process is practicing instrumental activities of daily living (IADL), such as preparing meals, cleaning, shopping and using a telephone. A pilot study by Lindén et al. (2000) came to the conclusion that activities like these can be practiced using desktop VR. The question addressed in this thesis is how a Virtual Environment (VE) should be designed to be a usable tool in brain injury rehabilitation. The thesis consists of three papers that describe three different studies that have been performed in order to further explore this area of research. Paper I describes the design of a practical VE application in the shape of a cash dispenser. A paper prototype was constructed which was first used to generate ideas from three occupational therapists. The prototype was then tested on six people with little or moderate computer knowledge and no experience of 3D computer simulations. The results from the evaluation were then used to implement a computer prototype with the VR development tool World Up. The computer prototype had automatic navigation, which meant that the position and orientation of the viewpoint, the user’s view into the VE, was controlled by the computer. The point-and-click method, which allows the user to move and manipulate objects with single mouse clicks, was used for interaction with objects. The computer prototype was then tested on five brain injury patients. The results of this evaluation are not included in paper I but are described in the thesis summary. Overall, all five subjects learned to handle the computer prototype sufficiently well. However, the interaction with objects posed some problems for them. For example, they initially tried to move the bankcard with drag-and-drop instead of point-and-click. Three subjects also pointed out that some parts of the VE, for example the display and the keypad, were unclear. All five subjects showed a positive attitude to the virtual cash dispenser The aim of paper II was to find a usable navigation input device for people with no experience of 3D computer graphics. After an initial discussion about various input devices it was decided that a Microsoft Sidewinder joystick and an IntelliKeys keyboard, both programmed with two and three degrees of freedom (DOF), should be compared in an experiment. Sixty able-bodied people with no experience of 3D computer graphics were divided into four groups. Each group was to perform a navigation task in a VE consisting of a kitchen and a corridor using one of the four input devices. The navigation task was designed to evaluate both fine adjustments of the viewpoint (maneuvering task) and transportation of the viewpoint from one location to another (search task). Each subject performed the task five times in a row and then answered a questionnaire consisting of five questions. Data logging and video recording were used to collect data. The study showed that both keyboard and joystick have their advantages and disadvantages. The keyboard seemed to be easier to control than the joystick for the maneuvering task. The keyboard was slightly easier to control also for the search task but was much slower than the joystick, which might make it an inconvenient input device for VEs that only involve search navigation. No significant difference could be found between two and three DOFs for the maneuvering task, but the 3rd DOF (sideways movement) seemed to facilitate the subjects’ navigation in some situations. Two DOFs was found to be slightly easier to control than three DOFs for the search task. The study described in paper III aimed at 1) evaluating a method for interaction with objects in VEs on people with no 3D computer graphics experience, and 2) finding a sufficiently usable input device for this purpose. After an initial discussion of possible methods for interaction with objects and various input devices, an experiment was conducted with 20 able-bodied people with no experience of 3D computer graphics. Our experiences of point-and-click from paper I and the pilot study (Lindén et al., 2000) made us think that maybe people have a more inherent understanding for drag-and-drop. Also, we had discussed using a virtual hand for carrying objects to simplify object movement. We therefore wanted to evaluate the following method for interaction with objects: 1) A virtual hand was used for carrying objects, 2) drag-and-drop was used for moving objects, 3) a single click was used for activating objects, and 4) objects were given a proper orientation automatically. Ten subjects used a regular desktop mouse and the other ten a touch screen to perform four interaction tasks in a kitchen VE five times in a row. Video recording was used to document the trial and the interview that was conducted afterwards. Broadly, the method for interaction with objects worked well. The majority of the subjects used the virtual hand for carrying objects. However, the fact that some subjects needed information before they started to use it indicates that its visibility and affordance needs to be improved. Opening and closing cupboard doors caused some problems, especially for the subjects in the touch screen group who tried to open them with drag-and-drop in a manner that resembled reality. No large difference in performance, except from the problem with the cupboard doors, could be seen between the mouse group and the touch screen group. The three studies described in this thesis is a step closer towards understanding how a VE should be designed in order to be a usable tool for people with brain injury. In particular, knowledge on how to make it as easy as possible for the user to navigate the viewpoint and interact with objects has been achieved. The work has also provided a deeper understanding on what effects the choice of input device has on the usability of a VE

Virtual reality exposure therapy for social phobia

This thesis presents researches and experiments performed in collaboration with a psychiatrist in order to validate and improve the use of virtual reality in social phobia psychotherapy. Cognitive and behavioral therapies are strongly based on the exposure to anxiety provoking stimuli. Virtual reality seems to be appropriate for such exposures as it allows for on-demand reproduction of reality. The idea has been validated for the treatment of various phobias but is more delicate in the case of social phobia; whereas the sense of presence provoked by the immersion in a virtual environment supports the emergence of fears linked to a location, we had to verify that we can reproduce social phobia related anxiety-provoking stimuli by simulating virtual humans. Therefore, and in order to provide therapists with an efficient virtual reality system dedicated to the exposure to social situations, we have developed software solutions supporting different immersion setups and enabling realistic simulations of inhabited virtual environments. We have experimented with public speaking scenarios within a preliminary study, three clinical case studies and a validation study on 200 subjects. We have been able to confirm that our virtual reality platform fulfilled therapeutic exposure requirements for social phobia. Moreover, we have been able to show that virtual reality exposure has additional advantages such as the possibility to improve clinical assessment with embedded monitoring tools. Our experiments with physiological measurements and eye tracking technology during immersion leaded to the validation of systems for objective and reliable assessment of patients' safety behaviors. The observation of such phobic reactions has confirmed the simulation impact and may provide therapists with enhanced pathological progression monitoring. During our experiments, we have also been able to observe that subjects' reactions during immersion were so much influenced by their sensitivity to fearful stimuli that their cognitive reactions were 'overloaded' by the arousal of anxiety and emotions. This has allowed us to consider that the sense of presence was more importantly related to the subjective impact of the content than to the technological process