Pre-class questions - Week 6 (Responses)
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Read the 3 papers and discuss your thoughts, questions and ideas regarding using the use of VR for behavior and attitude change as well as the use of VR for treatment of anxiety, phobia and other disorders in 1-2 paragraphs each.
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13/03/2017 08:22:37Christian Vazquez
Embodiment in VR can be a powerful tool to change the way we perceive ourselves and the world. Because of the immersive nature of Virtual Reality, people can be transported to localities that would otherwise not be available to them , or become beings that challenge their very notion of self. Two of the readings this week, focus on how Immersive Virtual Reality (IVR) can actually change the way we act and think about the world around us. I find Slater’s work on the reduction of implicit bias one of the most interesting readings this week. Not only does a brief exposure to the body illusion change people’s implicit bias, but the effects last for weeks! This obviously poses an important question: What happens when the use of VR becomes more predominant in society? The medium is characteristically proneto being employed as a platform for the video game industry. In fact, some of the prominent VR headsets (e.g. Oculus), were originally envisioned as a gamer first product. The video game industry is full of violent games (the gorier the better these days.) How being embodied in an avatar performing violent actions change the brain? Of course, one might argue that today’s children already engage in these violent affairs. However, there is a separation between player and avatar; our brain is aware of it. What happens when we shorten the divide?

The Proteus effect, discussed is another reading this week, could give us some insight as to how embodiment can change the way we interact with each other in virtual scenarios. The study found that participants who embodied taller or more attractive avatars behaved differently than those who did not, despite of the perception of others in the virtual scenario. I believe it is of importance to measure the extents of these effects on the participants perception of self in the real world. Can the effect transcend beyond the virtual experience? Slater's work seems to suggest it can. If so, then we could use embodiment's capability to change attitudes to train groups of professionals. For instance, embodiment could be used to help a police officer in his development, so to speak, to ensure a more unbiased execution in the line of duty.

A meta study in this week's readings explored the capacity of Virtual Reality to help patients recover from anxiety disorders and phobias. Despite the relatively small number of subjects, and phobias treated with these techniques, the findings seem to suggest that Virtual Reality treatment offers an equally if not slightly better approach than in vivo alternatives. Although the effects on patient lives is similar, virtual reality offers a cost effective alternative that provides user's with a wider range of scenarios to which patients can be subjected to for their treatment. Because VR can subject user's to these experiences in a controlled, safe environment, people can re-experience traumatic memories in order to overcome them. However, because of the nature of VR, it's important to note the dangers of doing this moving forward. Maybe today's VR headsets are not capable of rendering realities that closely match ours, but in the future, VR might be indistinguishable from reality. As IVR becomes more and more real, it's important to carefully tune the treatment's of phobias pso as not to disconnect patients from reality. In fact, VR can become a surrogate gateway to reality. Why engage in the seas of social interaction, when I can be safe in a virtual environment? A relevant piece of the media, "Surrogates", staring Bruce Willis in a world where the standard is living through the virtual embodiment of more attractive, and capable avatars shows a bleak future.

Combining the findings from the meta-study with the Proteus effect, one could argue that immersive virtual reality is an obvious choice to treat people with social ansxiety. It would be interesting to see how the perception of self can be slightly altered in such a way that the person is originally made to perceive themselves with more socially favored features (e.g. attractiveness.) Then, after interacting with other avatars or confederates, gradually change the features of their avatar to more closely resemble their true selves. Could this potentially convince the mind to accept it's own features as more socially favored. If so, can it help people introverts gradually shift into more extroverted roles?
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14/03/2017 12:54:23Huili Chen
Regarding the use of VR for behavior and attitude change, I have relatively mixed feelings. The two of the 3 papers showed that using VR was effective for social behavior change and implicit racial bias change via self-representation. It is true that VR may lead to observable difference in outcomes by presenting virtual environments and avatars for users to experience. However, we don’t really know whether simply visual exposure through VR can create lasting behavior and attitude change. For example, photography has been invented for more than half of a century, and we are able to remotely witness the cruelty of wars and other human suffering through a variety of photographs. However, many people still believe in the legitimacy of wars and justify the use of violence to achieve political goals. As a result, some photography critics argue that the overwhelming amount of war photographs, instead of eliciting empathy and our attitude toward wars, creates moral fatigue in us. Thus, we have to ask what is the difference between photography/videos and VR? Can VR truly lead to lasting behavior and attitude changes, or it may potentially morally fatigue the public through excessive visual exposure? Photography, when accompanied by narratives and “stories behind the scenes,” could arguably elicit viewers’ empathetic reactions and behaviors. With this being said, is it necessary to add narratives to the VR experience in addition to visual exposure?

The use of VR for treatment of disorders and PTSD may better lead to an intervention outcomes when coupled with meditation, relaxation methods and physiological interventions. Prior studies show that people’s current emotional states could reshape their understanding of the memory they are currently recalling. For example, if a PTSD participant is very anxious now and is recalling his/her traumatic past experiences, he/she may experience a secondary trauma, and this traumatic experience may be exaggerated and elicit more negative feelings to him/her. Thus, people’s current emotional and physiological experience is crucial for using VR to render visual experiences for them. Thus, perhaps people could first try to meditate and relax under the guidance of VR, and then receive the visual experience that is relevant to their disorders and PTSD.
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14/03/2017 23:12:51Nikhita Singh
Virtual reality provides a really compelling, and immersive platform to explore mechanisms of behavior and attitude change as well as treatment of psychological disorders and phobias. However, creating an easily accessible "virtual" world also comes with the potential for escapism and higher risks.

In the context of behavior and attitude change, there is compelling research to support that VR technology can be leveraged to shape self-perception and our perception of others. Explorations of ideas such as the Proteus Effect are a testament to this potential transformation. Since virtual environments enable people to easily alter their representation of self in the digital form, they provide a compelling platform to quickly, and iteratively explore our understanding of ourselves. Could people use VR to become more self-aware? Or understand how they would react in particular situations? Or uncover their biases and perceptions? However, this ease of self-manipulation is not without its tradeoffs. The ability to generate a "second self" so easily can also lead to escapism from the behaviors and attitudes we are working to change. For example, an individual using VR to learn how to become more assertive of accepting of their self-image and body may choose instead of immerse themselves into the virtual world rather than dealing with the issues at hand. The ease of access to such technology and the immersive nature of the experience can seem compelling in comparison with the hard work required to push our personal insecurities and change behaviors.

Exploring further, the possibility of using virtual reality as a means to treat anxiety, phobia, and other disorders also holds a great deal of promise. Research supports that VRET may positively influence treatment of various disorders, particularly when combined with CBT therapy. VR technology also has the ability to access individuals who may otherwise not seek out help due to fear or limited access to resources. Such individuals may be able to use VR technology as an initial step from the comfort of their home to make them more comfortable with speaking to a professional or partaking in group therapy. Additionally, VR technology provides the advantage of being able to actually immerse oneself in the experience to see how one reacts, as opposed to speaking in a hypothetical sense. That being said, therapy for disorders such as PTSD, panic disorders etc. can be highly individualized and dependent on traumatic past experiences. Creating technology that is sensitive to the needs of individuals in potentially precarious situations is difficult and the risks for "being wrong" are high. In leveraging VR for mental health, it is important to consider that it is not a one-size-fits-all solution, and supervision plays an important role.
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15/03/2017 01:23:58Ishaan Grover
Both the papers regarding the use of VR for behavior and attitude change were quite interesting and had their strengths and weaknesses. In general, using VR to eliminate gender bias seems like a good idea. In fact, the same idea could be extended to all sorts of biases and prejudices, including gender, ethnicity and religion. It would be interesting to see the long term effect of such studies. How many times must one be exposed to altered virtual realities in order to have a lasting effect. However, IAT might be a very shallow measure of deep seated biases. A number of factors could affect performance on such a test. Using it as measure to quantify racial bias might be an approximate but does not conclusive measure to claim causality. Even if the IAT score goes down, it might be that the deep seated bias still prevails and some other factor (like having figured out the purpose of the study) caused the IAT score to go down.

In the second study, it is really interesting to see how perception of the virtual embodiment of oneself can cause a person's behaviour to change. However, I have similar reservations regarding the study. Factors other than height or attractiveness could have caused the distance to be different or the split to be unequal. Factors such as general perception of oneself, personality traits (introverted/extroverted), culture, gender, etc can shape behaviour. In a behavioural study like this one, the number of participants plays a key role to claim results conclusively. How many participants does it take to ensure that something as complex as behavior can be concluded about? The paper on the US of VR for treatment of anxiety, phobia etc also talks about the need for more control groups in order to determine the effect of VR on behavior. The area of research seems promising and could perhaps be used in everyday situation as well. For instance, students studying for standardized tests could utilize VR to get a feel for the environment to alleviate anxiety during the test. People scared of sitting on a plane or being in social situations could use VR to better prepare for the real world. Perhaps, CVEs could be used to alleviate social anxiety.
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15/03/2017 23:52:20Wenying Wu
I am quite intrigued after reading three papers and learning about the use of VR for psychological disorders treatments. I am interested in seeing how in the future VR could be used to help study social interactions and reduce racial, sexual, and other types of discrimination in our society. VR has empowered us with tools to alter ourselves and our environments easily without the use of too much physical space and construction materials. However, I am having some doubts about the effectiveness of these treatments because everything happened in a virtual environment. According to the principals of VRET, "people feel ‘‘present’’ in the virtual environment; part or all of the individual’s perception fails to accurately acknowledge the role of the technology in the experience." I am suspicious about whether the effectiveness of virtual treatment will be as long-lasting as the physical treatment considering the difference between virtual presences and real-life presences. Current VR technologies are also limited to our visual and auditory senses. Psychological disorders could happen because of various other factors such as touch, smell, or taste. Failing to trigger these important senses might result in unsuccessful psychological disorder treatment. I think the most important part of VR technologies is in storytelling. Being able to craft good stories that stimulate emotions and senses is important in creating VR experiences that has long-lasting effects on users' memories.
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16/03/2017 00:03:25Adam Haar Horowitz
An ability to create embodiment in an environment like Tabitha Peck's, where stimuli are coded and entirely mutable, opens up so many possibilities for behavior change and anxiety treatment. It is remarkable, but somehow not surprising, that immersive experiences can lead to drops in both arachnophobia and implicit racial bias. Bem's self-perception theory in VR offers a means by which we can empower users to recreate their own identities based on rationalizing virtual behaviors and embodiments, rather than guiding them slowly to those real world behaviors/embodiments and encouraging their later noting of their practice and subsequent rationalization and identification. Patient autonomy like this, especially with regards to phobias and traumas, is key to successful and lasting treatments (van der Kolk).

And yet, this possibility for curation--a desire for curating oneself that exists in spite of deindividuation online, that persists in terms of self-reflection regardless of the way we are actually being perceived, is troubling as well. It seems, firstly, like a breeding ground for isolationist narcissism--Sherry Turkle's Alone Together comes to mind. The missing therapeutic alliance may add to this risk, and as behavioral changes transfer from in VR to in vivo, risks in terms of stability of behavior and behavioral change emerge without an evolving therapeutic alliance. Interpersonal aspects of trauma are not dealt with interpersonally in these interventions.

Lastly, I'd like to mention Bessel van der Kolk, who has worked for decades to move the field of trauma treatment into more holistic territory, recognizing the key role that embodied cognition plays in PTSD and encouraging integration of yoga into trauma therapies. The powerful technology involved in VR seems to suggest something powerful enough to combat and defeat trauma--'we will make them touch the spider in VR, then they will not run from real spiders'. But many psychiatrists, especially those who think the non-embrained aspects of trauma are primary, would argue these traumas are often to be encountered and accepted, not attacked and defeated. With researchers newly able to construct whole worlds around treatment, I have seen many CBT applications, and very few gentler ACT (Acceptance and Commitment Therapy) programs being created. VR lends itself to head-focused, high ambition and high confidence interventions, when some promising recent research encourages quite simple full body focus and a sense of acceptance rather than defeat of our 'imperfections' for moving forward with trauma.
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16/03/2017 01:48:49Jiabao Li
How is human's perception difference between ultra realistic rendered human and avatars? Could this influence their feeling? For example, some avatars are similar to human, but some subtle difference create fear and strange feelings. Empathy study test may include this factor.
Other than observe myself becoming other creatures, observe other's interaction seeing me being other creatures maybe also interesting and create empathy. For example, a male turns into a female and be put into some sexism conversations. He sees how other people's reaction to "her" differ from him as "he". Would he feels this discrimination ridiculous?
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16/03/2017 02:03:37Lucas Cassiano
[Putting yourself in the skin of a black avatar reduces implicit racial Bias]: This type of VR use could be also applied for other groups that suffer from negative social biases, or that majority of society does not treat equally, based on physical appearance/capabilities, e.g. a VR environment that puts you in a VR body that needs to use a wheelchair and also needs to realize the very same tasks the user does during his/her routine, like getting on a bus,buying groceries or using a public restroom (https://www.buzzfeed.com/louisebruton/everyday-struggles-for-a-wheelchair-user-f5b5).

[Virtual reality exposure therapy in anxiety disorders: a systematic review of process‐and‐outcome studies.] We can argue that VRET is a less aggressive experience for the patient when compared to exposure in vivo, and also more effective than just imaginal exposure. Also in some cognitive behavior therapy cases it is harder to setup a scenario for the patient for an exposure in vivo for many sessions and the doctors also have more control over the scenario.

[The Proteus effect: The effect of transformed self‐representation on behavior]This paper shows an interesting study of how the way we see ourselves impact in how we behave within other people. It’s also interesting the timeframe required to change our behaviors, just few minutes in a different body and we may change the way we interact with others. I think this also has a interesting effect on the idea of paragraph #1.
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16/03/2017 09:17:55
Pedro Colon-Hernandez
I think it is great that VR is being used for both behavior change and disorder treatment. It provides an alternative that can be used in private and can be adapted to an individual’s needs through some customization in the software. One of the larger questions that I have is how much time does this treatment last for. Most of the treatments presented seemed to last 6 months and in most cases they are stable. There are a few recorded that are lengthier and seem to be stable, but it would be interesting to see how far this goes (if it would last a lifetime). Another interesting study would be if VR could be utilized to help transgender people adapt better to a new image if they don’t have access to hormones for example.
I think there may also be a danger in the use of VR for these treatments. The danger is whether a patient becomes dependent on the VR instead of getting better. Although these studies limit the sessions, what if a user after the studies acquires a headset with the same software? Similarly, what if the user’s disorder is too strong, and the VR treatment worsens the condition.
As we move towards the future, VR experiences will be more detailed, and I believe that the treatments will improve their efficacy.
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16/03/2017 10:25:35Guillermo
The use of VR training and coaching tools in therapy programs holds special promise for increasing patient compliance and therapeutic effectiveness (EMeyerbröker, Emmelkamp 2010). VR technology enables the creation of controllable, interactive scenarios in which the patient, represented as an avatar, can respond to specific behavioral challenges similar to those they would encounter in the real world. They can also interact with their therapists and other individuals represented as avatars. VR-mediated behavioral therapy offers many potential advantages over traditional therapy:

• VR can be used to generate behavioral training exercises targeted to the specific needs of individual patients, using scenarios relevant to the patient’s real-life daily activities and behavioral triggers.
• The heightened sense of experience and game-like features of VR training help motivate patients and engage them more fully in the treatment process.
• The use of avatars also appears to promote the transfer of healthy behaviors from the virtual world to the real world. For example, VR users have been found to increase their physical activity after their avatar does (Yee & Bailenson, 2007).

Although little work has been done to see how virtual reality can attenuate our bias towards negativity, existing research suggests that VR may be a potentially successful method. For example, in a study that investigated whether this bias is reduced by a person’s affective context, the authors found that attention bias to negative information is attenuated or eliminated when positive constructs are made accessible (Smith et al., 2006). In other words, when individuals are primed with positive stimuli, the bias towards giving attention to negative stimuli is significantly reduced. While additional research is needed to provide empirical evidence, because research has shown that the effective components of virtual reality are not only perceived, but also affective at altering the mood states of individuals who experience the program, it is reasonable to hypothesize that “positive experience” virtual reality programs can attenuate the bias towards negative stimuli (Smith et al., 2006; Wegener & Petty, 1994). Additional evidence for the success of virtual reality in reducing attention to negative stimuli comes from a study conducted by Pratto & John (1991).
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16/03/2017 10:43:46Laya Anasu
The question: “But as we change our self-representations, do our self-representations change our behavior in turn?” was the one that really stood out to me. I think VR can play a very interesting role in giving people a way to experiment with their identity, thus impacting their behaviors, attitudes, and anxieties, phobias. Let me expand. This is something I’ve been thinking about: why should we restrict ourselves and our thoughts to what is “natural” to us based on our physical attributes and our backgrounds? I am more than my skin tone, my height, my eye and hair colors. For some people, it’s easier to transcend their physical barrier and achieve a level of being that is closer to their spirit regardless of the restrictions their physical self may put on them. For others, it’s a lot more difficult and people feel restricted by what they were born as. As a kid, one of the most fun activities was when we would have a big box of random supplies and costumes and we’d be free to take whatever we wanted and play act. We could be firefighters, soldiers, princesses, chefs—whatever we wanted. Even though we weren’t actually these things, we had enough imagination and pre-conceived notions to understand what we might be like if we were these things. In the future, will we really be bound by what we are physically born as? I think there are some students in Design Fiction working on thinking of a world without gender (with gender fluidity). Instead of thinking about gender fluidity, I’m interested in identity fluidity. In reading the articles about how VR avatars and our perception of VR avatars might change the way we act and behave in social situations, I think VR could be a great tool for us to explore our different identities and selves. In a way, VR avatars could be “tried on” and we can see which “fit” us better. For example, what would I, an Indian-American girl, be like if I was a tall white male? Or if I was someone with a gymnast’s body? Actually, let’s carry out the example of a gymnast’s body. Would I do more stunts? Would I try parkour? Would I extend the limits of my body more? Would I eat differently? Would I try to exercise more to maintain that VR body? How would I change? How would I feel in that body? Would I feel like an imposter? Or would I actually enjoy that body? Would I feel more like myself in that body? And here’s another important question: would an experience in that body change how I approach my own self in the future? Would I be inspired to or encouraged to exercise more and eat differently? Or would it just be an experience I enjoy for a few moments and forget about? I think VR could be used in a way similar to a clothes store. There are many clothes (“personas”/“avatars”) to try on, and we can see how they “fit” us and how we “feel” in them. Then, once we’ve explored a bit of the possibilities and how we feel, how our confidence is, etc, we can “choose” to “buy" those clothes…or in the VR case…we can “choose” to “be that person” in whatever way we interpret that phrase.

I think an important aspect of these VR experiences that was lacking in some of the experiences we read about was “awareness”. The researchers saw differences in the way the subjects acted in social situations based on if they were given attractive avatars or if they were taller or shorter in negotiation settings, but I don’t think the researchers informed the subjects later of the behavioral changes. I wonder what impact awareness would have on the subjects’ behavior. Would they be more mindful of their own biases and behaviors? I also think it’s important to couple this awareness of behavior change with awareness of how the subjects felt in that situation. Did they feel more like themselves? If so, what does it reveal about their own thoughts and wants? In the case of the phobias and anxieties, I think it’s important that the subjects realize that in some cases their phobias actually did decrease. I think VR could be used as a great platform for reflection and understanding how a person can change.
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16/03/2017 10:57:24Mina Khan
I think it’s fascinating that we’re able to feel so completely immersed in virtual environments. Mel Slater discussed the concept of ‘presence’ in VR, and categorizes it as Place Illusion (PI) and Plausibility Illusion (Psi). Place Illusion is when you feel that you are actually in a place, i.e. you can relate to your actions in that place [1]. Plausibility Illusion (Psi) is when you feel that the place in virtual reality is real, i.e. it responds to your expectations and actions [1]. Mel Slater argues that when both PI and Psi are present, people consider virtual reality as real. Embodiment can also be described using the Sense of Presence theory, which categorizes presence as sense of self-location, sense of agency and sense of body ownership [2].
The consequences of presence and embodiment in VR are amazing. I read a recent paper by Mel Slater [3] in which his team was able to reduce the fear of death in people by allowing them to experience out-of-body experiences in VR. In another experiment, it was shown that VR can be used to cultivate self-compassion in people in order to help them overcome depression [4]. Mel Slater also used VR to change people’s perceptions about race by helping them put themselves in the shoes of other people [5]. VR can also be used to change people’s perceptions about their bodies [6]. I think VR is a very important, if not the most important, tool for psychologists and neuroscientist. The ability to create new almost real worlds for people, and to help them see a completely new version of themselves can help unlock a lot of human potential, and overcome several psychological and social problems.

[1] Slater, M. “Place Illusion and Plausibility Can Lead to Realistic Behaviour in Immersive Virtual Environments”Philos Trans R Soc Lond B Biol Sci. 2009 Dec 12; 364(1535)
[2] Kilteni, Konstantina, Raphaela Groten, and Mel Slater. "The sense of embodiment in virtual reality." Presence: Teleoperators and Virtual Environments 21.4 (2012): 373-387.
[3] Bourdin P, Barberia I, Oliva R, Slater M (2017) A Virtual Out-of-Body Experience Reduces Fear of Death. PLoS ONE 12(1): e0169343. doi:10.1371/journal.pone.0169343
[4] Caroline J Falconer, Aitor Rovira, John A King, Paul Gilbert, Angus Antley, Pasco Fearon, Neil Ralph, Mel Slater, Chris R Brewin (2016) Embodying self-compassion within virtual reality and its effects on patients with depression British Journal of Psychiatry Open 2: 1. 74-80 Feb.
[5] D Banakou, H PD, M Slater (2016) Virtual Embodiment of White People in a Black Virtual Body Leads to a Sustained Reduction in their Implicit Racial Bias. Front. Hum. Neurosci. 10: 601.
[6] Konstantina Kilteni, Jean-Marie Normand, Maria V Sanchez-Vives, Mel Slater (2012) Extending body space in immersive virtual reality: a very long arm illusion. PLoS One 7: 7. 07.
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16/03/2017 11:09:09Juan Pablo Ugarte
VR for behavior and attitude change
As discussed in Yee and Bailenson (2007), the ways in which us and others perceive ourselves has the potential to affect our behavior and the behavior of others towards us. A possible use of VR which interests me in this regard is how VR avatars can affect human-robot interaction in hybrid creative practices. There are two specific aspects of it that I think could be worth exploring:
(i) How do the robotic system’s expectations about the user’s behavior may affect back how the user acts? And how could these expectations be conveyed using VR or AR? The aim here would be to have the robot exhibit behaviors intended to foster specific behaviors on the human. For instance, a robot may display human-like attributes such as being inviting and playful to elicit a curious attitude in the human agent. Other behaviors to be triggered could include caution, confidence, receptiveness, etc. As difficult as this could be, VR would definitely contribute making the user better understand the robot’s perceptions and expectations about them;
(ii) How would different robotic avatars affect the behavior of the human towards the robot? What type of information concerning the state of the robot and the tasks it is executing (which would be difficult to transmit otherwise) could be dynamically embedded in these avatars? Contrarily to the previous point, the idea here would be to explicitly provide information about the common task that is being executed and the state of the overall human-robot system. The question then is what type of information concerning the human-robot collaboration process lends itself to be communicated through a virtual avatar? A couple of simple ideas that come to mind are using color to convey the degree of understanding the robot has about his human counterpart’s actions and intentions, and creating an avatar that has a temporal dimension such that the user can understand previous and future states of the robotic agent.

VR for treatment of anxiety, phobia and other disorders
One area for VR use in the treatment of psychological disorders (and psychotherapy in general) could be online therapy. The aim would be to provide immersive virtual spaces where patient and therapist could interact in ways that would support the development of strong therapeutic alliances. There are several aspects to this notion:
First, it could simply provide a space for the therapy to take place —this may be important as it helps removing the patient out of their ordinary context to facilitate the appropriate mindset for the therapy session. There is lot of room (no pun intended) in this regard from an architectural perspective. Second, VR could be used to surrogate some features of face-to-face patient-client relationship that are missing in traditional online interactions. I am not an expert, but I think it is safe to assume different aspects of non-verbal communication absent in online interactions are important at the therapeutic alliance level and could be exploited in VR. Third, it could allow therapists to explore different avatars to fight patient’s biases. For example, a client may challenge the therapist’s competence based on age, race, general looks, gender, etc. Having the possibility of choosing an avatar different from themselves could help therapists fight these biases. It could be argued, however, that subverting the patient’s preconceptions is a task of the therapeutic process. The avatar modification could also be applied on the user to remove therapist’s biases as well; however, the implications of this change could have other unintended consequences on the therapist-client relationship at the personal and therapeutic levels. Fourth and final, VR could be used to have “augmented avatars” that communicate patient’s physiological metrics such as heart rate or skin conductance —this would require using invasive and/or non-invasive sensors. The aim would be to provide the therapist with real-time information about the patient’s anxiety level’s and general mood to inform therapeutic approaches.
Another separate use of VR in psychotherapy could be the application of projective tests. How would an immersive 3d Rorschach be like? Or how would it be to do the draw-a-person-in-the-rain by sketching in three dimensions using one’s body? Although part of the power of traditional projective tests precisely lies on their abstractions, adding a three-dimensional, embodied component to them (or to completely new tests altogether) could open new dimensions for these tools to assist diagnosis.
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16/03/2017 11:13:04John Stillman
Reducing Implicit Racial Bias
The findings of the Peck, Seinfeld, Aglioti and Slater study, that the use of avatars in a virtual social environment can increase empathy among a racially diverse group, were really encouraging. It would be informative to see follow-on studies since this one did not look at the longterm effects of these changes in empathy. The study participants were 60 females. I’m interested to see of the results would be the same for a group of males. Is there a measurable empathy gap between men and women?

The Proteus Effect
In contrast to the Reducing Implicit Racial Bias study, I was a little concerned with the findings of Yee and Bailenson in their paper on the Proteus Effect. It seems to me that hyper male avatars might contribute to some of the unseemly aspects of social interaction on the web including sexism (gamer gate) and cyber bullying. Is there some way we can encourage people to use avatars that will increase empathy? Can avatars ehance positive engagement between people?
I would be interested to see how and why people choose their avatars. Is it a form of ego enhansement? How do we educate people about the positive and negative unintended consequences of choosing various avatars?

VR Exposure Therapy
The review of various VR therapy studies by Meyebroker and Emmelkamp had some interesting findings. It’s encouraging that VR exposure therapy can clearly help with some less complex phobias such as fear of flying, acrophobia and battle induced PTSD. This is ideal since therapy in VR can be cheaper, easier and safer and more controlled than exposing patients to flying, spiders, combat, etc in vivo. I’m looking forward to reading some of the specific studies to learn more about about the successful VR therapies that were used.
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16/03/2017 11:23:49Alexandra
(Logistical Note: I interpreted the instructions to indicate students are invited to write 1-2 paragraphs about each of the 3 readings, I hope this is correct!)

*READING 1“Putting yourself in the skin of a black avatar reduces implicit racial bias.”*

I Initially learned of the research presented by Peck Et Al. “Putting yourself in the skin of a black avatar reduces implicit racial bias” in a Media Lab seminar where Mel Slater (ICREA Research Professor at the Event Lab, University of Barcelona, Barcelona, Spain Department of Computer Science, UCL, London, UK) spoke of connections between virtual body ownership and diminishing racial bias. In the paper by Peck Et Al., findings indicate "Implicit racial bias decreases when in a dark skinned body” when white people have the opportunity to embody individuals of different skin colours through VR. It is remarkable to note how this study stands in direct opposition to the Groom Et Al. study performed in 2009 which revealed an increase in racial bias through VR. However, in the study by Peck Et Al., researchers are careful to highlight the difference: their focus on body ownership and visuomotor synchrony (aspects missing from the 2009 study).

Through this depth of bodily connectedness with another body, their study afforded participants an experience of technically being a different person. Most are familiar with the expression “walk a mile in someone else’s shoes” ever since author Harper Lee popularized the saying. Originally a Cherokee proverb, it cautions us against the act of judging an individual before having experienced life as this individual. Through the implementation of VR, this study essentially provided the experience of" walking in another’s shoes". In light of this, it is important to note a certain ceremonial custom practiced by native peoples such as the Cherokee Native American tribe and the Yoreme people of Mexico who's documented perceptual anomalies include the perception of taking the form of another person or animal, also referred to in cultural mythologies as “shapeshifting" (Simonett, 2014). Many cultures around the world explore aspects of embodiment through cultural and religious practices. Therefore, it is fascinating to consider the implications and role of this practice throughout pillars of history as we move forward into the future of embodiment and visuomotor synchrony through VR. Perhaps there are other aspects of “shapeshifting” we can learn from the past to explore further ways to tackle complex challenges such as bias, anxiety or behavior. For example, if one were to consider the current environmental crisis, it would be interesting to conduct an experience to provide individuals with the opportunity to embody an animal or plant more directly impacted by deforestation, climate change or habitat loss. This could become an effective teaching tool for behavior modification and reinforce actions related to environmental protection (actions such as recycling, composting or activism which are less implemented due to the distance from environmental disasters, many of us are afforded).



*READING 2 The Proteus effect: The effect of transformed self‐representation on behavior.”*
Although the slogan “build your perfect self” sounds like an advertisement from the still frames of a Black Mirror episode, this next study broaches this very aspect. In the vein of the previous study exploring embodiment through VR, the study entitled, "The Proteus Effect: The Effect of Transformed Self-Representation on Behavior” by Yee Et Al. examines behavioral modification following an experience of being assigned to an avatar. In the two experiments conducted, the study concludes that participants who are given a more attractive avatar will be more likely to engage in self disclosure and closer proximity during an interpersonal exchange thereafter. simultaneously, participants with a taller avatar exhibit greater confidence in their following negotiation situation. These findings bring to mind a potential clinical therapeutic situation geared toward physiological counseling. Through this digital reality, therapists could rely upon the “character/avatar building” model to design an avatar with the sought-after traits which can in turn support the individual goals of the patient. This therapeutic intervention is however tentative as it greatly changes the conditions of the experiment.

Participants in these experiments tend to receive the behavior change triggers on a more subliminal level. To explore the extent of the applications, it would be vital to analyze following three aspects: 1)The impact of participant awareness; if awareness does not negatively impact the effectivity of the findings, the virtual avatar could become prime grounds to increase positive personal traits, acclimate to triggers and take measurable steps towards fear attenuation. 2) Could this effect lead to longitudinal biological changes? If so, an individual with mobility or gate challenges could gain greater confidence in walking or a patient with a high BMI could engage in behavior promoting weight loss. 3) Finally, with the increasing popularity of virtual avatar embodiment through video gaming, it is relevant to consider the behavioural impact especially as it relates to childhood maturation during stages of personality development and neurobiological growth.


*READING 3 “Virtual reality exposure therapy in anxiety disorders: a systematic review of process‐and‐outcome studies.”*
The third reading explores a targeted approach to anxiety disorders through VRET (Virtual Reality Exposure Therapy). The article begins by citing exposure therapy: an intervention that relies upon the process of habituation to acclimatize a patient to a specific fear. This therapeutic experience is sometimes conducted physically and other times purely in the imagination. Despite the level of documented effectiveness of this therapy, there are clearly constrains relating to that of the imagination or the range of fear situations difficult or dangerous to stage. The clinical trials and subject case examples presented in the article employed VRET in the cases of specific phobias.

Analysis revealed VRET interventions weald the same effectivity as exposure in vivo. As the study only explored two phobias and is lacking in information regarding PTSD, more research is required. Despite this, I can envision specific opportunities to bring much-needed mental health support to communities where resources are limited (i.e. developing counties, rural communities) through simple VRET interfaces. Furthermore, due to my background in working with individuals on the autism spectrum in clinical settings, a platform such as VRET can offer a presence-substantiated training grounds to examine, understand and explore aspects ranging from theory of mind to sensory overload aversion.

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16/03/2017 11:27:05Anna Fuste
VR for behavior and attitude change:
Embodiment in VR can greatly alter the perception of one's self. Self-confidence and self-esteem affect the way people act and virtual reality can serve as a tool to explore this connection and understand human nature better. Nick Yee and Jeremy Bailenson also present the idea of modulating human behavior patterns by adjusting our digital self-representation.
The question that remains is how persistent are the embodiment effects after the virtual reality experience and how we can make this behavior and attitude change prevalent in time. Could we introduce VR in education to teach younger generations and erase biases or aggressive behaviors?
It is also crucial to think about the perils of altering one’s self-representation in the virtual world. Could this potential adjustments of behavior affect our real self once we exit the virtual experience? How does this embodiment in virtual reality affect the perception of the person in the real world?

VR for treatment of anxiety, phobia and other disorders:
Virtual Reality has been proved to be effective in the treatment of various psychological disorders such as anxiety, phobias or PTSD. As seen in the second paper (Meyerbröker et Al.) different studies have compared the effects of virtual reality exposure therapy with other forms of therapy such as CBT or bibliotherapy. The outcomes of VRET are quite promising and have been proved for more individual specific phobias such as the fear of flying or acrophobia, however the authors mention that further studies are needed in order to have empirical proofs of its effectiveness in more complex disorders such as panic disorder or social phobias. This is actually one of the most direct and useful applications of virtual reality and could actually be extended to a lot more psychological treatments such as depression, ADHD, eating disorders or cognitive disorders. The possibilities of placing someone in a specific environment with a specific body/avatar, and with no limit of elements to show gives room for a great amount of psychological treatments and psychological exploration.
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16/03/2017 11:41:53Michael Skuhersky
It would be interesting to see if VR might be used to dissuade people from behaviors that society has deemed unacceptable. For example, a murderer might be put into the body of one of their victims so that they might experience the terror and pain of being murdered. It might also allow people to more safely live out harmful fantasies that might be unacceptable in real life, such as pedophilia, while making sure no actual humans are being harmed. One possible drawback to this is that people might have trouble returning to the real world where they are not allowed to do any of this. In addition, acting things out in the virtual world may make them more likely to induce these behaviors in the real world.

In regards to anxiety and other social disorders, VR might be used to allow people to practice social situations while feeling like the stakes are much lower. Or, for phobias, to ramp up fearful situations so one can gradually learn to deal with them. It will be interesting to see if the human brain will be able to suspend its disbelief at the unreality of the situation enough to correct real-world behaviors. Personally, I welcome the concept of VR in concert with brain-interface technologies to expand the ability of paralyzed and locked-in people to explore the world and communicate with others.
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16/03/2017 11:52:42Chrisoula Kapelonis
1. It was particularly interesting to understand how people ultimately reacted to embodying another person’s body with their reactions towards that race changing after the experience. The one thing that struck me though, was the possible long term effects of an experience like that. It doesn’t seem like the effects are long-lasting. Which brings up the question, what kinds of experiences need to be designed for VR so that biases can be altered or eliminated? Do the experiments need to be dramatic enough that they leave an impression? Does more storytelling and narrative need to exist within the experience? Do the subjects need to construct memories of that event in VR that they are powerful enough to be retained?

What I think is more interesting about the usage of VR for behavior and attitude experiments is the analysis part. Being able to finely tune an experience to test a variety of reactions is extremely powerful especially because the reactions are real, even though the event is simulated. This can allow for a multitude of experiments to be designed in ways that could test things more accurately than surveys and imagination based ones ever could.

2. The usage of VR for treatment of phobias is quite a provocative approach to the utilization of such an immersive technology. The idea makes sense: immerse someone in the space of their greatest fears, without the perils of reality, to have them slowly adapt to, and normalize the experience. This treatment strategy is perhaps one of the therapies that VR makes the most sense for, because the nature of VR is immersive and emulative, and the way people tend to let go of major fears, is through exposure. Therefore, VR makes perfect sense as a major milestone in dealing with specific phobias. The complexities though of more generalized anxiety disorders is a bit trickier to tackle because of the lack of specific trigger, but nevertheless, the emulation and experiential aspect of the medium VR provides could still help people who need practice, for example, in situations such as anxiety in social situations.

Where the immersive quality in VR with respect to fears and anxieties could get a bit tangled, is its possible reverse scenario: not as therapy, but as torture. VR makes sense as a therapy device because of the way it can soften the blow of fears and anxieties, but the same quality that enables this to occur, could also cause harm if used for the opposite reason. A recent Black Mirror episode in Season 3, “Playtest” shows what the effect of this kind of experience could do, and how much harm it could elicit. The fear of VR being used for torture is not new. In a recent article by Kill Screen, (https://versions.killscreen.com/we-should-be-talking-about-torture-in-vr/?_ga=1.23735226.1643798637.1489678672) the author brings up the effects that a VR torture machine could have in enhancing fears, creating new ones, and disrupting the psyche with experiences that though are not physically being done, feel as real as if they were. So the immerse nature of VR is a double edged sword.
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16/03/2017 12:12:48Yedan Qian
The environment and perception created by VR is very isolated and immersive. Human tends to temporarily forget who they are, what identity they have, what appearance they own and what kind of behavior they usually conduct due to the body illusion. And this new perception of ourselves in VR environment can strongly affect how we build up the self image and self scheme, which more profoundly will influence our decision making and social interactions. In traditional therapy, patients need a considerate amount of effort and training to have mental construction to achieve this, but this now can be easily accomplish in VR.

On the other hand, the environment and other agency in the environment can also affect our behavior and how we see ourselves. For example, if the people around our avatar tend to be more friendly and relaxing, we also feel more safe, less judged, then tend to behave more actively and naturally. But if the elements or agency in the environment becomes more alerting, then the behavior will strongly be influenced or altered. It also happens in real life, but with VR, altering other's behavior and attitude or changing the environment takes much less effort.

Ideas: Separating the visual self and our mental self can have a powerful influence on self reflecting. If we can observe ourselves from a close distance, would it affect our self reflection? What if we change some behaviors, facial expression, posture, voice? If we can jump into and out of your own avatar through timeline, and having the several version of ourselves collaborating on tasks that is impossible to achieve, listening to their words, seeing their emotion, would it affect our daily social interaction and behaviors in collaboration?
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16/03/2017 12:26:22Sophia Yang
The Proteus Effect and the implicit racial bias paper inspired me to think about an idea that would help improve teenagers’ relationship with their parents. Often times, teenagers have a hard time resolving the changing relationship with their parents. This might be caused by their limited ability to see things from their parents’ perspectives. As teenager, they might be growing at a rate that exceeds their parents’ expectations, they might also be eager to prove the speed of their transformation into a full grown person. They tend to act rebellious when parents treat them as anything younger than they feel comfortable. As parents, the teenage phase is a continuation of childhood where they made most of the decisions for their children. They saw their kids growing up from knowing nothing to being able to understand abstract concepts, while they’re proud of their children’s accomplishments, there are certain residual attitudes that were developed over a decade, it is very hard to suddenly change their attitudes toward their teenagers. What if we could provide both parents and teenagers a way to grow out of their current phase in life, and see themselves and each other at a future point in time? Imagine a VR set up where teenagers and the parents can interact with each other as if they’re 20 years older, where the teenagers have proven success to not only their parents, but their social circles and society, and their parents growing into retirement. The proteus effect would help them internalize their new roles and encourage them to take on a different perspective, teenagers may adopt an adult attitude influenced by how they see their parents behave, and parents may draw inspiration from their own parents. To increase realism, we would continuously scan their faces and overlay an aging treatment as they talk with each other. We could program a few common scenarios to kick start their interaction, for example, we could give them a prompt where they need to discuss the mischief of their imaginary children / grandchildren.

The VR exposure therapy paper gave me an idea for a VR experience for my mother who is afraid of heights. She would avoid going out on balconies of high rise buildings, looking out the window when we drive by tall bridges, and looking down a cliff while climbing mountains. She would definitely benefit from a bio feedback driven virtual platform that changes height based on her comfort level. Initially, she would step onto a platform in the middle of a familiar space where she’s able to quickly develop a sense of scale. For example, the platform could be situated on the sidewalk of a busy street surrounded by high rise buildings. Then the platform will rise slowly, similar to an elevator. Her stress response will be constantly monitored, and the platform will stop rising or begin to lower if her stress level reaches above a certain threshold. After many sessions of height exposure, she might even be ready to walk across a wooden plank between two high rise buildings in VR.
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16/03/2017 22:12:41Yujie Hong
It's interesting to see that virtual reality can help reduce racial bias, within the experiment's scope. But I do think that racial bias is a more complex social problem. From my own experience, I never judge a person by the person's nationality or race. I guess, the fundamental reason of discrimination might be fear? Some people don't have many experience interacting with other people from multiple backgrounds. In order to be protective, they comprehend it in an easier way, for example, some people think Chinese people don't like Japanese people because of the invasion history. But still some people from the two countries are very good friends because they are both good people.

I do think VR could be helpful for treatment of anxiety, phobia and other disorders. Going back to the question of fear, fear is due to lack of understanding. VR might be helpful to improve the understandings. The more you understand what you are afraid of, the less fearful you are. I think the paper also proves that VRET is effective. Maybe hospital could consider to design VR therapies.

(Sorry for submitting late. I'm sick literally... And thanks for providing VR papers which help me develop my literature review reading list.)
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19/05/2017 20:00:40Stefania Druga
After discovering how the Proteus effect could be used for changing behavior I am imagining how future VR games could be and for public speaking practice, language instruction or for helping people lose weight. While the Meyerbröker & all showed how VR therapy was used successfully to treat depression and anxiety, even more recent studies from Duke University reported that eight long-term paraplegics have regained feeling and some movement in their legs after training with a brain-controlled robotic device. The patients used a brain-machine interface, including a virtual reality system that used their own brain activity to help them recover sensation in their paralyzed limbs. It's the first time that partial neurological recovery has been reported in patients with long-term paralysis. The training consisted of weekly sessions that first started with virtual reality that used mind control to move the legs of avatars. This training ultimately allowed the rehab patients to re-engage spinal cord nerves that had survived the impact of the injuries that had paralyzed their lower limbs, the researchers believe. This leads us to imagine how future combination of VR and robotic therapy could be used for cases of paralysis or amputation by “tricking” the brain to react after seeing the limbs move/respond in VR. https://www.theguardian.com/science/2016/aug/11/brain-training-technique-restores-feeling-and-movement-to-paraplegics-virtual-reality. VR is also currently being used to cure/improve fears and phobia’s by putting the subject into trigger scenarios in VR. So if you have a fear of flying, you may spend time in a VR “flight” simulator. While such treatments could be efficient I think there is a fine line between making people who are lonely feel happy in a virtual world while isolating them even more in the real world and I am hoping that future designs of the headsets would allow for more shared experiences.
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