Abstract
Background: Exposure therapy involves exposure to feared stimuli and is considered to be the gold-standard treatment for anxiety disorders. While its application in Virtual Reality (VR) has been very successful for phobic disorders, the effects of exposure to virtual social stimuli in Social Anxiety Disorder are heterogeneous. This difference has been linked to demands on realism and presence, particularly social presence, as a pre-requisite in evoking emotional experiences in virtual social interactions. So far, however, the influence of social presence on emotional experience in social interactions with virtual agents remains unknown.Objective: We investigated the relationship between realism and social presence and the moderating effect of social presence on the relationship between agent behavior and experienced emotions in virtual social interaction.Methods: Healthy participants (N = 51) faced virtual agents showing supportive and dismissive behaviors in two virtual environments (short interactions and oral presentations). At first, participants performed five blocks of short one-on-one interactions with virtual agents (two male and two female agents per block). Secondly, participants gave five presentations in front of an audience of 16 agents. In each scenario, agent behavior was a within subjects factor, resulting in one block of neutral, two blocks of negative, and two blocks of positive agent behavior. Ratings of agent behavior (valence and realism), experience (valence and arousal), and presence (physical and social) were collected after every block. Moderator effects were investigated using mixed linear models with random intercepts. Correlations were analyzed via repeated measures correlations.Results: Ratings of valence of agent behaviors showed reliable relationships with experienced valence and less reliable relationships with experienced arousal. These relationships were moderated by social presence in the presentation scenario. Results for the interaction scenario were weaker but potentially promising for experimental studies. Variations in social presence and realism over time were correlated but social presence proved a more reliable moderator.Conclusion: Our findings emphasize the role of social presence for emotional experience in response to specific agent behaviors in virtual social interactions. While these findings should be replicated with experimental designs and in clinical samples, variability in social presence might account for heterogeneity in efficacy of virtual exposure to treat social anxiety disorder.
Highlights
1.1 Theoretical BackgroundExposure Therapy is considered the gold-standard treatment for anxiety disorders, especially phobic disorders
On a meta-analytic level, Carl et al (2019) concluded that VRET is as effective as in vivo exposure for Social Anxiety Disorder (SAD), whereas a recent meta-analysis, with more stringent criteria on what constitutes in vivo exposure, concluded that in vivo exposure is more effective compared to VRET for Social Phobia (Wechsler et al, 2019)
During blocks of interactions with non-neutral behaviors of interaction partners, ratings of valence of agent behavior correlate with ratings of experienced valence, r(149) 0.82, p < 0.001, and experienced arousal, r(149) −0.21, p 0.011
Summary
1.1 Theoretical BackgroundExposure Therapy is considered the gold-standard treatment for anxiety disorders, especially phobic disorders. Whereas the confrontation in vivo (in the real world) is highly effective for a variety of disorders, there are a number of problems which hinder its application in routine care, among them the considerable effort involved in preparing and conducting the exercises, often outside the common therapy setting (Neudeck and Einsle, 2012) These problems can be countered by the application of exposure therapy in virtuo, i.e., in Virtual Reality (Virtual Reality Exposure Therapy, VRET; Rothbaum et al, 1997). On a meta-analytic level, Carl et al (2019) concluded that VRET is as effective as in vivo exposure for SAD, whereas a recent meta-analysis, with more stringent criteria on what constitutes in vivo exposure, concluded that in vivo exposure is more effective compared to VRET for Social Phobia (Wechsler et al, 2019) Given these contrasting results, a better understanding of the underlying working mechanisms of virtual reality exposure in the case of social anxiety is clearly required. The influence of social presence on emotional experience in social interactions with virtual agents remains unknown
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
