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At the end of the 6th session

This session focuses on relapse prevention, understanding high risk situations, and the importance of learning from lapses. It also discusses transitioning from virtual to physical reality and fostering presence and anxiety management.

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At the end of the 6th session

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  1. 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.

  2. 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».

  3. 1997: Fear of Flying

  4. 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

  5. Behavioral Outcome – 3 month follow-up

  6. Behavioral Outcome – 3 year follow-up

  7. VRMC Video Clip: Aviophobia

  8. Airport: Side by Side Shots Unreal (Tournament) Real

  9. Fear of Flying: Anticipatory Anxiety

  10. Controlled Studies: n > 8 Aviophobia

  11. Controlled Studies: n > 8 Fear of Public Speaking

  12. 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. Scenario : 8 formally dressed avatars, seated around a table Three variables : • 2 designed to assess the degree of self-reported anxiety generated by experience • The other to measure the speaker’s assessment of their performance. • (With a modified form of the Personal Report of Confidence as a Speaker - MPRCS) Positive audience Negative audience

  13. Anova Type of audience, p < .05 Neutral > Positive = Negative, p < .05 ANCOVA (estimated from data in the paper) Type of audience, p < .05 Negative > positive = neutral. Pertaub, Slater & Barker (2001, 2002)

  14. Public Speaking Virtual Environment

  15. Controlled Studies: n > 8 Needle Phobia

  16. Virtual Environment Polar view of the layout of the virtual student health

  17. 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

  18. Heart Rate at Various Stages 140 • Highest Mean heart rate is when the injection is moving closer to the arm (i.e., situation INJ2 = 95.08 beats per minute) • Decrease in heart rate in INJ3 • Mean Heart rate for the first 6 situations did not vary much 120 100 Mean Heart Rate 80 60 Desk2 ArmUp INJ1 INJ3 Desk1 Desk3 Swab INJ2 40 Various Stages

  19. 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 6.0 8 5.17 5.71 4.41 5.05 4.6 7 4.5 6 3.65 5 Mean SUDS 4 3 2 1 Desk1 Desk3 Swab INJ2 Desk2 ArmUp INJ1 INJ3 Various Stages

  20. Scripps Clinic Movie Clip

  21. Controlled Studies: n > 8 Acrophobia

  22. Virtual Reality Research Set-up

  23. 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

  24. 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 Measures

  25. Acrophobia: Fear of Heights Self-Reported Anxiety Heart Rate SUDS = 0-10

  26. Acrophobia: Fear of Heights Skin Conductance Desynchrony/Discordance: HR & Self-Report

  27. Acrophobia: Fear of Heights Synchrony/Concordance: Skin Conductance & Self-Report

  28. Acrophobia: Fear of Heights Mean Arterial Blood Pressure Ear Pulse Transit Time

  29. Self-reported Anxiety Blood pressure Skin conductance Somatic activity Respiration rate (both) 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 Summary Results Increased: Decreased:

  30. Acrophobia: Fear of Heights Side by Side Pictures Real Virtual Reality

  31. Acrophobia: Fear of Heights Acrophobia: Cable Car

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