Abstract
Virtual reality exposure therapy has been proposed as a viable alternative in the treatment of anxiety disorders, including social anxiety disorder. Therapists could benefit from extensive control of anxiety eliciting stimuli during virtual exposure. Two stimuli controls are studied in this study: the social dialogue situation, and the dialogue feedback responses (negative or positive) between a human and a virtual character. In the first study, 16 participants were exposed in three virtual reality scenarios: a neutral virtual world, blind date scenario, and job interview scenario. Results showed a significant difference between the three virtual scenarios in the level of self-reported anxiety and heart rate. In the second study, 24 participants were exposed to a job interview scenario in a virtual environment where the ratio between negative and positive dialogue feedback responses of a virtual character was systematically varied on-the-fly. Results yielded that within a dialogue the more positive dialogue feedback resulted in less self-reported anxiety, lower heart rate, and longer answers, while more negative dialogue feedback of the virtual character resulted in the opposite. The correlations between on the one hand the dialogue stressor ratio and on the other hand the means of SUD score, heart rate and audio length in the eight dialogue conditions showed a strong relationship: r(6) = 0.91, p = 0.002; r(6) = 0.76, p = 0.028 and r(6) = −0.94, p = 0.001 respectively. Furthermore, more anticipatory anxiety reported before exposure was found to coincide with more self-reported anxiety, and shorter answers during the virtual exposure. These results demonstrate that social dialogues in a virtual environment can be effectively manipulated for therapeutic purposes.
Highlights
Social anxiety disorder, commonly referred as social phobia, is one of the most prevalent mental disorders [1]
A similar pattern was found in the heart rate measurement, participants’ heart rate in the job interview scene was higher than in the blind date scene and the participants’ heart rate in the blind date scene was again higher than in the neutral VR world. The goal of this experiment was to investigate whether exposure to various social scenes in virtual reality is associated with different levels of anxiety (H1)
Our results based on subjective as well as objective measurements of anxiety yielded that as the social scene changed from the neutral VR world to the blind date scene or the job interview scene, the participants’ anxiety level significantly increased, which suggests that these various VR scenes could evoke different levels of anxiety
Summary
Commonly referred as social phobia, is one of the most prevalent mental disorders [1]. Exposure in vivo is an effective treatment for most patients, it is associated with some limitations, such as the limited therapeutic control over different aspects of exposure and a relatively high number of drop outs as some patients are not willing to get exposed to feared situations [2,3,4]. Virtual Reality Exposure Therapy (VRET) has been proposed as an effective alternative to overcome these shortcomings of exposure in vivo [5,6,7,8,9]. Exposure in virtual reality (VR) makes the control of exposure elements more manageable since the patient is exposed in a controlled Virtual Environment (VE) where the parameters of anxiety evoking stimuli can be changed and manipulated by the therapist. At the start of the treatment, an anxiety hierarchy of anxiety-arousing social situations is established. This hierarchy is used to order the VR situations the patient will be gradually exposed to, starting with less anxiety-arousing situations and eventually moving to more anxiety-arousing situations as treatment progresses
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