Tailored Immersion: Implementing Personalized Components Into Virtual Reality for Veterans With Post-Traumatic Stress Disorder

Nancy Van Veelen,Elbert Geuze,Martijn L Van Emmerik,Mirjam J Nijdam,Rudy C Boonekamp,Chelsea Jones,Eric Vermetten,Tjeerd A.J Schoonderwoerd,Bastiaan Bruinsma

doi:10.3389/frvir.2021.740795

Abstract

With the application of virtual reality (VR), tailored interventions can be created that mirror the traumatic experiences of veterans with post-traumatic stress disorder (PTSD). Visual elements can be mimicked, and auditory and other senses stimulated. In doing so, the degree of immersion can be adjusted to optimize the therapeutic process. Objectively measuring the sensory immersion is key to keep subjects within their personal window of tolerance. Based on this information the therapist can decide manipulate the sensory stimulation embedded in the treatment. The objectives of this article are to explore the different immersive design aspects of VRET that can be modified to influence the experienced presence in veterans with PTSD, and to discuss possible methods of measuring the emotional response facilitated by immersive design aspects and experienced presence. Four design aspects are discussed: system, sensory cues, narrative and challenge. We also report on a user experiment in three veterans that informed on quality and depth of immersion. Believability of the neutral virtual environment was important for maintaining the veterans’ presence within the VR experience. The immersive design aspects that were personalized and supportive in the narrative of the veteran such as music and self-selected images appeared to have a strong influence on recall and reliving of the traumatic events. Finally, in order to increase the therapeutic effect in veterans with PTSD, the highlighted design aspects should be recognized and tailored to maximize immersion in virtual reality exposure therapy.

Highlights

Veterans and military personnel are exposed to extreme situations and potentially traumatic experiences during their deployment
These aforementioned design aspects can be utilized in various ways to modify the immersion, resulting in a spectrum of VE designs
The presented VE in the user experience of the current study could be placed in the middle of this spectrum

Summary

Introduction

Veterans and military personnel are exposed to extreme situations and potentially traumatic experiences during their deployment. Treatment options currently available to address PTSD have proven to be less effective in military and veteran populations when compared to their civilian counterparts (Haagen et al, 2015) These traditional psychotherapies have important commonalities, such as emotion regulation and imaginal exposure (Schnyder et al, 2015). With virtual reality exposure therapy (VRET), it is possible to create an immersive, realistic, and safe environment where veterans can be exposed to traumarelated stimuli in a controlled setting (Rizzo and Shilling, 2017; Eshuis et al, 2020) These facilitators enable a customized and tailored psychotherapy experience for veterans with PTSD, which may be effective through enhanced emotional engagement and challenging classic symptoms of PTSD such as avoidance (Nijdam and Vermetten, 2018; van Gelderen et al, 2018)

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Discussion

Conclusion