At the end of the 6th session
 Relapse prevention :
 what have you learned ?
 what are your high risk situations ?
 lapse vs relapse :
 a lapse is a source of information about what went wrong… and
your reaction could turn a lapse into a relapse.
 From virtual to physical reality :
 Plan self-exposure homework in necessary.
Fostering Presence / Anxiety
Talk in «non virtual» terms.
«Walk toward the table and then please close the door».
Highlight useful virtual stimuli.
«Ouch, it’s a big spider… its legs are so long… and its looking at
you». «Let the spider walk on the wall behind you».
Give the participant some «story line».
«Somebody collects spiders in that apartment and we’ll visit it
for awhile».
Suggest sensations when you talk.
«It feels cold in here … bend over if you don’t want to hit
your head on the lamp».
1997: Fear of Flying
Aviophobia: 30 phobics
(Wiederhold BK, Wiederhold MD, 1999)
3 groups
VR Exposure with NO physiological
feedback
VR Exposure WITH physiological feedback
Imaginal exposure therapy (VIZ)
2 sessions breathing retraining
6 sessions of exposure
# of Participants
Behavioral Outcome – 3 month followup
10
9
8
7
6
5
4
3
2
1
0
VR + Physio
VR Alone
VIZ
Flying without meds
# of Participants
Behavioral Outcome – 3 year follow-up
10
9
8
7
6
5
4
3
2
1
0
VR + Physio
VR Alone
VIZ
Flying without meds
VRMC Video Clip: Aviophobia
Airport: Side by Side Shots
Real
Unreal (Tournament)
Fear of Flying: Anticipatory Anxiety
Controlled Studies: n > 8
Aviophobia
Author
Country Year # of Pts
Tx Grps
Wiederhold
U.S.
1999
30
VR w/Fdbk, VR no Fdbk, VIZ
Rothbaum
U.S.
2000
49
PC VR, In vivo, WLC
Botella
Spain
2002
11
PC VR w/Anticipatory
Maltby
U.S.
2002
45
VRE, In vivo
Wiederhold
U.S.
2002
30
VRGETno, VRGETpm, IET
Korea
2002
11
Driving vs. Flying
Wiederhold
U.S.
2002
58
Phobic, non-phobic
Rothbaum
U.S.
2002
49
VR, SE, WLC
Wiederhold
U.S.
2003
30
VRGETno, VRGETpm, IET
Muhlberger
Germany
2003
45
VRCBT, WLC
Spain
2004
9
Multiple baseline
Jang
Botella
Controlled Studies: n > 8
Fear of Public Speaking
Author
Country
Year
# of Pts
Test Groups
North
U.S.
1998
16
PC VR, WLC
Botella
Spain
2001
8
Internet-based PC VR
Pertaub
Harris
Slater
U.K.
U.S.
U.K.
2001
2002
2004
43
14
40
Phobic, non-phobic
VRT, WLC
Phobic, non-phobic
People React to Avatars’ Behaviors
(Pertaub, Slater, & Barker, 2001, 2002)
Static audience
Subjects : 43 fear of public speaking patients
- Randomly assigned to one of three
groups, distinguished by the type of
virtual audience
- Subjects have to talk in front of the
virtual audience, at least twice.
Positive audience
Scenario : 8 formally dressed avatars, seated
around
a table
Three variables :
2 designed to assess the degree of selfreported anxiety generated by experience
The other to measure the speaker’s assessment Negative audience
of their performance.
(With a modified form of the Personal Report
of Confidence as a Speaker - MPRCS)
Pertaub, Slater & Barker (2001, 2002)
Satisfaction towards the
performance
14
12
MPRCS
10
8
6
4
2
0
Neutral
Positive
Negative
Type of audience
ANCOVA (estimated from data in the paper)
Type of audience, p < .05
Negative > positive = neutral.
100
90
80
70
60
50
40
30
20
10
0
Neutral
Positive
Negative
Type of audience
Anova
Type of audience, p < .05
Neutral > Positive = Negative, p < .05
Public Speaking Virtual Environment
Controlled Studies: n > 8
Needle Phobia
Author
Country
Year
# of Pts
Hamza
South
Africa
2000
16
Test Groups
Needle phobic
Virtual Environment
Polar view of the
layout of the virtual
student health
Virtual Scenario
Simulation of a doctor’s
appointment
Two types of exposure to
the injection
Injection lying on the
further end of the doctor’s
desk
Simulation of the injecting
procedure:
Doctor applies a virtual
swab to the avatar's arm
and injects the needle
Heart Rate at Various Stages
 Highest Mean heart
rate is when the
injection is moving
closer to the arm (i.e.,
situation INJ2 = 95.08
beats per minute)
140
120
100
Mean Heart
Rate
 Decrease in heart rate
in INJ3
 Mean Heart rate for
the first 6 situations
did not vary much
80
60
40
Desk2
ArmUp
INJ1
INJ3
Desk1
Desk3
Swab
INJ2
Various Stages
SUDS at Various Stages
• As patients moved
closer to the needle,
mean SUD increased
• Mean SUDS
decreased between
when the patient has
raised his/her arm and
after swab is applied
5.17
8
4.6
7
6
6.0
5.71
5.05
4.41
4.5
3.65
5
Mean
SUDS
4
3
2
1
Desk1
Desk3
Swab
INJ2
Desk2
ArmUp
INJ1
INJ3
Various Stages
Scripps Clinic Movie Clip
Controlled Studies: n > 8
Acrophobia
Author
Country
Year
# of Pts
Hodges, North
U.S.
1995
17
SG VR, WLC
Lamson
U.S.
1995
9
SG VR, WLC
Bullinger
Switzerland
1997
8
SG VR, In vivo
U.S.
1998
10
CAVE, In vivo
Emmelkamp
Netherlands
1999
10
PC VR, In vivo
Emmelkamp
Netherlands
2002
33
PC VR, In vivo
Emmelkamp
Netherlands
2002
37
PC VR , CAVE, WLC
Canada
2002
8
Videogame VR
U.S.
2004
30
Stroop Physio, VR Physio,
In vivo
Huang
Bouchard
Sirbu
Tx Grps
Virtual Reality Research Set-up
Physiological Differentiation in Participants with High and
Low Fear Scores Exposed to a VR Heights Environment
(Wiederhold, Wilhelm, Nguyen, Kim, & Gross)
 Protocol
 Participants stood on a platform in a darkened room
 5-minute baseline
 Viewed neutral film through HMD
 15-minute VR exposure
 Post-exposure, participants completed self-report
questionnaires to identify a number of physiological
sensations and emotions
Acrophobia: Fear of Heights
Measures
 Self-Reported Anxiety
 HR: Heart Rate
 MAP: Mean Arterial Blood
Pressure
 FPA: Finger Pulse Amplitude
 FPTT: Finger Pulse Transit
Time
 EPA: Ear Pulse Amplitude
 EPTT: Ear Pulse Transit
Time
 TEMP: Peripheral Skin
Temperature
 SCL: Skin Conductance
Levels
 RR: Respiratory Rate
 TV: Tidal Volume
 ACT: Somatic Activity
Acrophobia: Fear of Heights
Self-Reported Anxiety
8
High Acrophobia
Anxiety Rating (0-10)
7
Low Acrophobia
6
5
4
Heart Rate
3
2
100
1
High Acrophobia
0
0
2
4
6
8
10
12
Low Acrophobia
95
14
Minute
SUDS = 0-10
Heart Rate
90
85
80
75
70
0
2
4
6
8
Minute
10
12
14
Acrophobia: Fear of Heights
12
High Acrophobia
Skin Conductance
Low Acrophobia
11
10
SCL
9
8
7
6
5
0
2
4
6
8
10
12
14
Minute
Desynchrony/Discordance: HR & Self-Report
8
100
High Acrophobia
High Acrophobia
Low Acrophobia
Low Acrophobia
95
6
90
5
Heart Rate
Anxiety Rating (0-10)
7
4
3
85
80
2
75
1
0
70
0
2
4
6
8
Minute
10
12
14
0
2
4
6
8
Minute
10
12
14
Acrophobia: Fear of Heights
Synchrony/Concordance:
Skin Conductance & Self-Report
8
High Acrophobia
Low Acrophobia
6
12
5
11
High Acrophobia
4
Low Acrophobia
10
3
SCL
Anxiety Rating (0-10)
7
2
9
8
1
7
0
0
2
4
6
8
Minute
10
12
14
6
5
0
2
4
6
8
Minute
10
12
14
Acrophobia: Fear of Heights
High Acrophobia
Low Acrophobia
100
95
Ear Pulse Transit Time
90
220
85
High Acrophobia
Low Acrophobia
215
80
0
2
4
6
8
10
12
14
Minute
Mean Arterial Blood
Pressure
210
EPTT
Mean Arterial Blood Pressure
105
205
200
195
190
0
2
4
6
8
Minute
10
12
14
Acrophobia: Fear of Heights
Summary Results
Increased:
 Self-reported Anxiety
 Blood pressure
 Skin conductance
 Somatic activity
 Respiration rate (both)
Decreased:
 Ear pulse transit time
(indicative of greater
sympathetic activation)
 Heart Rate (result of
compensatory changes
driven by the blood
pressure changes?)
Acrophobia: Fear of Heights
Side by Side Pictures
Real
Virtual Reality
Acrophobia: Fear of Heights
Acrophobia: Cable Car