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Although virtual reality exposure has been reported as a method to induce paranoid thought, little is known about mechanisms to control specific virtual stressors. This paper reports on a study that examines the effect of controlling the stream of potential paranoia evoking events in a virtual restaurant world. A 2-by-2 experiment with a non-clinical group (n = 24) was conducted with as two within-subject factors: (1) the cycle time (short/long) for when the computer considers activation of a paranoia evoking event and (2) the probability that a paranoia-evoking event (low/high) would be triggered at the completion of a cycle. The results showed a significant main effect for the probability factor and two-way interaction effect with the cycle time factor on the number of paranoid comments participants made and their self-reported anxiety.

Effective psychological interventions for anxiety disorders often include exposure to fearful situations. However, individuals with low self-efficacy may find such exposure too overwhelming. We created a vicarious experience in virtual reality, which enables observation of one's experience from a first person perspective without actual performance and which might increase self-efficacy. With similarities to both traditional vicarious experiences and direct experiences, the level of self-identification with the experience was hypothesized to affect self-efficacy and its relationship with direct experiences. To test this, vicarious experiences with two distinct levels of self-identification were compared in a betweensubjects experiment (n = 60). After being exposed to a vicarious experience of giving lectures on elementary arithmetic in front of a virtual audience with either a high or low level of selfidentification with the public speaker, participants from both conditions actively gave another lecture. The results revealed that self-identification affected people's self-efficacy after vicarious experience. They further revealed that self-identification is a moderator of (1) the correlation between perceived performance and self-efficacy, (2) the correlation between self-efficacy measured after the vicarious and the follow-up direct experience; and (3) the correlation between the sense of presence reported in the vicarious and in the follow-up direct experience. We anticipate that the first-person-perspective experiences with high-level of self-identification have the potential to be beneficial for training where changing people's self-efficacy is desirable. [ABSTRACT FROM AUTHOR]

Virtual cognitions (VCs) are a stream of simulated thoughts people hear while emerged in a virtual environment, e.g. by hearing a simulated inner voice presented as a voice over. They can enhance people's self-efficacy and knowledge about, for example, social interactions as previous studies have shown. Ownership and plausibility of these VCs are regarded as important for their effect, and enhancing both might, therefore, be beneficial. A potential strategy for achieving this is the synchronization of the VCs with people's eye fixation using eye-tracking technology embedded in a head-mounted display. Hence, this paper tests this idea in the context of a pre-therapy for spider and snake phobia to examine the ability to guide people's eye fixation. An experiment with 24 participants was conducted using a within-subjects design. Each participant was exposed to two conditions: one where the VCs were adapted to eye gaze of the participant and the other where they were not adapted, i.e. the control condition. The findings of a Bayesian analysis suggest that credibly more ownership was reported and more eye-gaze shift behaviour was observed in the eye-gaze-adapted condition than in the control condition. Compared to the alternative of no or negative mediation, the findings also give some more credibility to the hypothesis that ownership, at least partly, positively mediates the effect eye-gaze-adapted VCs have on eye-gaze shift behaviour. Only weak support was found for plausibility as a mediator. These findings help improve insight into how VCs affect people. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Freeman et al. reported that a substantial minority of the general population has paranoid thoughts while exposed in a virtual environment. This suggested that in a development phase of a virtual reality exposure system for paranoid patients initially a non-clinical sample could be used to evaluate the system's ability to induce paranoid thoughts. To increase the efficiency of such an evaluation, this paper takes the position that when appropriately primed a larger group of a non-clinical sample will display paranoid thoughts. A 2-by-2 experiment was conducted with priming for insecurity and vigilance as a within-subject factor and prior-paranoid thoughts (low or high) as a between-subjects factor. Before exposure into the virtual world, participants (n = 24) were shown a video and read a text about violence or about mountain animals. While exposed, participants were asked to comment freely on their virtual environment. The results of the experiment confirmed that exposure in a virtual environment could induce paranoid thought. In addition, priming with an aim to create a feeling of insecurity and vigilance increased paranoid comments in the non-clinical group that otherwise would less often exhibit ideas of persecution. [ABSTRACT FROM AUTHOR]

We propose to combine Virtual Reality (VR) and bio-neuro feedback to help treat stress-related disorders. As a first step in that direction, we here attempted to induce stress through VR and identify (neuro)physiological correlates. Nine participants performed a surveillance task in two different cities within VR while EEG, ECG and cortisol level were recorded over time. We aimed to induce stress by simulating a bomb explosion and providing negative feedback about the participant's performance. Associative stress was elicited by having participants return to the city where the bomb explosion occurred and they supposedly performed badly. (Associative) stress was reflected in EEG mid-frontal alpha asymmetry, heart variability and cortisol level. General stress levels as expressed by cortisol and midfrontal alpha asymmetry correlated between participants. These results are promising for a successful implementation of a VR bio-neuro feedback system. [ABSTRACT FROM AUTHOR]

Background: Systems incorporating virtual agents can play a major role in electronic-mental (e-mental) health care, as barriers to care still prevent some patients from receiving the help they need. To properly assist the users of these systems, a virtual agent needs to promote motivation. This can be done by offering motivational messages.Objective: The objective of this study was two-fold. The first was to build a motivational message system for a virtual agent assisting in post-traumatic stress disorder (PTSD) therapy based on domain knowledge from experts. The second was to test the hypotheses that (1) computer-generated motivating messages influence users' motivation to continue with therapy, trust in a good therapy outcome, and the feeling of being heard by the agent and (2) personalized messages outperform generic messages on these factors.Methods: A system capable of generating motivational messages was built by analyzing expert (N=13) knowledge on what types of motivational statements to use in what situation. To test the 2 hypotheses, a Web-based study was performed (N=207). Participants were asked to imagine they were in a certain situation, specified by the progression of their symptoms and initial trust in a good therapy outcome. After this, they received a message from a virtual agent containing either personalized motivation as generated by the system, general motivation, or no motivational content. They were asked how this message changed their motivation to continue and trust in a good outcome as well as how much they felt they were being heard by the agent.Results: Overall, findings confirmed the first hypothesis, as well as the second hypothesis for the measure feeling of being heard by the agent. Personalization of the messages was also shown to be important in those situations where the symptoms were getting worse. In these situations, personalized messages outperformed general messages both in terms of motivation to continue and trust in a good therapy outcome.Conclusions: Expert input can successfully be used to develop a personalized motivational message system. Messages generated by such a system seem to improve people's motivation and trust in PTSD therapy as well as the user's feeling of being heard by a virtual agent. Given the importance of motivation, trust, and therapeutic alliance for successful therapy, we anticipate that the proposed system can improve adherence in e-mental therapy for PTSD and that it can provide a blueprint for the development of an adaptive system for persuasive messages based on expert input. [ABSTRACT FROM AUTHOR]

• Using the training system with virtual cognitions enhanced negotiation knowledge. • The training system also improved people's self-efficacy. • The self-motivational statements in virtual cognitions further boosted self-efficacy. • The effects obtained from using the training system remained after multiple weeks. Negotiating serves as an essential skill in our daily life, however, it is quite challenging to negotiate well. Various negotiation training systems have been developed to solve this problem and improve people's performance in negotiation. Nevertheless, these systems mainly focus on skills practice and less on negotiation understanding or self-efficacy development. Aiming at improving both people's negotiation knowledge and self-efficacy, a virtual reality negotiation training system is proposed that exposes users to virtual cognitions during negotiating with virtual characters. The virtual cognitions, delivered as a personalised voice-over, provide users with a stream of thoughts that reflects on the negotiation progress and their performance, and also presents self-motivational statements. To study the effectiveness of the system and the self-motivational statements included in virtual cognitions, an empirical study with 48 participants was conducted. The study employed a between-subjects design with three groups: waitlist, training with self-motivational statements, and training without self-motivational statements. 24 waitlist participants were also randomly assigned to and completed the training following the waiting period. The results indicated that 1) the system significantly enhanced people's knowledge about negotiation and increased their self-efficacy, 2) the self-motivational statements included in virtual cognitions even further improved self-efficacy. Furthermore, these effects remained after multiple weeks. [ABSTRACT FROM AUTHOR]