Previous studies have demonstrated the use of virtual reality (VR) in mass-casualty incident (MCI) simulation; however, it is uncertain if VR simulations can be a substitute for in-person disaster training. Demonstrating that VR MCI scenarios can elicit the same desired stress response achieved in live-action exercises is a first step in showing non-inferiority. The primary objective of this study was to measure changes in sympathetic nervous system (SNS) response via a decrease in heart rate variability (HRV) in subjects participating in a VR MCI scenario.

An MCI simulation was filmed with a 360º camera and shown to participants on a VR headset while simultaneously recording electrocardiography (EKG) and HRV activity. Baseline HRV was measured during a calm VR scenario immediately prior to exposure to the MCI scenarios, and SNS activation was captured as a decrease in HRV compared to baseline. Cognitive stress was measured using a validated questionnaire. Wilcoxon matched pairs signed rank analysis, Welch’s t-test, and multivariate logistic regression were performed with statistical significance established at P <.05.

Thirty-five subjects were enrolled: eight attending physicians (two surgeons, six Emergency Medicine [EM] specialists); 13 residents (five Surgery, eight EM); and 14 medical students (six pre-clinical, eight clinical-year students). Sympathetic nervous system activation was observed in all groups during the MCI compared to baseline (P <.0001) and occurred independent of age, sex, years of experience, or prior MCI response experience. Overall, 23/35 subjects (65.7%) reported increased cognitive stress in the MCI (11/14 medical students, 9/13 residents, and 3/8 attendings). Resident and attending physicians had higher odds of discordance between SNS activation and cognitive stress compared to medical students (OR = 8.297; 95% CI, 1.408-64.60; P = .030).

Live-actor VR MCI simulation elicited a strong sympathetic response across all groups. Thus, VR MCI training has the potential to guide acquisition of confidence in disaster response.

Deficiency in contextual and enhanced responding in cued fear learning may contribute to the development of posttraumatic stress disorder (PTSD). We examined the responses to aversive Pavlovian conditioning with an unpredictable spatial context as conditioned stimulus compared to a predictable context. We hypothesized that the PTSD group would demonstrate less hippocampal and ventromedial prefrontal cortex (vmPFC) activation during acquisition and extinction of unpredictable contexts and an over-reactive amygdala response in the predictable contexts compared to controls.

A novel combined differential cue-context conditioning paradigm was applied using virtual reality with spatial contexts that required configural and cue processing. We assessed 20 patients with PTSD, 21 healthy trauma-exposed (TC) and 22 non-trauma-exposed (HC) participants using functional magnetic resonance imaging, skin conductance responses, and self-report measures.

During fear acquisition, patients with PTSD compared to TC showed lower activity in the hippocampi in the unpredictable and higher activity in the amygdalae in the predictable context. During fear extinction, TC compared to patients and HC showed higher brain activity in the vmPFC in the predictable context. There were no significant differences in self-report or skin conductance responses.

Our results suggest that patients with PTSD differ in brain activation from controls in regions such as the hippocampus, the amygdala, and the vmPFC in the processing of unpredictable and predictable contexts. Deficient encoding of more complex configurations might lead to a preponderance of cue-based predictions in PTSD. Exposure-based treatments need to focus on improving predictability of contextual processing and reducing enhanced cue reactivity.

Access to evidence-based psychological treatment is a challenge worldwide. We assessed the effectiveness of a fully automated aviophobia smartphone app treatment delivered in combination with a $5 virtual reality (VR) viewer.

In total, 153 participants from the Dutch general population with aviophobia symptoms and smartphone access were randomized in a single-blind randomized controlled trial to either an automated VR cognitive behavior therapy (VR-CBT) app treatment condition (n = 77) or a wait-list control condition (n = 76). The VR-CBT app was delivered over a 6-week period in the participants' natural environment. Online self-report assessments were completed at baseline, post-treatment, at 3-month and at 12-month follow-up. The primary outcome measure was the Flight Anxiety Situations Questionnaire (FAS). Analyses were based on intent-to-treat.

A significant reduction of aviophobia symptoms at post-test for the VR-CBT app compared with the control condition [p < 0.001; d = 0. 98 (95% CI 0.65–1.32)] was demonstrated. The dropout rate was 21%. Results were maintained at 3-month follow-up [within-group d = 1.14 (95% CI 0.46–1.81)] and at 12-month follow-up [within-group d = 1.12 (95% CI 0.46–1.79)]. Six participants reported adverse effects of cyber sickness symptoms.

This study is the first to show that fully automated mobile VR-CBT therapy delivered in a natural setting can maintain long-term effectiveness in reducing aviophobia symptoms. In doing so, it offers an accessible and scalable evidence-based treatment solution that can be applied globally at a fraction of the cost of current treatment alternatives.

Functional deficits, that is, problems in fulfilling appropriate social roles in daily life, are very common in people with a psychotic disorder. In recent years, Virtual Reality (VR) has emerged as a potential tool to improve SCT. Our research group has developed an immersive VR-SCT (‘Dynamic Interactive Social Cognition Training in Virtual Reality’: ‘DiSCoVR’).

To evaluate to effects of a VR-based social cognition training (SCT) for people with a psychotic disorder.

This intervention was compared the an active VR-control condition in a multicenter RCT. Both interventions contained sixteen individual 45-60-minute on-site sessions, administered twice a week. Main study outcomes are social cognition and social functioning in daily life assessed with experience sampling.

From baseline to post-treatment (n=72), none of the time*group interactions were significant, indicating an absence of treatment effects. A significant effect of time was observed for the SERS total score (b=9.84, 95% CI=3.81-15.87, p=.002), indicating overall improvement in self-esteem.

We did not find any significant treatment effects. An effect of time on self-esteem was found at post-treatment, but not follow-up, suggesting a temporary improvement in self-esteem in both groups. One way to interpret these results is that, contrary to other SCT interventions, DiSCoVR does not improve social cognition or social functioning. This could be due to characteristics of the treatment protocol. Another possibility is that, contrary to the premise of VR-SCT, our VR environments inadequately simulated reality. Adapting an established protocol to VR, could further elucidate the merit of VR as a training method.

No significant relationships.

No significant relationships.

Surrey and Borders NHS Foundation Trust’s AVATr (Augmented Virtual-reality Avatar in Training) is a unique ground-breaking Virtual Patient simulation system, which uses the Xenodu platform to train learners in essential clinical and complex communication skills. Over 30 patient scenarios have been developed after identifying learner-specific development needs, including exploration of overt psychosis, assessment of capacity, sharing bad news, and neglect in care home residents.

During the session, the trainee is projected on to a large screen, using a camera and video special effects, which results in a life-like interaction with the Virtual Patient. Trainees can view themselves interacting with the Virtual Patient in real-time, from a unique ’out-of-body’ perspective, immersed in a customdesigned interactive virtual environment. This is different to a first-person perspective used in virtual or augmented-reality systems in several clinical specialties. During the COVID-19 pandemic, we evolved the AVATr model to remote or hybrid sessions, where simulations were digitally enhanced, and have been run through Microsoft Teams. The simulation facilitator is connected to a multi-user video call, enabling the Virtual Patient to be projected as an attendee using Microsoft Teams.

To evaluate the feedback from Doctors in training taking part on the education sessions.

We collected qualitiative and quanttaive infromation from participants after the teaching session.

We received strongly positive reults in all parameters measured. the presenters will show a detailed breakdoen in the session.

The digitalised delivery of the virtual patient simulation, has been pivotal in limiting interruptions to communication skills training in mental health.

The NHS trust has co produced the simulation platform with a private software firm Xenadu Virtual Environments

The integration of virtual reality into everyday life is changing sociocultural practices, including those related to cyberaggression, which causes negative consequences for mental health and well-being. Particular attention needs to be paid to the poorly researched but widespread roles of bystanders and defenders in cyberaggression (Machackova, 2020; Polanco-Levican, Salvo-Garrido, 2021).

The aim is to study the behavioral witness strategies in cyberaggression in VR and their relation to personal and psychophysiological characteristics.

50 adolescents aged 14-18 years old (50% female) witnessed cyberaggression in an experimental situation in the virtual space of VR-chat. Participants also filled Ten-Item Personality Inventory (Gosling et al., 2003; Egorova, Parshikova, 2016), I7-Impulsiveness (Eysenck, Eysenck, 1985; Kornilova, Dolnikova, 2011), Prosocial Behaviour (Furmanov, Kuhtova, 1998). To determine the functional state Heart rate variability (UPTF 1/30 Psychophysiologist, Mediсom) was measured before and after the experiment.

Behavioral strategies in VR-aggression were divided into uninvolved bystanders (58%) and defenders (42%). All participants experienced stress and functional state decline when faced with cyberaggression, but the defenders were more affected (U=207, p<0.043). Defenders were more likely to have higher social responsibility (U=207, p<0.056) and lower neuroticism (U=208, p<0.054). There were no significant differences in impulsiveness.

Cyberaggression in a virtual environment is stressful, especially for active defenders, who are more included in the situation compared to passive bystanders. The prosocial role of a defender rather than a passive bystander may be related to such characteristics as social responsibility and emotional stability, but not to impulsiveness. The research was supported by RSF (project No. 18-18-00365)

This work was supported by the Russian Science Foundation, project # 18-18-00365.

Social anxiety disorder (SAD) can accompany emotional symptoms as well as physical reactions. The assessment and real-time measurement of SAD is difficult in real-world.

This study aims to predict the severity of specific anxiety states and virtual reality (VR) sickness in SAD patients by a machine learning model based on only quantitative measuring of autonomic physiologic signals during VR therapy sessions.

In total, 32 individuals with SAD symptoms were enrolled in VR participatory sessions. We assessed patients’ specific anxiety symptoms through Internalized Shame Scale (ISS) and Post-Event Rumination Scale (PERS), and VR sickness through Simulator Sickness Questionnaire (SSQ). Specific anxiety symptoms and VR sickness were divided into severe and non-severe states based on the total score of each scale by K-means clustering. Logistic regression, Random Forest, Naïve Bayes classifier, and Support Vector Machine were used based on the physiological signal data to predict the severity group in subdomains of ISS, PERS, and SSQ.

Prediction performance (F1 score) for the severity of the ISS mistake anxiety subdomain was higher than other scales with 0.8421. For VR sickness, prediction performance for the severity of the physical subdomain was higher than the non-physical subdomain with 0.7692.

The study findings present that mistake anxiety and physical sickness could be predicted more accurately by only autonomic physiological signals, suggesting these features are probably associated with autonomic responses. Based on the present study results, we could provide the evidence for predicting the severity of specific anxiety or VR adverse effects only based on in-situ physiological signals.

No significant relationships.

Neurofeedback regimes in the treatment of adult ADHD are commonly EEG-based and have several shortcomings, including a weak signal-to-noise ratio, low transfer rates from laboratory to everyday environments and ambiguous evidence in respect to adequate brain signals of interest.

To investigate, if an eyetracking-based real-time feedback in a virtual environment can enhance attentional performance, as measured by behavioral, EEG and eyetracking parameters.

Overall, n=18 adult patients with ADHD and n=18 healthy controls (HC) performed a continuous performance task (CPT) in a virtual seminar room, while distracting virtual events occurred. In case the participant’s gaze drifted away from the task an automated audiovisual feedback indicated the participant to refocus on the task. Three 20-minutes blocks were presented in counter-balanced order, that differed in respect to whether real feedback, sham feedback or no feedback was additionally provided.

Mixed ANOVAs with within-subject factors ‘Condition’ (real feedback, sham feedback, no feedback) and ‘Phase’ (distractor phases vs. non-distractor phases) and a between-factor ‘Group’ (ADHD patients vs. HC) revealed better task performances in HC than ADHD patients in respect to omission errors (p = .023), mean reaction times (p = .042) and reaction time variabilities (p = .007; cf. Figure 1). Moreover, omission errors turned to be higher during distractor-present than distractor-absent trials (p = .007), especially in ADHD.

Figure 1.

CPT results. DP=distractor-phases, NDP=non-distractor-phases

While the virtual CPT turns out to discriminate well between patients with ADHD and HC, the behavioral results do not indicate an attentional performance enhancement based on the gaze-dependent feedback.

No significant relationships.

With the application of virtual reality (VR), tailored interventions can be created that mirror the traumatic experiences of veterans with post-traumatic stress disorder (PTSD). Visual elements can be mimicked, and auditory and other senses stimulated. In doing so, the degree of immersion can be adjusted to optimize the therapeutic process. Objectively measuring the sensory immersion is key to keep subjects within their personal window of tolerance. Based on this information the therapist can decide manipulate the sensory stimulation embedded in the treatment.

The objectives of this study are to explore the different immersive design aspects of VRET that can be modified to influence the experienced presence in veterans with PTSD, and to discuss possible methods of measuring the emotional response facilitated by immersive design aspects and experienced presence.

Four design aspects are discussed: system, sensory cues, narrative and challenge. We also report on a user experiment in three veterans that informed on quality and depth of immersion.

Believability of the neutral virtual environment was important for maintaining the veterans’ presence within the VR experience. The immersive design aspects that were personalized and supportive in the narrative of the veteran such as music and self-selected images appeared to have a strong influence on recall and reliving of the traumatic events.

Finally, in order to increase the therapeutic effect in veterans with PTSD, the highlighted design aspects should be recognized and tailored to maximize immersion in virtual reality exposure therapy.

No significant relationships.

I am co-founder and have shares of VRelax, a company providing VR relaxation software.

The development of emotional intelligence is an urgent issue of teaching people in our time. The use of a virtual reality (VR) systems for the development of emotional intelligence is a problem of modern pedagogy.

The research is aimed at studying interrelations of the level of development of emotional intelligence the manifestations of the ability to perceive and identify emotional expression demonstrated by a virtual avatar in VR CAVE system. The research is aimed at finding unusual ways to develop emotional intelligence.

The study involved 55 participants aged 18 to 25 years (average age-20.38 ± 0.28), 23 of whom were men and 22 were women. During the study we diagnosed the level of development of emotional intelligence (Sergienko, Vetrova, 2009) and spatial abilities (Rimfeld et al., 2017), type of attachment to the loved one (Sabelnikova, Kashirsky, 2015), and the negotiating style of personality (Soldatova, Gasimov, 2019). In the VR CAVE system, a situation was simulated in which the subject had to detect the avatar and determine the emotional-facial expression displayed by it.

It was shown that the level of respondent’s emotional intelligence development does not determine the success of identifying the avatar’s emotion in VR. The success of identifying emotions depends on the level spatial abilities development. Therefore, it is assumed that in the simulated situation, the avatar is perceived as a special spatial image, and not as a full-fledged partner for interpersonal communication.

Thus, the use of VR systems for training and development of emotional intelligence is not proven.

No significant relationships.

The integration of Motivational Interviewing (MI) with behavioural and psychological interventions for the treatment of obesity has the potential to improve health-related outcomes of patients in the long-term.

Our objective is to examine the usability of a VR embodiment tool for treating obesity.

Fourteen participants (6 healthy and 8 with morbid obesity) with a desire to make lifestyle changes were randomly assigned to the experimental group (EG) and the control group (CG). Participants from the EG engaged in a virtual self-conversation aiming at understanding their own motivation to make lifestyle changes. Using the body swapping technique, participants were embodied alternately in their own virtual representation and in their counsellor’s body. To better guide this virtual self-conversation, participants were previously trained on MI skills. Participants from the CG were embodied in their own virtual bodies and participated in a “scripted dialogue” with a virtual counsellor who gave them practical recommendations about how to achieve lifestyle changes. A mixed-methods design was used, involving a semi-structured interview examining users´ satisfaction with the virtual experience, as well as self-report questionnaires, including readiness to change habits, body ownership, and system usability.

Participants showed high usability of the platform with higher scores among participants from the EG compared to the CG. Levels of body ownership were satisfactory, with no differences between groups.

Through the integration of MI in the VR context with the patient being properly trained to carry out his/her own motivational self-conversation, we will provide an important advance in the psychological treatments of obesity.

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 951930

Successful interventions have been developed for smoking cessation although the success of smoking relapse prevention protocols has been limited. Cognitive behavioural therapy (CBT) in particular has been hampered by a high relapse rate. Because relapse can be due to conditions associated with tobacco consumption (such as drinking in bars with friends), virtual reality cue exposure therapy (VRCE) can be a potential tool to generate 3D interactive environments that simulate risk situations for relapse prevention procedures.

To assess the effectiveness of VRCE with CBT, a comparative trial involving 100 smoking abstinent participants was designed with all required virtual environments (VE) created with an inexpensive graphic engine/game level editor.

Outcome measures confirmed the immersive and craving eliciting effect of these VEs. Results demonstrated that more participants in the VRCE group did not experience smoking relapse and that VRCE is at least as efficacious as traditional CBT in terms of craving reduction and decrease in nicotine dependence. Dropout and relapse rate in the VRCE group was noticeably lower than the CBT group. Aside from mood scores, no significant differences were found regarding the other scales.

The present clinical trial provides evidence that VRCE was effective in preventing smoking relapse. Improvement in technology and methodology for future research and applications is delineated.