Virtual Reality Exposure Therapy (Vret)

Research Paper VRET (2018) MediaLAB Amsterdam, The Netherlands VIRTUAL REALITY EXPOSURE THERAPY (VRET) Agnetha Mortensen Janina Saarnio Abstract MediaLAB Amsterdam, HvA University of Turku We sought to develop a virtual reality exposure therapy Wibautstraat 2-4, Amsterdam Finland (VRET) environment that is adaptable to the biofeedback of the user. Our prototype is built in Unity The Netherlands [email protected] and integrates the sensory data from Mio Link heart [email protected] rate monitor transferring it through a computational Yujie Shan model that individually adapts to the VR environment. Christiaan van Leeuwen Kyushu University, Our final concept is a user case located in an Hoegschool van Rotterdam Japan underwater VR environment focused on the specific The Netherlands [email protected] phobia of sharks; galeophobia. Our research follows a [email protected] multidisciplinary approach, combining fields of design thinking, psychology, cognitive neuroscience, human- computer interaction (HCI) and affective computing. Author Keywords Virtual reality; affective computing; exposure therapy; biofeedback; emotion detection; sensor technology ACM Classification Keywords H.5. Human-Centered Computing (e.g. HCC): Human- Permission to make digital or hard copies of part or all of this work for Computer Interaction (HCI) personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights Introduction for third-party components of this work must be honored. For all other We were assigned a task on how to track emotions and uses, contact the Owner/Author. transform it to a Virtual Reality (VR) environment. Copyright is held by the owner/author(s). The ability of VR to simulate real-life situations that elicit similar subjective and physiological body reactions has made its way into psychological research [1]. The immersive nature of VR is seen capable of activating “real” emotions and therefore, it offers new possibilities 1 to easily investigate human behaviors in a controlled physiological responses from our body, it is highly environment. The premise of VRET is relying on possible that the self-reflection of the subject does not triggering the perceptual cues that activate our correlate with the “emotional” data. Due to this simple emotional experiences and create the sense of feeling fact, emotions appear and remain somehow unfamiliar in a VR environment - which we will from now on call as and unresolved for us. As Marvin Minsky [5] states, presence. We know high presence is especially crucial human emotions come under the category of ‘suitcase for emotional involvement during the initial phase of like’ definitions we use only to conceal “...the VRET to ensure the immersion of the user. [1] complexity of extensive ranges of different things whose relationships we do not yet comprehend.”. The opportunities of using virtual reality as a medium Therefore, it is only possible to make estimates of for exposure therapy has already been investigated. In emotions. contrast to in vivo exposure therapy, VRET provides some advantages, such as higher acceptance among Physiologically our emotions are seen to be processed patients, lower costs and higher accessibility [2]. Also, through a limbic system, which is situated behind the nowadays technology by itself is shown to create an neocortex part of our brain. The neocortex parts deal emotional presence that may become useful when with conscious thoughts and decision making. On the designing mental health applications directly aiming to contrary, the very nature of the limbic system and our Figure 1; Generic model of modify problematic emotions. [1] emotions are illogical, irrational and unreasonable [6]. emotion detection. Our prototype follows a basic and the most common In cognitive neuroscience, emotions are strongly linked method of exposure therapy relying on “fear to our decision making as whenever exposed to a habituation” [3], but the individual biofeedback will particular stimulus we construct and store a somatic automatically control the steps of a graded exposure. marker between the stimulus and our affective state. We believe that our design based on triggering the Then these somatic markers are stored in our memory fearful stimulus up to a point before the activation of and later used for decision making in similar or maladaptive behavioral responses (i.e., avoidance or different context [7]. In fact, at the psychological level panicking) is an effective way to treat specific phobias. emotions are regarded as tacit appraisals of different situations regarding personal goals, concerns or needs Emotions and Behavior [8]. Until today there is no universally accepted theory According to the emotion-focused therapy approach as about emotions. We decided to follow the famous well as having emotions we also live in a constant Russell’s circumplex model of affect (1980) that divides process of making sense of our emotions [9]. The all emotions into a two-scale diagram according to their dialectical-constructivist view of human functioning intensity of arousal and valence. Commonly, emotions helps to explain the process. The circular process of can be measured from physiological changes (i.e., making sense of experience is run through bodily-felt heart rate), behavioral responses (i.e., facial sensations connected to our awareness and memory expression) and/or cognitive interpretation (i.e., self- and later articulated in language. Therefore, emotions reporting) (see Figure 1) [8]. The most important in the are an adaptive form of information-processing and study of emotions is to use ROIs (regions of interests) action readiness that guides people in their interactions to extract information from our affective nature [4]. with other people and the surrounding environments However, even though we could be able to extract all [9]. 2 philosophical point of view, the difference between fear Fear as an Emotion and anxiety lies in their relation to an object, as Sara Ahmed [12] states. According to Ahmed, fear has an Fear is defined as one of the basic emotions by object whereas anxiety has not. The temporal consensus [8, 10]. From a physiological perspective, dimension in fear only appears when we are affronted fear is sympathetic arousal and an aversive subjective to a threat. The fearful moment “projects us from the threat. Our sympathetic nervous system (SNS) is present into a future” which is felt as an intense bodily activated through the amygdala and involves experience of the present. Sweating, increased heart alterations in blood pressure (BP) that can be rate, and unpleasant intensity through the whole body physiologically measured from the changes in heart push us to either flight-freeze-or-fight. Ahmed rate or skin conductance, for example [11, 21]. concludes that we fear when an object approaches us and we anticipate it to hurt us [12]. From an evolutionary point of view, negative emotions are often useful and even necessary for our survival. In Practically this means that even though the amygdala is fact, anxiety, anger, and fear would not exist if they central to emotional learning and memory, it is not were not useful. However, the risk is that unpleasant critical to the expression and regulation of emotion. The emotions can turn dysfunctional when they also endure amygdala only serves as a “smoke detector”, pre- in the circumstances where they are not needed [9]. consciously interpreting whether the incoming sensory People who have a particular kind of phobia share a information is a threat or not [9]. Therefore, the standard feature of amygdala hyper-responsiveness activation of our conscious interpretation is needed to over the hippocampus and medial prefrontal cortex help us overwrite the maladaptive fear memories (see (mPFC) that are responsible for cognitive interpretation Figure 2). However, the change can only occur by first [13]. activating the emotional memory with a fearful stimulus which we will simulate in VR. Relevant for our concept is that usually, people try to Figure 2; A basic model showing push down the unpleasant emotions such as pain, fear the link between the physical or anxiety. However, all of these so-called “escape Overcoming Fear through Exposure Therapy world relying on perceptual cues methods” will only cause harm in the long term. Exposure therapy has shown to be the most effective and their references to the Avoidance of emotion often creates a long-term feeling treatment for phobias. Most commonly it is practiced by different layers in our mental of suffering and prevents us to live life to its fullest [9]. using one of the two scientifically proven methods; world. In order, not to let the negative emotions take over flooding or graded-exposure. Research indicates that one’s actions and behavior one needs to be aware of, to gradual and prolonged exposure is the most optimal. tolerate and to regulate negative emotionality as well Exposure therapy is rooted in classical conditioning as enjoy positive emotionality [14]. Scientifically we where every exposure trial starts by activating the often refer to this regarding emotion regulation or maladaptive experience and making the patients emotional intelligence. Emotional intelligence means contact with the feared, conditioned stimulus (CS). The that the individual can use emotions as a guide, instead condition is maintained until the anxiety is lowered of being a slave or a victim of emotions [22]. down. This process is often referred to as habituation and can only lead to successful outcomes if the patients The primary challenge of detecting fear is its close are prevented to avoid the phobic stimuli in their sight relation to anxiety and the oppression of our [15]. The traditional exposure therapy methodology parasympathetic nervous system. From the relies on the assumption that performance during 3 training and fear reduction within an exposure trial memory should be taken into account when designing (also referred to as within-session habituation WSH) is the exposure trial in VR.

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