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

Acquisition and extinction across multiple virtual reality contexts: implications for specific phobias and current treatment methods

Victor Wong studied human acquisition learning over multiple contexts using virtual reality. He found that learning an association over multiple contexts can impact subsequent extinction training. This suggests that fears acquired over multiple contexts may be more difficult to treat using exposure-based therapies and will need to be augmented for effectiveness

Virtual Reality as a Tool in the Treatment of Claustrophobia - A Review

Within the context of psychology, virtual reality (VR) is presented as a technological tool to address and treat the symptoms of claustrophobia. Claustrophobia is distinguished by a fear of small or enclosed environments, which can be a challenge for conventional treatments. This research work focused on conducting a detailed analysis of the existing literature on using VR as an alternative tool to treat claustrophobia symptoms. The research results indicated that treatment with VR technology may be effective in providing a controlled and safe way to expose patients to situations such as those they fear, allowing them to overcome their fears more effectively. This review article provides a comprehensive analysis of the use of VR to treat laustrophobia. A total of 384 manuscripts from different virtual databases were analyzed, from which 61 major articles were selected. The results showed that VR allows for treating different types of phobias such as Acrophobia, Agoraphobia, rachnophobia, claustrophobia, Fear of flying, Fear of public speaking and Fear of injections, achieving significant patient results. Studies have proven the effectiveness of VR in reducing the symptoms of claustrophobia, and it is anticipated that it will continue to be an important tool in the future

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

Simulating interactions with virtual characters for the treatment of social phobia

Virtual Reality (VR) has nowadays become a very useful tool for therapists in the treatment of phobias. Indeed, it allows the simulation of scenarios which are difficult to reproduce in real life. It also allows for a situation to be repeated as much as one wants. Moreover, it allows for a complete control over the situation. The simulation can be stopped if the patient cannot handle it. It can also be tweaked for gradual exposure. Virtual Reality Exposure Therapy (VRET) has proven to be efficient in the context of phobias such as acrophobia or the fear of flying. Social phobia, however, are much harder to deal with. Indeed, as humans, we are experts in human representations and behaviors; it makes it much harder to obtain credible and immersive environments. In this thesis, we describe a set of tools and applications which we have developed to be used in VRET of social phobia and agoraphobia with crowds. We first describe how we create different scenarios for VRET of social phobia. We then expose the application we have developed which allows for elaborate interactions between a user and virtual characters. In particular, we have designed and implemented a software which allows for virtual characters to change behavior depending on the user's eye contact behavior. It allows them to seem interested when being looked at and distracted when not. We then describe the model we have implemented to simulate gaze attention behaviors for crowds of virtual characters. This consists of a method that automatically detects where and when each virtual character in a crowd should look. Secondly, it consists of a dedicated gaze Inverse Kinematics (IK) solver in order for the virtual characters to satisfy the constraints defined by the automatically detected points to be looked at. This allows for the characters to perform the looking motion in a natural and human like way. We then describe the architecture we have developed to combine the work we have done in the domain of social phobia and this model of attention behaviors for crowd characters. We thus use our model of looking behaviors to allow for crowd characters to look at each other. We also use eye-tracking and optical motion capture to determine where a user is looking in a CAVE environment. The virtual characters then respond by either looking at the user, looking at what the user is looking at, or looking at other characters in the crowd. We thus obtain an immersive and interactive environment for VRET in the domain of agoraphobia with crowds. The third part of this thesis describes various experiments we have conducted in order to validate our applications. Our first study consists of using VR in a head-mounted display (HMD) for the treatment of social phobia. In this study, we also use eye-tracking in order to analyze eye contact avoidance behaviors before and after therapy. We then discuss the use of eye-tracking as a tool to help assess and diagnose social phobia. Since eye contact avoidance behaviors are frequent in people suffering from such phobias, eye-tracking can certainly be a helpful tool. We describe an experiment in which we tested eye-tracking as a diagnosis and assessment tool on a phobic population and on a control group. We also describe an experiment to evaluate the potential of our proposed interaction loop in the context of social phobia. Finally, we describe the experiment we have conducted to evaluate our application in the context of agoraphobia with crowds

Contributions to Neuropsychotherapy of the Combined Use of Neuroimaging and Virtual Exposure for Assessment in Psychological Treatments

Neuropsychotherapy is a new philosophy in the treatment of mental disorders that bases its principles in the application of the information we have about the brain activations and brain functioning to adjust the therapy to them, in order to center the process in how the brain evolves to its normal activations. New tools in the field of neuroimaging have helped in this process, providing accurate and detailed information about how the particular brain of each patient works. Between the many neuroimaging techniques available nowadays, the functional magnetic resonance (fMRI) stands out by its high spatial resolution, which allows a better knowledge of which brain area is activated before each stimulus or while performing each activity. The disadvantages this technique presents in terms of size of the scanner and restriction of movements give light to another technique, more suitable in certain domains: the electroencephalography (EEG), which provides a greater freedom of movement and higher temporal resolution. For the purposes of this PhD Thesis, both techniques will be compared, in order to find which one better suits our interests. For doing so, another factor will be taken into account. Due to the limitations the neuroimaging techniques have in terms of presentation of the stimuli, we are not able to expose the subject to certain kinds of real life situations. There is where the virtual reality (VR) enters the scene. With VR we are able to move the subject to a virtual world where any kind of stimulus is possible. In the case of neuropsychotherapy, it will allow the exposition of the patient to a situation related to his disorder, in a safer and more controlled environment. In fact, virtual reality has been widely used for the treatment of psychological disorders; but, until now, it has not been applied during the assessment of the disease. For the aims of this Thesis, virtual environments will be used for the assessment of subjects before and after undergoing a psychological treatment for a specific disorder, using neuroimaging techniques to find useful information that could help during the therapeutic process. As an example of disorder, the phobia to small animals (spiders and cockroaches) has been chosen, although the conclusions of this study could be extended to other kinds of psychological disorders. Before being able to assure that the brain activations obtained are related to the disorder and not to other issues, it is needed to measure the sense of presence the subjects felt during the virtual experience. This is why before the assessment of a psychological disorder, a study of the sense of presence in a virtual environment was introduced. This study also helped in the decision of which neuroimaging technique apply in the second part of the Thesis. EEG and fMRI were used for the measure of presence in the same virtual environments, and the results in terms of brain activations were compared. Presence was also measured by means of questionnaires, the traditional subjective way of measuring it. As a result of this study it is expected to check if VR could effectively stimulate presence and which neuroimaging technique is more appropriate for the targets of this Thesis. To sum up, the initial hypotheses of this Thesis are that: 1- The new neuroimaging techniques can provide of useful information to use during neuropsychotherapy. 2- Virtual reality would help in the assessment of the disorder, improving the accuracy in the way the subjects are exposed to the stimuli. 3- The environments used would be immersive enough so the patient will feel present in them and feel them as real. For fulfilling these objectives, each of the two courses of work (study of presence and assessment of a mental disorder) was divided in two parts. In total, four studies were developed: 1- Study of the sense of presence in a virtual environment using fMRI: the aim of this part of the Thesis was to check if the environments were able to stimulate the sense of presence, correlating the results with those given to questionnaires. 2- Study of the sense of presence in a virtual environment using EEG: the aim here was to compare the brain activations obtained with EEG with those from the previous study, and if the responses of the questionnaires were equivalent despite being in a less intrusive scanner. As a result of these two studies, it was decided that the environments were immersive enough to induce the sense of presence, and that the best neuroimaging technique for the next part of the Thesis was the fMRI, due to the higher spatial resolution it brought. 3- Assessment of a psychological disorder, pre-treatment: once decided the study will continue with fMRI, the areas related to a specific disorder (small animals¿ phobia) were studied using VR as stimulus. Until now, the assessment has been done using real animals as stimuli but not using VR, which here is hypothesized to allow a better approach to the phobic experience than the view of photographs or videos of real animals. 4- Assessment of the state of subjects with a psychological disorder, post-treatment: once the patients had underwent a treatment to cure the disorder, they were assessed again to check if the brain areas related to the phobia stopped being activated after it. As a result of this second part of the Thesis, the brain areas related to the phobia (that stopped being activated after the treatment) were obtained, and this information is hoped to be useful in future neuropsychotherapeutic works, for the better adjustment of the disorder. In conclusion, this PhD Thesis studies the advantages that the new neuroimaging techniques and virtual reality could bring to the study of neuropsychotherapy.Clemente Bellido, M. (2014). Contributions to Neuropsychotherapy of the Combined Use of Neuroimaging and Virtual Exposure for Assessment in Psychological Treatments [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/37234TESI

Aware : monitorização psicológica com realidade aumentada em smartphone

Mestrado em Engenharia de Computadores e TelemáticaA exposição a agressões psicológicas subsequentes do estilo de vida na sociedade atual, como o stress, trauma, ou a deslocalização constante, têm um forte impacto na condição psicológica e comportamental das pessoas, podendo mesmo conduzir a distúrbios de ansiedade. Desta forma, é imperativo que os processos de terapia recriem ambientes semelhantes aos do quotidiano do indivíduo (“contextos ecologicamente válidos”), para que este possa ser exposto aos seus receios de forma controlada. No entanto, existe alguma dificuldade em obter dados ecologicamente precisos, uma vez que as ferramentas de medição ou métodos de monitorização utilizados induzem alterações no contexto real, colocando em causa a viabilidade da execução do processo num ambiente natural para o utilizador. Nesta dissertação, propomos o sistema AWARE, uma solução que permite avaliar as condições fisiológicas e comportamentais do(s) participante(s) de uma experiência. Este sistema permite integrar o individuo num contexto ecologicamente válido (fora de laboratório), durante a execução de terapia, recorrendo aos recursos de localização, deteção de movimento e conectividade disponíveis num smartphone, bem como a dispositivos dedicados de medição de sinais vitais, de uma forma não intrusiva, abstraindo o sujeito do mesmo. A existência de uma estrutura de persistência de dados suportada na Cloud garante também um acesso remoto a estes resultados. Terapias associadas a distúrbios comportamentais têm usualmente como componente fundamental a exposição a estímulos que despoletam reações de ansiedade. Desta forma, e paralelamente à monitorização, o sistema proposto está preparado para a apresentação de estímulos, permitindo a avaliação da consequente reação do utilizador. Graças à implementação de tecnologias de realidade aumentada, torna-se possível apresentar modelos 3D virtuais, integrados na perspetiva do mundo real do sujeito. Esta proposta de solução constitui, assim, uma ferramenta flexível e de utilização intuitiva, com a qual podemos avaliar as alterações provocadas no comportamento em cada sujeito, quando confrontado com estímulos específicos. O sistema AWARE foi testado em dois contextos diferentes: 1. A componente de monitorização foi utilizada em artistas aquando da representação de variados temas de música clássica; 2. As componentes de monitorização e realidade aumentada foram aplicadas em simultâneo no contexto do estudo e tratamento de fobias. No primeiro caso de estudo, verificou-se um aumento da frequência cardíaca em momentos cruciais das peças, como a subida ao palco e o início da atuação. No segundo contexto, verificou-se que o aparecimento de um estímulo despoleta alterações fisiológicas (exemplo: alterações na frequência cardíaca). Em terapias de tratamento de fobias, os indivíduos são repetidamente sujeitos ao mesmo tipo de testes/estímulos, de forma a avaliar a reação à exposição continuada aos mesmos (cuja variação irá, em teoria, sofrer uma diminuição, caso o sujeito seja fóbico). Na nossa experiência, dois voluntários não fóbicos realizaram dois testes sucessivos, não havendo um padrão de variação da frequência cardíaca do primeiro para o segundo teste. Este valor vai de encontro ao esperado, dada a caracterização não fobica dos sujeitos. Os resultados apresentados sugerem que o sistema proposto pode revelar-se uma ferramenta útil quer na monitorização não intrusiva, quer em terapias de exposição, sendo de fácil integração num contexto real.The exposure to psychologically hostile situations in today's society, like stress, trauma or constant life event changing have a strong negative influence on people's psychological condition and general behavior, possibly leading to anxietyrelated disorders. Therefore, it is of extreme importance that the therapy processes are able to recreate a natural and familiar ("ecological") environment, according to the individual everyday life, allowing him/her to face his/her fear in a controlled environment. However, up to this day, there are issues related to the gathering of ecologically precise data, due to the real world variations induced by the measuring tools or the viability issues related to the therapy's execution. In this dissertation, we propose the AWARE system, a solution that allows the assessment of a subject's physiological and behavioral condition in an ecologically valid context, using the location, movement description and connectivity resources available on a smartphone, as well as dedicated vital signal measuring devices. The whole process is executed outside of the lab, in a real ecosystem, while keeping the subject oblivious about the whole monitoring activity. The existence of a data persistence based on the Cloud assures the remote availability of this results. Parallel to the monitoring, the proposed solution is also ready to present stimuli, providing a means of evaluating the subject's reaction. Augmented reality technologies are employed in order to present different 3D models embedded into the subject's real world perspective. Our system establishes itself as a flexible and intuitive tool, with which we can study the behavioral changes caused by the confrontation of a person with a specific set of stimuli. AWARE was tested in two different contexts: 1. Independently, the monitoring features were used in musicians during the performance of classical plays; 2. On a different scenario, both the augmented reality and the monitoring modules were tested together in phobia analysis and treatment. In the first study case, a heart rate frequency increase was detected in crucial moments of the plays (like going to the stage, or beginning the performance). In the second study case, some physiological reactions to the presented stimuli (e.g. heart rate frequency variation) were observed. In phobia treatment therapies, subjects repeat the same series of tests multiple times, in order to evaluate the reaction to continuous exposure to the same stimuli (which will, in theory, have a progressively lower variation in phobic subjects). In our experiments, the volunteers executed two tests each, and there was not any visible heart rate standard deviation decrease, an expected result, given their non-phobic condition. The presented results suggest that the proposed system may be a useful tool in non-intrusive monitoring, and in exposure therapies, being the system integration in real contexts of straightforward use

Anxiety activating virtual environments for investigating social phobias

Social phobia has become one of the commonest manifestations of fear in any society. This fear is often accompanied by major depression or social disabilities. With the awareness that fear can be aggravated in social situations, virtual reality researchers and psychologists have investigated the feasibility of a virtual reality system as a psychotherapeutic intervention to combat social phobia. Virtual reality technology has rapidly improved over the past few years, making for better interactions. Nevertheless, the field of virtual reality exposure therapy for social phobia is still in its infancy and various issues have yet to be resolved or event uncovered. The key concept of virtual reality exposure therapy in the treatment of social phobia is based on its characteristic of perceptual illusion - the sense of presence - as an anxiety-activating system, instead of conventional imaginal or in-vivo exposure techniques. Therefore, in order to provoke a significant level of anxiety in virtual environments, it is very important to understand the impact of perceptual presence factors in virtual reality exposure therapy. Hence, this research mainly aims to investigate all the aspects of the correlation between anxiety and the components of the virtual environment in a computer-generated social simulation. By understanding this, this thesis aims to provide a framework for the construction of effective virtual reality exposure therapy for social phobia care which enables anxiety stimuli to be controlled in a gradual manner as a conventional clinical approach. This thesis presents a series of experimental studies that have been conducted with a common theme: the function of 3D inhabitants and visual apparatus in anxiety-activating virtual social simulation, a job-interview. However, each study is conducted using different research objectives. The experimental results are presented in this thesis, with psycho-physiological approach, revealing a variation of the distribution of participants' anxiety states across various VR conditions. The overall conclusion of this research is that an appropriate realism of VR stimuli is essential in sustaining the state of anxiety over the course of VR exposure. The high fidelity of virtual environment generally provoke a greater degree of anxiety, but this research also shows that aspects of VR fidelity is more related to the mental representation of individuals to the context of the stressful situation rather than any technology that is being used