Igroup Presence Questionnaire Research Articles

SmoothRide: A Versatile Solution to Combat Cybersickness in Elevation-Altering Environments.

Cybersickness continues to bar many individuals from taking full advantage of virtual reality (VR) technology. Previous work has established that navigating virtual terrain with elevation changes poses a significant risk in this regard. In this paper, we investigate the effectiveness of three cybersickness reduction strategies on users performing a navigation task across virtual elevation-altering terrain. These strategies include static field of view (FOV) reduction, a flat surface approach that disables terrain collision and maintains constant elevation for users, and SmoothRide, a novel technique designed to dampen a user's perception of vertical motion as they travel. To assess the impact of these strategies, we conducted a within-subjects study involving 61 participants. Each strategy was compared against a control condition, where users navigated across terrain without any cybersickness reduction measures in place. Cybersickness data were collected using the Fast Motion Sickness Scale (FMS) and Simulator Sickness Questionnaire (SSQ), along with galvanic skin response (GSR) data. We measured user presence using the IGroup Presence questionnaire (IPQ) and a Single-Item Presence Scale (SIP). Our findings reveal that users experienced significantly lower levels of cybersickness using SmoothRide or FOV reduction. Presence scores reported on the IPQ were statistically similar between SmoothRide and the control condition. Conversely, terrain flattening had adverse effects on user presence scores, and we could not identify a significant effect on cybersickness compared to the control. We demonstrate that SmoothRide is an effective, lightweight, configurable, and easy-to-integrate tool for reducing cybersickness in simulations featuring elevation-altering terrain.

Real and Virtual Lecture Rooms: Validation of a Virtual Reality System for the Perceptual Assessment of Room Acoustical Quality

Enhancing the acoustical quality in learning environments is necessary, especially for hearing aid (HA) users. When in-field evaluations cannot be performed, virtual reality (VR) can be adopted for acoustical quality assessments of existing and new buildings, contributing to the acquisition of subjective impressions in lab settings. To ensure an accurate spatial reproduction of the sound field in VR for HA users, multi-speaker-based systems can be employed to auralize a given environment. However, most systems require a lot of effort due to cost, size, and construction. This work deals with the validation of a VR-system based on a 16-speaker-array synced with a VR headset, arranged to be easily replicated in small non-anechoic spaces and suitable for HA users. Both objective and subjective validations are performed against a real university lecture room of 800 m3 and with 2.3 s of reverberation time at mid-frequencies. Comparisons of binaural and monoaural room acoustic parameters are performed between measurements in the real lecture room and its lab reproduction. To validate the audiovisual experience, 32 normal-hearing subjects were administered the Igroup Presence Questionnaire (IPQ) on the overall sense of perceived presence. The outcomes confirm that the system is a promising and feasible tool to predict the perceived acoustical quality of a room.

Effects of gymnasium envelope and daylight pattern on exercisers’ feedback in a virtual reality

The daylight environment determined by the building envelope significantly influences the exercisers' well-being and perception. However, assessment methods that focus on exercisers' feedback for gymnasium envelope and associated daylight pattern have rarely been explored. Additionally, changing the detailed envelope form is time-consuming and costly in physical environment. The Cave Automated Virtual Environment (CAVE) was employed to investigate exercisers' feedback under a virtual matrix of four ratio of covered shadings on the facade (SFCR) conditions and four skylight (SL) conditions. Feedback from exercisers consisted of subjective and attention quality evaluation. The subjective evaluation was employed to measure psychosocial perception of exercisers and validity of virtual environment, including comprehensive assessment, psychological perception, the Igroup presence questionnaire (IPQ), and the Virtual Reality Sickness Questionnaire (VRSQ). Furthermore, exercisers' attention quality was also evaluated by task efficiency of the attention task and physiological responses including electrodermal activity (EDA) and heart rate variability (HRV). The results indicated that envelope form have significant impact on exercisers' feedback, suggesting that existing gymnasium envelope and irregular daylight pattern were inefficient for improving exercisers' perception. Specifically, better feedback was reported in conditions with SFCR3 (SFCR = 0.7) and SL3 (strip skylight) or SL4 (ring skylight), while the worst feedback was reported in conditions with SL2 (spot skylight), followed by conditions with SFCR1 (SFCR = 0) and SL1 (no-skylight), which were designed to replicate a real gymnasium. The novel assessment method for measuring exercisers' feedback in virtual environment has demonstrated its potential to enhance exercisers’ perception, health, and efficiency.

Transforming Interactive Educational Content into Immersive Virtual Reality Learning Objects

Currently, the integration of immersive virtual reality applications into learning management systems is limited, which disadvantages kinesthetic learners, as the majority of learning material is mostly written or visual in nature. This research presents a method on how to transform existing conventional learning material into immersive virtual reality and integrate it into learning management systems, demonstrating it with a pilot study and an immersive virtual reality application prototype. The prototype application uses WebXR technology and provides integration into the Moodle learning management system using the Sharable Content Object Reference Model standard. The developed learning object was evaluated using the System Usability Scale, Web-based Learning Tool evaluation scale and the igroup Presence Questionnaire. The results of the pilot study revealed that the learning object performed above average in all tested fields and is preferable to established non-IVR solutions.

Prior exposure to a sensorimotor game in virtual reality does not enhance stress reactivity toward the OpenTSST VR

Compared to the in-person Trier Social Stress Test (TSST), virtual reality (VR) variants reduce resource-intensity and improve standardization but induce stress with smaller effect sizes. However, higher cortisol reactivity is given for more immersive TSST-VRs. Immersivity depends on the VR-system, but perceived immersion may be targeted by exposure to, or interaction with the VR. We investigated whether stress reactivity towards the openly accessible OpenTSST VR can be enhanced by prior exposure to a sensorimotor game completed in VR as mediated by increased immersion. Therefore, N = 58 healthy participants underwent the OpenTSST VR or its inbuilt control condition (placebo TSST-VR, pTSST-VR). Beforehand, participants completed a sensorimotor game either in VR or in real life. Stress was measured by means of self-reports, salivary cortisol concentrations, and salivary alpha-amylase (sAA) activity. Perceived immersion was assessed with the Igroup Presence Questionnaire (IPQ). The TSST-VR-group showed higher subjective stress than the pTSST-VR-group. Even though area under the curve measures indicated significant differences in cortisol levels between TSST-VR and pTSST-VR, this effect was not replicated in omnibus-analyses. Likewise, sAA was not responsive to stress. Our data suggests the OpenTSST VR does not reliably trigger physiological stress reactivity. Likewise, participants playing the VR-game before exposure to the TSST-VR did not show enhanced stress reactivity. Importantly, playing the VR-game did not lead to increased immersion (indicated by the IPQ), either. The key question resulting from our study is which manipulation may be fruitful to obtain a comparable stress response toward the TSST-VR compared to the in-person TSST.

PublicVR: a virtual reality exposure therapy intervention for adults with speech anxiety

Speech anxiety, or Glossophobia, currently affects approximately 75% of the population with potentially severe negative effects on those with this condition. There are several treatments currently available with research showing that the use of Virtual Reality (VR) as a non-pharmacologic treatment can have positive effects on individuals suffering from such social phobias. However, there is a significant lack of treatments currently available for speech anxiety, even though such a large number of the population are affected by it. In this paper, we aim to contribute to efforts to improve the effects of speech anxiety through a VR intervention. Our VR solution was designed following the Exposure Therapy approach for treating social anxiety disorders. The evaluation of this work was twofold: A. to assess the ability of our solution to positively change participants’ perception of factors related to non-verbal communication contributing to anxiety toward public speaking, and B. to determine whether it is able to induce a sense of presence. We carried out an empirical evaluation study that measured participants’ self-reported anxiety level towards public speaking using the Personal Report of Public Speaking Anxiety and their perceived sense of presence using the iGroup Presence Questionnaire. Our results demonstrate the potential of VR Exposure Therapy solutions to assist towards positively changing perception of factors related to non-verbal communication skills that contribute to increasing public speaking anxiety for participants suffering from self-reported speech anxiety symptoms. Our findings are of wider importance as they contribute to ongoing efforts to improve social anxiety-related phobias.

Virtual reality to reduce periprocedural anxiety during invasive coronary angiography: rationale and design of the VR InCard trial

IntroductionPatients undergoing invasive coronary angiography (ICA) experience anxiety due to various reasons. Procedural anxiety can lead to physiological and psychological complications, compromising patient comfort and overall procedural outcomes. Benzodiazepines are...

Effectiveness of Virtual Reality Environment for Post-Operative Pain Management

Objectives The imperative need of post-operative period is effective pain management. Virtual reality (VR) causes psychological distraction from pain stimuli, and thus may cause pain alleviation. The study was undertaken to determine the effectiveness of VR distraction on post-operative pain and experience of VR sessions among the patients. Material and Methods A hospital-based interventional study was conducted for a period of two months with the objectives to estimate changes in post-operative pain intensity after VR session as well as to analyze experience related to VR interventions. It comprised patients of either gender undergoing surgery and with 1–3 days of hospitalization, who were randomized into two groups (age and gender matched). The control group was kept on standard post-operative pain management. The interventional group was subjected to VR exposure in addition to standard care therapy. The Numerical Rating Scale (NRS) scores were obtained twice post-operatively in subsequent days. I-group presence questionnaire (IPQ) responses were obtained after the VR session. Results Both control and interventional groups had 25 participants each for analysis. In both the groups, majority were given bupivacaine for anesthesia and combination of paracetamol and diclofenac for post-operative analgesia. The NRS scores of both groups obtained post-operatively on standard therapy without VR intervention did not show any significant difference. However, the post-VR-sessions’ NRS scores showed significant reduction as compared to pre-session scores among the participants of the interventional group. The responses obtained via IPQ revealed acceptance for the features of realism, engagement, and presence during VR intervention. Majority confirmed their willingness to undergo VR sessions in future. Conclusion VR session helped in significant reduction of pain perception as VR simulation diverted considerable attention away from the pain. Majority expressed positive inclination for utilization of VR in comprehensive patient care.

Digital Interventions for Stress Among Frontline Health Care Workers: Results From a Pilot Feasibility Cohort Trial.

The COVID-19 pandemic has challenged the mental health of health care workers, increasing the rates of stress, moral distress (MD), and moral injury (MI). Virtual reality (VR) is a useful tool for studying MD and MI because it can effectively elicit psychophysiological responses, is customizable, and permits the controlled study of participants in real time. This study aims to investigate the feasibility of using an intervention comprising a VR scenario and an educational video to examine MD among health care workers during the COVID-19 pandemic and to use our mobile app for longitudinal monitoring of stress, MD, and MI after the intervention. We recruited 15 participants for a compound intervention consisting of a VR scenario followed by an educational video and a repetition of the VR scenario. The scenario portrayed a morally challenging situation related to a shortage of life-saving equipment. Physiological signals and scores of the Moral Injury Outcome Scale (MIOS) and Perceived Stress Scale (PSS) were collected. Participants underwent a debriefing session to provide their impressions of the intervention, and content analysis was performed on the sessions. Participants were also instructed to use a mobile app for 8 weeks after the intervention to monitor stress, MD, and mental health symptoms. We conducted Wilcoxon signed rank tests on the PSS and MIOS scores to investigate whether the VR scenario could induce stress and MD. We also evaluated user experience and the sense of presence after the intervention through semi-open-ended feedback and the Igroup Presence Questionnaire, respectively. Qualitative feedback was summarized and categorized to offer an experiential perspective. All participants completed the intervention. Mean pre- and postintervention scores were respectively 10.4 (SD 9.9) and 13.5 (SD 9.1) for the MIOS and 17.3 (SD 7.5) and 19.1 (SD 8.1) for the PSS. Statistical analyses revealed no significant pre- to postintervention difference in the MIOS and PSS scores (P=.11 and P=.22, respectively), suggesting that the experiment did not acutely induce significant levels of stress or MD. However, content analysis revealed feelings of guilt, shame, and betrayal, which relate to the experience of MD. On the basis of the Igroup Presence Questionnaire results, the VR scenario achieved an above-average degree of overall presence, spatial presence, and involvement, and slightly below-average realism. Of the 15 participants, 8 (53%) did not answer symptom surveys on the mobile app. Our study demonstrated VR to be a feasible method to simulate morally challenging situations and elicit genuine responses associated with MD with high acceptability and tolerability. Future research could better define the efficacy of VR in examining stress, MD, and MI both acutely and in the longer term. An improved participant strategy for mobile data capture is needed for future studies. ClinicalTrails.gov NCT05001542; https://clinicaltrials.gov/study/NCT05001542. RR2-10.2196/32240.

Design and Evaluation of Maliki V-Lab: A Metaverse-Based Virtual Laboratory for Computer Assembly Learning in Higher Education

Some schools keep using online learning media even after the new normal of COVID-19 to provide broader reach for students and teachers. Online learning in practicum class requiring physical practice equipment remains a challenge. This research proposes Maliki V-Lab, a metaverse-based VR laboratory that provides practicum class for computer assembly as an online learning media platform. The developed system then evaluated for the usefulnes and sense of virtual presence. System usability was measured using the System Usability Scale (SUS) questionnaire, and virtual presence was measured using the Igroup Presence Questionnaire (IPQ) that consist four categories. The system usability test result is marginally acceptable, while virtual presence test result is acceptable for general presence, spatial presence, and expected realism category, and marginally acceptable for involvement category. Based on these results, this system can used for practical learning specifically according to the criteria that have been tested. Maliki V-Labs needs to improve the level of usability and virtual presence before it can be expanded with another practicum class and another type of respondent.

Feasibility of using virtual reality in geriatric psychiatry.

Virtual Reality-based interventions have become an important element of digital mental health, offering accessible and scalable treatment options. However, studies on VR-based approaches in elderly patients are scarce. This explorative study examined the feasibility of using Virtual Reality (VR) for elderly patients with psychiatric illness, focusing on the sense of presence as the primary outcome. The study included N=30 patients between the ages of 59-92years who were currently in geriatric psychiatric inpatient and day clinic treatment. Participants were assessed before, during and after a relaxing ten-minute VR experience. Attitude towards digital media and VR, subjective digital competence, and previous experience were examined using questionnaires. Motion sickness was measured repeatedly during the VR experience using the Fast Motion Sickness Scale (FMS). Patients rated their motion sickness and their general well-being in the virtual environment. Sense of presence in the virtual environment was quantified with the Igroup Presence Questionnaire (IPQ). Participants reported a notable sense of presence (M=0.41±1.4) in the virtual environment, particularly in terms of spatial presence. Motion sickness was reported by a minority of patients. Three patients terminated the VR application before it was finished. The average well-being during the VR experience was reported as high (70/100). Sense of presence and motion sickness showed a significant negative correlation. Presence, motion sickness and well-being were not significantly correlated with age, nor did they differ significantly between groups. This study underscores the potential of VR-based experiences in the treatment of elderly psychiatric patients and highlights their willingness and ability to engage with VR technology. While the results are promising, future research should explore more interactive VR scenarios and assess their safety and feasibility in elderly populations.

Train vs. Play: Evaluating the Effects of Gamified and Non-Gamified Wheelchair Skills Training Using Virtual Reality.

This study compares the influence of a gamified and a non-gamified virtual reality (VR) environment on wheelchair skills training. In specific, the study explores the integration of gamification elements and their influence on wheelchair driving performance in VR-based training. Twenty-two non-disabled participants volunteered for the study, of whom eleven undertook the gamified VR training, and eleven engaged in the non-gamified VR training. To measure the efficacy of the VR-based wheelchair skills training, we captured the heart rate (HR), number of joystick movements, completion time, and number of collisions. In addition, an adapted version of the Wheelchair Skills Training Program Questionnaire (WSTP-Q), the Igroup Presence Questionnaire (IPQ), and the Simulator Sickness Questionnaire (SSQ) questionnaires were administered after the VR training. The results showed no differences in wheelchair driving performance, the level of involvement, or the ratings of presence between the two environments. In contrast, the perceived cybersickness was statistically higher for the group of participants who trained in the non-gamified VR environment. Remarkably, heightened cybersickness symptoms aligned with increased HR, suggesting physiological connections. As such, while direct gamification effects on the efficacy of VR-based wheelchair skills training were not statistically significant, its potential to amplify user engagement and reduce cybersickness is evident.

Enhanced Presence Evaluation in Virtual Reality Feedback System with TOPSIS Model

Researcher has been trying to optimize the method for evaluating presence in virtual reality (VR) to address variability and uncertainty in quick evaluations using questionnaires. We recommend using the Technique for Order Performance by Similarity to Ideal Solution (TOPSIS) model to calculated the iGroup Presence Questionnaire to measure users’ overall presence in VR prototyping, instead of the weighted sum approach. The effects of two presence factors (scene density and motion trajectory technology) on a self-developed VR swimming virtual system were tested using the TOPSIS model with 20 participants each 12 tasks in a user experiment. The results were compared using two different weighting methods, fuzzy hierarchical analysis and uniform weighting methods. TOPSIS had a narrower range of data within the 95% confidence interval and a significantly lower coefficient of variation (CV). This indicates enhanced precision in evaluating presence and can be used to compare different technique setting of virtual systems.

Using Virtual Reality Head-Mounted Displays to Assess Skills in Emergency Medicine: Validity Study.

Many junior doctors must prepare to manage acutely ill patients in the emergency department. The setting is often stressful, and urgent treatment decisions are needed. Overlooking symptoms and making wrong choices may lead to substantial patient morbidity or death, and it is essential to ensure that junior doctors are competent. Virtual reality (VR) software can provide standardized and unbiased assessment, but solid validity evidence is necessary before implementation. This study aimed to gather validity evidence for using 360-degree VR videos with integrated multiple-choice questions (MCQs) to assess emergency medicine skills. Five full-scale emergency medicine scenarios were recorded with a 360-degree video camera, and MCQs were integrated into the scenarios to be played in a head-mounted display. We invited 3 groups of medical students with different experience levels to participate: first- to third-year medical students (novice group), last-year medical students without emergency medicine training (intermediate group), and last-year medical students with completed emergency medicine training (experienced group). Each participant's total test score was calculated based on the number of correct MCQ answers (maximum score of 28), and the groups' mean scores were compared. The participants rated their experienced presence in emergency scenarios using the Igroup Presence Questionnaire (IPQ) and their cognitive workload with the National Aeronautics and Space Administration Task Load Index (NASA-TLX). We included 61 medical students from December 2020 to December 2021. The experienced group had significantly higher mean scores than the intermediate group (23 vs 20; P=.04), and the intermediate group had significantly higher scores than the novice group (20 vs 14; P<.001). The contrasting groups' standard-setting method established a pass-or-fail score of 19 points (68% of the maximum possible score of 28). Interscenario reliability was high, with a Cronbach α of 0.82. The participants experienced the VR scenarios with a high degree of presence with an IPQ score of 5.83 (on a scale from 1-7), and the task was shown to be mentally demanding with a NASA-TLX score of 13.30 (on a scale from 1-21). This study provides validity evidence to support using 360-degree VR scenarios to assess emergency medicine skills. The students evaluated the VR experience as mentally demanding with a high degree of presence, suggesting that VR is a promising new technology for emergency medicine skills assessment.

The Effect of Sex Differences and Experience of Using Virtual Reality on Presence

Presence greatly affects user experience and comfort when using virtual reality (VR). Presence is often associated with personal factors such as sex differences and experience using the instrument. There is a research gap related to presence judging by several studies, so it is an interesting topic for further study. This research aims to identify the effect of sex differences and experience using VR on presence. This study used two approaches namely subjective indicators by employing an Igroup Presence Questionnaire (IPQ) and objective indicators in the form of heart rate (HR) and task scores. The study made use of Kruskal-Wallis and MANOVA to determine whether there is an effect of sex differences and experience in using VR on presence. This study found that the sex variable affects a person's presence when playing VR, especially spatial score on the IPQ test, where women have a higher marginal means value than men. Another finding is that the experience of playing VR affects the delta heart rate, with the result that someone with no experience using VR is higher than those who have used VR before.

Polish Adaptation of the Igroup Presence Questionnaire

Presence, defined as a psychological state of “being there”, is experienced during an interaction with Immersive Virtual Environments, particularly with Virtual Reality – the most popular type of such environment. Measuring presence is crucial because its level determines the effectiveness of virtual environments. The authors conducted a translation and a study (n = 245) that aimed to provide a Polish version of the Igroup Presence Questionnaire (IPQ-PL). The structure of the questionnaire and relations with other constructs were tested. The results indicate that IPQ-PL may be considered a valid tool for measuring presence and may beused in studies conducted on Polish samples.

Analysis of the impact of Vlog news media form shaping on audience psychological immersion based on psychological experience process

BackgroundHow to enhance the psychological immersion of the audience is a major concern for the media at this stage. The psychological immersion of the audience not only affects the communication effect and influence of the media but also brings a more positive experience of reality to the audience. This project, therefore, analyses the psychological immersion of the audience based on the psychological experience process of shaping the media form of Vlog news.Subjects and MethodsIn this research, 228 college students were selected as the subjects of the experimental research. The mean age was 21.12±1.67 years, with 146 male students and 82 female students. The general demographic characteristics of all subjects were counted before the experiment and there were no significant differences (P &gt; 0.05). All subjects were divided into a control group and a research group in a completely randomized manner. The control group disseminated news through traditional means, while the research group used a Vlog news medium based on a psychological experience process to disseminate news. The immersion scale was assessed using the Igroup Presence Questionnaire (IPQ), which consists of 13 items, with questions 1-5 on the spatial presence (SP) dimension, questions 6-9 on the involvement (INV) dimension, and questions 10-13 on the reality (REAL) dimension. Each item was scored on a scale of 0 to 6, with 0 indicating total disagreement and 6 indicating total agreement.ResultsOn the IPQ scale, the mean score of SP dimension was 3.12 ± 0.34 in the control group and 4.87 ± 0.42 in the research group, with a significant difference between the two groups (P &lt; 0.05); the mean score of INV dimension was 2.53 ± 0.36 in the control group and 4.71 ± 0.38 in the research group, with a significant difference (P &lt; 0.05); the score of REAL dimensions was 2.98 ± 0.28 in the control group and 4.52 ± 0.41 in the research group, with a significant difference. and 4.52 ± 0.41 in the research group, with a significant difference (P &lt; 0.05). See Table 1 for details.Table 1.Comparison of IPQ scores between the two groupsItemControl groupResearch groupAverageStandard deviationAverageStandard deviationSP3.120.344.87*0.42INV2.530.364.71*0.38REAL2.980.284.52*0.41Note: * indicates P &lt; 0.05.ConclusionsBased on the psychological experience process, Vlog news media forms can increase the audience’s spatial immersion, psychological involvement, and authenticity experience. This increases the communication effect and influence of the media and has good research value.

Investigation of visual and game-playing performance under different genders, display and operation interfaces

Technological progress has led to 3D displays becoming a trend in the market, yet few studies have evaluated 3D techniques in head-mounted displays (HMD) under different topics simultaneously, such as gender and operation interfaces. This study investigated these research issues to examine the effect of gender (male, female), display interface (2D TV, 3D HMD), and operation interface (joystick, keyboard) on usability, accuracy, change of critical flicker frequency (change of CFF), Simulator Sickness Questionnaire (SSQ), and iGroup Presence Questionnaire (IPQ). Thirty participants with no NBA2K15 basketball game-playing experience were recruited in the experiment. The results showed significant effects of gender on accuracy, usability, and change of CFF, where males demonstrated higher accuracy, lower usability, and lower visual fatigue. In addition, display interface had significant effects on usability, SSQ and IPQ. The 2D TV was associated with higher usability and lower SSQ and IPQ. Furthermore, the operation interface had significant effects on accuracy, usability, change of CFF, and IPQ. The joystick led to a higher usability and IPQ but a lower change of CFF. The results provide suggestions to game players that choosing 2D TVs with joysticks generates greater usability. In addition, although they achieved a higher presence, players also had greater visual fatigue when wearing HMDs. This study concluded that males have better performance in accuracy and visual fatigue while females have better usability when playing basketball games.

How Much Presence is Enough? Qualitative Scales for Interpreting the Igroup Presence Questionnaire Score

Presence is often used to evaluate Virtual Reality (VR) applications. However, the raw scores are hard to interpret and need to be compared to other data to be meaningful. This paper leverages a database of 1909 responses to the Igroup Presence Questionnaire (IPQ) in different contexts to put forward a scale that qualitatively interprets raw Presence scores for VR experiences. The qualitative grading encompasses the acceptability dimension and analogous academic grading scales ranging from A to F and the adjective of such scores in a scale from Excellent to Unacceptable. Furthermore, the qualitative grading system encompasses Presence and its subscales Spatial Presence, Involvement, and Experienced Realism as defined by the IPQ. Adopting this grading system, supported by a robust dataset of Presence scores, enables practitioners to evaluate and interpret individual IPQ scores, allowing them to gain insights regarding the evaluated applications’ effectiveness.

Experiences of Patients and Therapists Testing a Virtual Reality Exposure App for Symptoms of Claustrophobia: Mixed Methods Study.

The effectiveness of virtual reality exposure (VRE) in the treatment of anxiety disorders is well established. Several psychological mechanisms of VRE have been identified, whereby both emotional processing and the sense of presence play a key role. However, there are only few studies that contribute to our knowledge of examples of implementation in the case of VRE for claustrophobia based on patients' experiences and the perspective of therapists. This study asks for key elements of a VRE app that are necessary for effective exposure for people with claustrophobic symptoms. A mixed methods design was applied in which patients (n=15) and therapeutic experts (n=15) tested a VRE intervention of an elevator ride at 5 intensity levels. Intensity was varied by elevator size, duration of the elevator ride, and presence of virtual humans. Quantitative measures examined self-reported presence with the Igroup Presence Questionnaire (IPQ) ranging from 0 to 6 and 15 Likert-scaled evaluation items that had been developed for the purpose of this study, ranging from 1 to 5. In both measures, higher scores indicate higher levels of presence or agreement. Think-aloud protocols of the patients and semistructured interviews posttreatment of all participants were conducted to gain in-depth perspectives on emotional processes. The intervention induced a feeling of presence in patients and experts, posttreatment scores showed a high IPQ presence score (mean 3.84, SD 0.88), with its subscores IPQ spatial presence (mean 4.53, SD 1.06), IPQ involvement (mean 3.83, SD 1.22), and IPQ experienced realism (mean 2.75, SD 1.02). Patients preferred a setting in the presence of a therapist (mean 4.13, SD 0.83) more than the experts did (mean 3.33, SD 1.54). Think-aloud protocols of the patients revealed that presence and anxiety both were achieved. Qualitative interviews of patients and experts uncovered 8 topics: feelings and emotions, personal story, telepresence, potential therapeutic effects, barriers, conditions and requirements, future prospects, and realization. The intensity levels were felt to appropriately increase in challenge, with ambivalent results regarding the final level. Virtual humans contributed to feelings of fear. Key elements of a VRE app for claustrophobic symptoms should include variation of intensity by adding challenging cues in order to evoke presence and anxiety. Virtual humans are a suitable possibility to make the intervention realistic and to provide a sense of closeness; however, some of the fears might then be related to symptoms of social phobia or agoraphobia. Patients may need the physical presence of a therapist, though not all of them share this view. A higher degree of sophistication in the intensity levels is needed to deliver targeted help for specific symptoms of anxiety.