Virtual reality, real emotions: a novel analogue for the assessment of risk factors of post-traumatic stress disorder
A Commentary on
Virtual Reality, Real Emotions: A Novel Analogue for the Assessment of Risk Factors of Post-traumatic Stress Disorder
by Dibbets, P., and Schulte-Ostermann, M. A. (2015). Front. Psychol. 6, 681. doi: 10.3389/fpsyg.2015.00681
With the progress of media technology, the image world has turned from a two-dimensional plane to a three-dimensional, and the sense of immersion/“presence” (Sanchez-Vives and Slater, 2005), which is closely related to body perception, has become the most controversial topic in the media era (Geng, 2022). From Merleau- Ponty's pioneering philosophical thinking to the present (Merleau-Ponty, 1965), the relationship between body and space as the core of digital media constitutes one of the most worth exploring trends of human-computer interaction (Evans and Rzeszewski, 2020). The trauma film paradigm was developed to show movies depicting traumatic events to non-clinical participants to trigger a stress response similar to the response to traumatic events in real life (Speisman et al., 1964). Trauma movies usually consist of several clips, such as the scenes of car accidents and interpersonal violence. It has been proved that watching such movies with various scenes can reliably induce similar symptoms (Weidmann et al., 2009; James et al., 2016). Although the TFP can act as an analog of PTSD, inducing involuntary invasion, the participants are still “outsiders,” unable to completely immerse themselves in the film scenes and emotionally separated from the events (Lazarus et al., 1965; Koriat et al., 1972).
As early as 2015, Pauline Dibbets and others creatively realized that VR showed different effects in trauma induction compared with TFP. Therefore, Dibbets and their colleagues recruited 43 college students and divided them into two groups, with an average age of 22.16 years and 23.45 years, respectively (Dibbets and Schulte-Ostermann, 2015). They compared the VR paradigm with the traditional traumatic film (TFP) on post-traumatic stress disorder (PTSD).
It is assumed that compared with TFP, PTSD caused by VR can make people immerse deeper, cause negative emotions and ruminate more strongly. However, the research results are quite the opposite. Compared with TFP, VR does not lead to more extreme changes in negative emotions or more (painful) invasions (Dibbets and Schulte-Ostermann, 2015). Such results are not typical. Generally speaking, the psychological and physiological activation in VR is generally high (Schweizer et al., 2018). Although the results need to be discussed, this experiment finally innovatively inspired us. The research contents of Dibbets are presented in tabular form, as shown in Table 1.
Researchers are convinced that there are differences between TFP and VR paradigms. Generally speaking, VR quantifies the image scene into visible differences such as the number of details of physical injuries, the impact contrast of color differences, and so forth, which has higher imageability and can more effectively induce traumatic memory. TFP generally uses the lens perspective and close-up scenes of specific movie narratives, lacking subjective perspective switching ability and imagination space. Nevertheless, the actual research shows a contrary situation. The film paradigm seems to trigger a more robust stress response, which may be more similar to real-life trauma (Hilberdink et al., 2022). Moreover, the types of trauma (body, sex, traffic, disgust) caused by the themes of different films have different direct subjective and physiological responses (Arnaudova and Hagenaars, 2017). The film paradigm is an invasive memory caused by psychological trauma (Holmes and Bourne, 2008), even beyond the perspective of first-hand experience (James et al., 2016).
As this research is the first to use VR for trauma induction, it is limited by many conditions. For clinical and non-clinical people, different generalization mechanisms are individualized due to fear and anxiety (Kenntner-Mabiala et al., 2008) non-clinical people were taken as the experimental subjects in the experiment.
After that, the paradigm of PTSD induced by a series of movies and VR clips has been gradually improved, as shown in Table 1. The use of psychometrics can complement the paradigm to track physiological response and emotional regulation changes during PTSD (Yang et al., 2021).
In addition to VR being used as a way to induce traumatic memory for the first time, a series of ways to intervene in psychotherapy using VR technology has been gradually improved (Andreatta et al., 2010; Ready et al., 2010; Rizzo et al., 2011). For example, there are studies on VR cognitive rehabilitation training for clinical people (Jahn et al., 2021). A recent qualitative study emphasizes that VR in art therapy can bring positive experiences, such as positive emotions, games, and exploration (Hacmun et al., 2018, 2021; Kothgassner et al., 2019; Kaimal et al., 2020).
Although this study cannot prove that VR can induce PTSD more than traditional trauma movies, Pauline Dibbets et al.' s pioneering experiments prove that TFP and VR seem to be promising psychological intervention technology that deserves our continued exploration. Especially compared with the computer screen, VR has been proved to be more immersive (Visch et al., 2010; Ding et al., 2018; Jones, 2019; Pallavicini et al., 2019), and people can immerse themselves in a virtual environment and interact with it (Riva et al., 2007). VR contributes to a pleasant wake-up state because it brings a novel, intense and sensational experience (Bartsch et al., 2006; Bartsch and Viehoff, 2010), VR can be developed as an emotional medium to induce users' specific emotions. Factors such as hardware and software costs of VR should also be considered. Fortunately, with the growth of the VR commercial consumer market, we can see that the accessibility of VR software has increased, and the prices of VR equipment have decreased (Mishkind et al., 2017; Norr et al., 2018). On all accounts, using VR mobilizes the embodied perception of participants and highlights the importance of the body as a direct medium for feeling and contacting the external world (Human body perception from the inside out: Advances in visual cognition., 2006; Harris et al., 2015; Zahiu, 2020). Breaking through the previous mode of psychological intervention with visual media, Dibbets and his colleagues provided a convincing example of this kind of research and the future direction to explore.
Author Contributions
The author confirms being the sole contributor of this work and has approved it for publication.
Funding
This work was supported by Zhejiang Normal University.
Conflict of Interest
The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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References
Andreatta, P. B., Maslowski, E., Petty, S., Shim, W., Marsh, M., Hall, T., et al. (2010). Virtual reality triage training provides a viable solution for disaster-preparedness. Acad. Emerg. Med. 17, 870–876. doi: 10.1111/j.1553-2712.2010.00728.x
Arnaudova, I., and Hagenaars, M. A. (2017). Lights … action: Comparison of trauma films for use in the trauma film paradigm. Behav. Res. Ther. 93, 67–77. doi: 10.1016/j.brat.2017.02.007
Bartsch, A., Mangold, R., Viehoff, R., and Vorderer, P. (2006). Emotional gratifications during media use – An integrative approach. Eur. J. Commun. Res. 31, 261–278. doi: 10.1515/COMMUN.2006.018
Bartsch, A., and Viehoff, R. (2010). The use of media entertainment and emotional gratification. Procedia-Soc. Behav. Sci. 5, 2247–2255. doi: 10.1016/j.sbspro.2010.07.444
Dibbets, P.. (2020). A novel virtual reality paradigm: Predictors for stress-related intrusions and avoidance behavior. J. Behav. Ther. Exp. Psychiatry 67, 101449. doi: 10.1016/j.jbtep.2019.01.001
Dibbets, P., Lemmens, A., Benning, R., and Smeets, T. (2021). Can you escape the virtual room? A novel paradigm to assess avoidance behaviour. Comput. Hum. Behav. Rep. 3, 100061. doi: 10.1016/j.chbr.2021.100061
Dibbets, P., and Schulte-Ostermann, M. A. (2015). Virtual reality, real emotions: a novel analogue for the assessment of risk factors of post-traumatic stress disorder. Front. Psychol. 6, 681. doi: 10.3389/fpsyg.2015.00681
Ding, N., Zhou, W., and Fung, A. Y. (2018). Emotional effect of cinematic VR compared with traditional 2D film. Telemat. Inform. 35, 1572–1579. doi: 10.1016/j.tele.2018.04.003
Evans, L., and Rzeszewski, M. (2020). Hermeneutic relations in VR: Immersion, embodiment, presence and HCI in VR gaming. Comp. Sci. 12211, 23–38. doi: 10.1007/978-3-030-50164-8_2
Geng, Y.. (2022). Virtual Reality (VR) advertising communication design based on 3D wireless active visual sensing. J. Sensors 2022, 1551118. doi: 10.1155/2022/1551118
Hacmun, I., Regev, D., and Salomon, R. (2018). The principles of art therapy in virtual reality. Front. Psychol. 9, 2082. doi: 10.3389/fpsyg.2018.02082
Hacmun, I., Regev, D., and Salomon, R. (2021). Artistic creation in virtual reality for art therapy: a qualitative study with expert art therapists. Arts Psychother. 72, 101745. doi: 10.1016/j.aip.2020.101745
Harris, L. R., Carnevale, M. J., D'Amour, S., Fraser, L. E., Harrar, V., Hoover, A. E. N., et al. (2015). How our body influences our perception of the world. Front. Psychol. 6, 819. doi: 10.3389/fpsyg.2015.00819
Hilberdink, C. E., de Rooij, S. R., Olff, M., Bosch, J. A., and van Zuiden, M. (2022). Acute stress reactivity and intrusive memory development: a randomized trial using an adjusted trauma film paradigm. Psychoneuroendocrinology 139, 105686. doi: 10.1016/j.psyneuen.2022.105686
Holmes, E. A., and Bourne, C. (2008). Inducing and modulating intrusive emotional memories: A review of the trauma film paradigm. Acta Psychol. 127, 553–566. doi: 10.1016/j.actpsy.2007.11.002
Human body perception from the inside out: Advances in visual cognition. (2006). New York, NY, US: Oxford University Press.
Jahn, F. S., Skovbye, M., Obenhausen, K., Jespersen, A. E., and Miskowiak, K. W. (2021). Cognitive training with fully immersive virtual reality in patients with neurological and psychiatric disorders: a systematic review of randomized controlled trials. Psychiatry Res. 300, 113928. doi: 10.1016/j.psychres.2021.113928
James, E. L., Lau-Zhu, A., Clark, I. A., Visser, R. M., Hagenaars, M. A., and Holmes, E. A. (2016). The trauma film paradigm as an experimental psychopathology model of psychological trauma: intrusive memories and beyond. Clin. Psychol. Rev. 47, 106–142. doi: 10.1016/j.cpr.2016.04.010
Jones, S.. (2019). “Towards the essence of cinematic VR: embracing new technologies to define a medium,” in Augmented Reality and Virtual Reality, (Springer), 321–335.
Kaimal, G., Carroll-Haskins, K., Berberian, M., Dougherty, A., Carlton, N., and Ramakrishnan, A. (2020). Virtual reality in art therapy: a pilot qualitative study of the novel medium and implications for practice. Art Ther. 37, 16–24. doi: 10.1080/07421656.2019.1659662
Kenntner-Mabiala, R., Andreatta, M., Wieser, M. J., Mühlberger, A., and Pauli, P. (2008). Distinct effects of attention and affect on pain perception and somatosensory evoked potentials. Biol. Psychol. 78, 114–122. doi: 10.1016/j.biopsycho.2008.01.007
Koriat, A., Melkman, R., Averill, J. R., and Lazarus, R. S. (1972). The self-control of emotional reactions to a stressful film 1. J. Pers. 40, 601–619. doi: 10.1111/j.1467-6494.1972.tb00083.x
Kothgassner, O. D., Goreis, A., Kafka, J. X., Van Eickels, R. L., Plener, P. L., and Felnhofer, A. (2019). Virtual reality exposure therapy for posttraumatic stress disorder (PTSD): a meta-analysis. Eur. J. Psychotraumatol. 10, 1654782. doi: 10.1080/20008198.2019.1654782
Lazarus, R. S., Opton Jr, E., Nomikos, M. S., and Rankin, N. O. (1965). The principle of short-circuiting of threat: further evidence. J. Pers. 33, 622–35. doi: 10.1111/j.1467-6494.1965.tb01408.x
Mishkind, M. C., Norr, A. M., Katz, A. C., and Reger, G. M. (2017). Review of virtual reality treatment in psychiatry: evidence versus current diffusion and use. Curr. Psychiatry Rep. 19, 1–8. doi: 10.1007/s11920-017-0836-0
Norr, A. M., Smolenski, D. J., Katz, A. C., Rizzo, A. A., Rothbaum, B. O., Difede, J., et al. (2018). Virtual reality exposure versus prolonged exposure for PTSD: Which treatment for whom? Depress Anxiety 35, 523–529. doi: 10.1002/da.22751
Pallavicini, F., Pepe, A., and Minissi, M. E. (2019). Gaming in virtual reality: what changes in terms of usability, emotional response and sense of presence compared to non-immersive video games? Simul. Gaming 50, 136–159. doi: 10.1177/1046878119831420
Ready, D. J., Gerardi, R. J., Backscheider, A. G., Mascaro, N., and Rothbaum, B. O. (2010). Comparing virtual reality exposure therapy to present-centered therapy with 11 US Vietnam veterans with PTSD. Cyberpsychol. Behav. Soc. Netw. 13, 49–54. doi: 10.1089/cyber.2009.0239
Riva, G., Mantovani, F., Capideville, C. S., Preziosa, A., Morganti, F., Villani, D., et al. (2007). Affective interactions using virtual reality: the link between presence and emotions. Cyberpsychol. Behav. 10, 45–56. doi: 10.1089/cpb.2006.9993
Rizzo, A., Parsons, T. D., Lange, B., Kenny, P., Buckwalter, J. G., Rothbaum, B., et al. (2011). Virtual reality goes to war: a brief review of the future of military behavioral healthcare. J. Clin. Psychol. Med. Settings 18, 176–187. doi: 10.1007/s10880-011-9247-2
Sanchez-Vives, M. V., and Slater, M. (2005). From presence to consciousness through virtual reality. Nat. Rev. Neurosci. 6, 332–339. doi: 10.1038/nrn1651
Schweizer, T., Renner, F., Sun, D., Kleim, B., Holmes, E. A., and Tuschen-Caffier, B. (2018). Psychophysiological reactivity, coping behaviour and intrusive memories upon multisensory Virtual Reality and Script-Driven Imagery analogue trauma: a randomised controlled crossover study. J. Anxiety Disord. 59, 42–52. doi: 10.1016/j.janxdis.2018.08.005
Speisman, J. C., Lazarus, R. S., Davison, L., and Mordkoff, A. M. (1964). Experimental analysis of a film used as a threatening stimulus. J. Consult. Psychol. 28, 23. doi: 10.1037/h0047028
Visch, V. T., Tan, E. S., and Molenaar, D. (2010). The emotional and cognitive effect of immersion in film viewing. Cognit. Emot. 24, 1439–1445. doi: 10.1080/02699930903498186
Weidmann, A., Conradi, A., Gröger, K., Fehm, L., and Fydrich, T. (2009). Using stressful films to analyze risk factors for PTSD in analogue experimental studies – which film works best? Anxiety Stress Coping 22, 549–569. doi: 10.1080/10615800802541986
Yang, M., Mady, N., and Linnaranta, O. (2021). Utility of psychophysiological metrics in guiding treatment of trauma symptoms: a systematic review. J. Behav. Cogn. Ther. 31, 249–266. doi: 10.1016/j.jbct.2021.01.004
Keywords: PTSD, VR, TFP, induced PTSD, trauma film paradigm
Citation: Shi Z (2022) Commentary: Virtual Reality, Real Emotions: A Novel Analogue for the Assessment of Risk Factors of Post-traumatic Stress Disorder. Front. Psychol. 13:936930. doi: 10.3389/fpsyg.2022.936930
Received: 05 May 2022; Accepted: 17 May 2022;
Published: 09 June 2022.
Edited by:
Weiguo Li, Harbin Institute of Technology, ChinaReviewed by:
Yunrun Liu, Hong Kong Baptist University, Hong Kong SAR, ChinaYan Zhang, Hunan Normal University, China
Copyright © 2022 Shi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Zhongyu Shi, c3p5MjAxOSYjeDAwMDQwO3pqbnUuZWR1LmNu