"Being there" and remembering it: Presence improves memory encoding

A mixed reality for midwifery students: a qualitative study of the technology's perceived appropriateness in the classroom

BACKGROUND

Virtual reality and mixed reality have shown great promise in training and education across a range of professional and pedagogical domains. The perception of such technologies by midwifery students remains an underexplored area of study.

METHODS

Thirty-three MSc midwifery students received a demonstration of a proof-of-concept mixed reality lesson about the foetal descent during labour. Twelve students were subsequently interviewed about their experiences, and thematic analysis was used to analyse the qualitative dataset produced by the interview transcripts.

RESULTS

Analysis found [1] that mixed reality was viewed by the students as a valuable novelty which facilitates new insights while scaffolding prior learnings [2], that mixed reality was postulated to gel well with other learning methods and modalities such as simulation-based training, and [3] that while mixed reality was intuitive or easy to use, adaptable or customisable content should be a key consideration in immersive lesson design.

CONCLUSIONS

The study concludes that mixed reality can be a valuable supplement to existing teaching methods and tools. Students expressed optimism about mixed reality's potential to enhance educational outcomes. While it cannot replace dialogue with a qualified instructor, mixed reality may be well suited to facilitating peer-to-peer learning.

CLINICAL TRIAL NUMBER

Not applicable.

Impact of immersive virtual reality compared to a digital static approach in word (re)learning in post-stroke aphasia and neurotypical adults: Lexical-semantic effects?

BACKGROUND

Word production difficulty is one of the most common and persisting symptoms in people suffering from aphasia (i.e., anomia). However, there is a considerable variability in patients' responses to treatment, leading to the need of new effective approaches. Also, the mechanisms underlying word (re)learning is little known in production even in neurotypical adult native language and especially in relationship with the lexical-semantic integration of (re)learnt words. The lexical-semantic network being highly contextual and multimodal, new technologies such as immersive virtual reality (iVR) may become pertinent approaches, but still need scientific proof, especially as past studies have found no advantage over a control method and have never used an immersive version of VR. Yet, the immersion has been identified as being a key factor of positive outcomes in learning. Therefore, the aim of the present study was to investigate whether iVR provides a benefit in word learning in neurotypical adults (Study 1) and in the treatment for anomia in people suffering from aphasia following stroke (Study 2).

METHOD

In study 1, 32 neurotypical adults learned two matched lists of 30 rare words each in their native language (French) during a one-week protocol alternating test and learning sessions with iVR and a digital static learning method. Study 2 followed the same design over a two week-period with 16 people with aphasia (re)learning two matched lists of 28 frequent words.

RESULTS

Neurotypical adults demonstrated a higher accuracy rate in word production for words learned with iVR in comparison to those learned with the digital static learning method. For people suffering from anomia, the iVR did not differ from the control method on total accuracy but led to a greater reduction of lexical errors.

CONCLUSION

iVR has a potential of use for learning new words but also for the treatment of word production difficulties, especially in people with aphasia that produce mainly lexical errors. These two main results lead to the hypothesis that iVR promotes lexical-semantic processes.

Viewing mock crimes in virtual reality increases presence without impacting memory

Traditional methods of displaying stimuli in eyewitness memory research, such as mock crime videos, are often criticised for lacking ecological validity. To overcome this, researchers have suggested using virtual reality (VR) technology to display the stimuli as it can promote a sense of presence, leading to real-world responses. However, little research has compared VR with traditional methods to demonstrate this enhanced validity. In Study 1, 54 participants viewed a mock crime video on screen or in VR while their heart rate was recorded, then completed measures of presence and emotion, and had their recall tested after 10 min. In Study 2, 74 participants' recall was tested after a 7-day delay and included a more in-depth exploration of emotional experience. In both studies, participants in the VR group reported a statistically significant increase in their sense of general presence, spatial presence, and involvement in the scene; however, there was no statistically significant difference in recall between the groups. Participants in the VR group had a statistically significant increase in heart rate in Study 1 only, and emotional experience in Study 2 only. The findings of this research suggest that VR may provide a more ecologically valid eyewitness experience than videos, without impacting participant memory or wellbeing. The findings of the current research are discussed in relation to previous literature and implications for experimental eyewitness memory research.

Too beautiful to be fake: Attractive faces are less likely to be judged as artificially generated

Technological advances render the distinction between artificial (e.g., computer-generated faces) and real stimuli increasingly difficult, yet the factors driving our beliefs regarding the nature of ambiguous stimuli remain largely unknown. In this study, 150 participants rated 109 pictures of faces on 4 characteristics (attractiveness, beauty, trustworthiness, familiarity). The stimuli were then presented again with the new information that some of them were AI-generated, and participants had to rate each image according to whether they believed them to be real or fake. Despite all images being pictures of real faces from the same database, most participants did indeed rate a large portion of them as 'fake' (often with high confidence), with strong intra- and inter-individual variability. Our results suggest a gender-dependent role of attractiveness on reality judgements, with faces rated as more attractive being classified as more real. We also report links between reality beliefs tendencies and dispositional traits such as narcissism and paranoid ideation.

The relationship between environmentally induced emotion and memory for a naturalistic virtual experience

Emotional stimuli (e.g. words, images) are often remembered better than neutral stimuli. However, little is known about how memory is affected by an environmentally induced emotional state (without any overtly emotional occurrences) - the focus of this study. Participants were randomly assigned to discovery (n = 305) and replication (n = 306) subsamples and viewed a desktop virtual environment before rating their emotions and completing objective (i.e. item, temporal-order, duration) and subjective (e.g. vividness, sensory detail, coherence) memory measures. In both samples, a Partial Least Squares Correlation analysis showed that an emotional state characterised by high negative emotion (i.e. threat, fear, anxiety) and arousal was reliably associated with better memory in both objective (i.e. item) and subjective (i.e. vividness and sensory detail) domains. No reliable associations were observed for any temporal memory measures (objective or subjective). Thus, an environmentally induced state of negative emotion corresponds with enhanced memory for indices of episodic memory pertaining to "what" happened, but not necessarily "when" it happened.

Emotional dissociations in temporal associations: opposing effects of arousal on memory for details surrounding unpleasant events

Research targeting emotion's impact on relational episodic memory has largely focused on spatial aspects, but less is known about emotion's impact on memory for an event's temporal associations. The present research investigated this topic. Participants viewed a series of interspersed negative and neutral images with instructions to create stories linking successive images. Later, participants performed a surprise memory test, which measured temporal associations between pairs of consecutive pictures where one picture was negative and one was neutral. Analyses focused on how the order of negative and neutral images during encoding influenced retrieval accuracy. Converging results from a discovery study (N = 72) and pre-registered replication study (N = 150) revealed a "forward-favouring" effect of emotion in temporal memory encoding: Participants encoded associations between negative stimuli and subsequent neutral stimuli more strongly than associations between negative stimuli and preceding neutral stimuli. This finding may reflect a novel trade-off regarding emotion's effects on memory and is relevant for understanding affective disorders, as key clinical symptoms can be conceptualised as maladaptive memory retrieval of temporal details.

Are multiple types of associative memory differently impacted by emotion?

The effect of emotion on associative memory is still an open question. Our aim was to test whether discrepant findings are due to differential impact of emotion on different types of associative memory or to differences in the way participants encoded stimuli across studies. We examined the effect of negative content on multiple forms of associative memory, using the same encoding task. Two registered experiments were conducted in parallel with random allocation of participants to experiments. Each experiment included 4 encoding blocks, in which participants read a neutral text comprised of 6 paragraphs, which were interleaved with neutral or negative images. Images were controlled for visual properties and semantic similarity. Memory tests included recognition memory, Remember/Know, order memory, temporal source memory and contextual memory. Analyses showed that emotion decreased contextual memory but not order memory or temporal source memory. We also found that temporal source memory and contextual memory were correlated. Recognition accuracy and subjective recollection were not impacted by emotion. In agreement with previous work, participants self-reported a reduced ability to integrate blocks containing negative images with paragraphs. In contrast to our hypothesis, results suggest that emotion does not impact all types of associative memory when stimuli are controlled.

Immersive collaborative virtual reality for case-based graduate student teaching in thoracic surgery: A piloting study

Background

In medical education various non-digital teaching methods are established. However, studies have proven that the immersive character of virtual reality (VR) applications positively impact the understanding of spatial relationships.This study outlines the development and pilot testing of a novel system for collaborative, case-based VR teaching, utilizing real-time volume rendered computed tomography (CT) data of thoracic cases among graduate students.

Methods

A system was configured and deployed to provide real-time volume rendered CT data in a collaborative, multiuser VR environment. A thoracic surgery VR course was implemented into the surgical graduate curriculum, which has subsequently been evaluated with questionnaires.

Results

Seventy students assessed the curriculum through a questionnaire. Usability was rated intuitive (77.14 %) while few students (5.71 %) reported cyber sickness.A vast majority (98.57 %) agreed VR improved their understanding of anatomy compared to traditional methods and most students found learning more effective. (88.57 %) and joy during participation was rated high (97,14 %). A majority of the students (61.43 %) believed VR could partly replace traditional methods. They supported integrating VR into preclinical (81.43 %) and clinical teaching (94.29 %) as well as taking VR courses from home (78.57 %). Most participants (90,72 %) encouraged the expansion of VR infrastructure.

Conclusion

The concept of a collaborative real-time VR-based educational program in medical graduate teaching has proven its technical feasibility and positive acceptance with a desire for more VR integration in surgical curricula. A two-armed study will be conducted to evaluate the objective impact as the expansion of VR environments for teaching continues.

Decoding episodic autobiographical memory in naturalistic virtual reality

Episodic autobiographical memory (EAM) is a long-term memory system of personally experienced events with their context - what, where, when - and subjective elements, e.g., emotions, thoughts, or self-reference. EAM formation has rarely been studied in a controlled, real-life-like paradigm, and there is no predictive model of long-term retrieval from self-rated subjective experience at encoding. The present longitudinal study, with three surprise free recall memory tests immediately, one-week and one-month after encoding, investigated incidental encoding of EAM in an immersive virtual environment where 30 participants either interacted with or observed specific events of varying emotional valences with simultaneous physiological recordings. The predictive analyses highlight the temporal dynamics of the predictors of EAM from subjective ratings at encoding: common characteristics related to sense of remembering and infrequency of real-life encounter of the event were identified over time, but different variables become relevant at different time points, such as the emotion and mental imagery or prospective aspects. This dynamic and time-dependent role of memory predictors challenges traditional views of a uniform influence of encoding factors over time. Current evidence for the multiphasic nature of memory formation points to the role of different mechanisms at play during encoding but also consolidation and subsequent retrieval.

Self-reference and emotional reaction drive aesthetic judgment

Traditional philosophical inquiry, and more recently neuroscientific studies, have investigated the sources of artworks' aesthetic appeal. A substantial effort has been made to isolate the objective features contributing to aesthetic appreciation. While variables such as contrast or symmetry have been shown to robustly impact aesthetic judgment, they only account for a small portion of the intersubjective variability in aesthetic ratings. Recent multiprocess model of aesthetic appreciation could accommodate this finding by proposing that evaluative processes based on self-reference underpin the idiosyncrasy of aesthetic judgment. We tested this hypothesis in two behavioral studies, that were basically conceptual replications of our previous work, in which we took advantage of the self-reference effect on memory. We also tried to disentangle the role of self-reference and emotional reaction to artworks in guiding aesthetic judgments, by comparing an aesthetic judgment encoding condition to a self-reference condition (Study 1), and an emotional evaluation condition (Study 2). We show that artworks encoded in an aesthetic judgment condition exhibit a similar mnesic advantage compared to both the self-reference and the emotional evaluation encoding conditions. Moreover, retrospective emotional judgment correlates with both self-reference and aesthetic judgments ratings. These results suggest that a basic mechanism, appraisal of self-relevance, could ground aesthetic judgments.

Effectiveness of Virtual Reality Training in Teaching Personal Protective Equipment Skills: A Randomized Clinical Trial

Importance

Training on the proper use of personal protective equipment (PPE) is critical for infection prevention among health care workers. Traditional methods, such as face-to-face and video-based training, can strain resources and present challenges.

Objective

To determine the effectiveness of 360° virtual reality (VR) training for PPE donning and doffing compared with face-to-face and video training in enhancing the PPE use skills of prospective health care practitioners.

Design, Setting, and Participants

A blinded, prospective, and randomized noninferiority clinical trial was conducted from August to December 2021 at Teikyo University School of Medicine in Tokyo, Japan, with a mixed population of medical students. Participants were second- to fourth-year medicine, medical technology, or pharmacy students aged 20 years or older with no prior PPE training. Participants were randomized into 1 of 3 training groups (VR, face-to-face, or video) based on their enrollment order. An intention-to-treat analysis was conducted.

Intervention

A 30-minute lecture on PPE procedures was delivered to all participants before the training. After the lecture, the VR group trained with an immersive 360° VR tool, the face-to-face group trained with actual PPE, and the video group trained by watching video footage on a computer and a projector. After 3 days, a standardized practical skills test was administered.

Main Outcomes and Measures

The primary outcome was the mean score on a 20-point practical skills test, and the secondary outcome was the percentage of correct execution.

Results

A total of 91 participants were recruited and randomized into 3 groups: VR (n = 30), face-to-face (n = 30), and video (n = 31) training. After excluding 1 participant due to illness, 90 participants (mean [SD] age, 24.2 [3.15] years; 54 males [60.0%]) completed the assessment. The mean (SD) scores were 17.70 (2.10) points for the VR group, 17.57 (2.45) points for the face-to-face group, and 15.87 (2.90) points for the video group. The VR group demonstrated no significant difference in performance from the face-to-face group. However, the VR group had significantly higher effectiveness than the video group (17.70 vs 15.87 points; P = .02).

Conclusions and Relevance

Results of this trial indicate that VR training was as effective as face-to-face training in enhancing PPE donning and doffing skills and was superior to video training. The findings suggest that VR training is a viable resource-conserving training option.

Trial Registration

Japan Registry of Clinical Trials Identifier: jRCT103021029.

The effects of age on objective and subjective recollection after visiting a virtual apartment

While aging has been associated with decreased retrieval of episodic memory details, subjective ratings about memory quality seem to remain stable. This suggests that subjective memory judgments are based on different information according to age. Here, we tested the hypothesis that older people would rather base their subjective judgments on the retrieval of personal elements (such as emotions and thoughts), whereas younger people would rather base their judgments on the retrieval of event-related elements (such as time, place, and perceptual details). Sixty participants (20 to 79 years old) performed eight actions in a virtual apartment and were then asked to verbally recall each action with a maximum of associated elements and to rate the subjective quality of their memories. The elements reported were classified into "person-related" and "event-related" categories. Executive functions, memory performance on traditional memory tasks, and subjects' perception of memory functioning were also evaluated. Results revealed that aging was associated with reduced retrieval of event-related elements, which was explained by decreasing executive resources. However, age did not affect the retrieval of person-related elements, and the subjective memory judgments of older people were not based on these elements to a greater extent than those of younger people. Finally, our results highlight the value of virtual reality (VR) in memory evaluations since subjects' perception of memory functioning was associated with their performance in the VR task but not in traditional memory tasks.

Keeping track of reality: embedding visual memory in natural behaviour

Since immersive virtual reality (IVR) emerged as a research method in the 1980s, the focus has been on the similarities between IVR and actual reality. In this vein, it has been suggested that IVR methodology might fill the gap between laboratory studies and real life. IVR allows for high internal validity (i.e., a high degree of experimental control and experimental replicability), as well as high external validity by letting participants engage with the environment in an almost natural manner. Despite internal validity being crucial to experimental designs, external validity also matters in terms of the generalizability of results. In this paper, we first highlight and summarise the similarities and differences between IVR, desktop situations (both non-immersive VR and computer experiments), and reality. In the second step, we propose that IVR is a promising tool for visual memory research in terms of investigating the representation of visual information embedded in natural behaviour. We encourage researchers to carry out experiments on both two-dimensional computer screens and in immersive virtual environments to investigate visual memory and validate and replicate the findings. IVR is valuable because of its potential to improve theoretical understanding and increase the psychological relevance of the findings.

The effect of visual perspective on episodic memory in aging: A virtual reality study

The possibility of flexibly retrieving our memories using a first-person or a third-person perspective (1PP or 3PP) has been extensively investigated in episodic memory research. Here, we used a Virtual Reality-based paradigm to manipulate the visual perspective used during the encoding stage to investigate age-related differences in the formation of memories experienced from 1PP vs. 3PP. 32 young adults and 32 seniors participated in the study. Participants navigated through two virtual cities to encode complex real-life virtual events, from either a 1PP (as if from their egocentric viewpoint) or a 3PP, while actively controlling an avatar. While recognition accuracy was higher in young adults after encoding in 1PP compared to 3PP, there was no benefit in memory formation in 1PP for older adults. These findings are discussed in terms of both age-related changes in episodic memory functioning and self-referencing processes.

Respiratory sinus arrhythmia during biofeedback is linked to persistent improvements in attention, short-term memory, and positive self-referential episodic memory

Background

Heart rate variability (HRV) biofeedback, an intervention based on the voluntary self-regulation of autonomic parameters, has been shown to affect prefrontal brain functioning and improve executive functions. The interest in using HRV biofeedback as cognitive training is typically ascribed to parasympathetic activation and optimized physiological functioning deriving from increased cardiac vagal control. However, the persistence of cognitive effects is poorly studied and their association with biofeedback-evoked autonomic changes has not yet been explored. In addition, no study has so far investigated the influence of HRV biofeedback in adults on long-term episodic memory, which is particularly concerned with self-referential encoding processing.

Methods

In the present study, a novel training system was developed integrating HRV and respiratory biofeedback into an immersive virtual reality environment to enhance training efficacy. Twenty-two young healthy adults were subjected to a blinded randomized placebo-controlled experiment, including six self-regulation training sessions, to evaluate the effect of biofeedback on autonomic and cognitive changes. Cardiac vagal control was assessed before, during, and 5 min after each training session. Executive functions, episodic memory, and the self-referential encoding effect were evaluated 1 week before and after the training program using a set of validated tasks.

Results

Linear mixed-effects models showed that HRV biofeedback greatly stimulated respiratory sinus arrhythmia during and after training. Moreover, it improved the attentional capabilities required for the identification and discrimination of stimuli ( η p 2 = 0.17), auditory short-term memory ( η p 2 = 0.23), and self-referential episodic memory recollection of positive stimuli ( η p 2 = 0.23). Episodic memory outcomes indicated that HRV biofeedback reinforced positive self-reference encoding processing. Cognitive changes were strongly dependent on the level of respiratory sinus arrhythmia evoked during self-regulation training.

Conclusion

The present study provides evidence that biofeedback moderates respiration-related cardiac vagal control, which in turn mediates improvements in several cognitive processes crucial for everyday functioning including episodic memory, that are maintained beyond the training period. The results highlight the interest in HRV biofeedback as an innovative research tool and medication-free therapeutic approach to affect autonomic and neurocognitive functioning. Finally, a neurocognitive model of biofeedback-supported autonomic self-regulation as a scaffolding for episodic memory is proposed.

ObReco-2: Two-step validation of a tool to assess memory deficits using 360° videos

Traditional neuropsychological evaluations are usually carried out using psychometric paper and pencil tests. Nevertheless, there is a continuous discussion concerning their efficacy to capture life-like abilities. The introduction of new technologies, such as Virtual Reality (VR) and 360° spherical photos and videos, has improved the ecological validity of the neuropsychological assessment. The possibility of simulating realistic environments and situations allows clinicians to evaluate patients in realistic activities. Moreover, 360° photos and videos seem to provide higher levels of graphical realism and technical user-friendliness compared to standard VR, regardless of their limitations in terms of interactivity. We developed a novel 360° tool, ObReco-2 (Object Recognition version 2), for the assessment of visual memory which simulates a daily situation in a virtual house. More precisely, patients are asked to memorize some objects that need to be moved for a relocation. After this phase, they are asked to recall them after 15 min and later to recognize them in the same environment. Here we present a first study about the usability of ObReco-2, and a second one exploring its clinical efficacy and updated usability data. We focused on Free Recall and Recognition scores, comparing the performances obtained by the participants in the standard and the 360° test. The preliminary results support the use of 360° technology for enhancing the ecological value of standard memory assessment tests.

Comparison of Object Detection in Head-Mounted and Desktop Displays for Congruent and Incongruent Environments

Virtual reality technologies, including head-mounted displays (HMD), can provide benefits to psychological research by combining high degrees of experimental control with improved ecological validity. This is due to the strong feeling of being in the displayed environment (presence) experienced by VR users. As of yet, it is not fully explored how using HMDs impacts basic perceptual tasks, such as object perception. In traditional display setups, the congruency between background environment and object category has been shown to impact response times in object perception tasks. In this study, we investigated whether this well-established effect is comparable when using desktop and HMD devices. In the study, 21 participants used both desktop and HMD setups to perform an object identification task and, subsequently, their subjective presence while experiencing two-distinct virtual environments (a beach and a home environment) was evaluated. Participants were quicker to identify objects in the HMD condition, independent of object-environment congruency, while congruency effects were not impacted. Furthermore, participants reported significantly higher presence in the HMD condition.

In search of a naturalistic neuroimaging approach: Exploration of general feasibility through the case of VR-fMRI and application in the domain of episodic memory

Virtual Reality (VR) is an increasingly widespread tool for research as it allows the creation of experiments taking place in multimodal and daily-life-like environments, while keeping a strong experimental control. Adding neuroimaging to VR leads to a better understanding of the underlying brain networks activated during a naturalistic task, whether for research purposes or rehabilitation. The present paper focuses on the specific use of concurrent VR and fMRI and its technical challenges and feasibility, with a brief examination of the general existing solutions. Following the PRISMA guidelines, the review investigates the particular case of how VR-fMRI has explored episodic memory so far, with a comparison of object- and place-based episodic memory. This review confirms the involvement of cerebral regions well-known to be implicated in episodic memory and unravels other regions devoted to bodily and narrative aspects of the self, promoting new avenues of research in the domain of naturalistic episodic memory. Future studies should develop more immersive and interactive virtual neuroimaging features to increase ecological and embodied neurocognition aspects.

Virtual reality experiences promote autobiographical retrieval mechanisms: Electrophysiological correlates of laboratory and virtual experiences

Recent advancements in memory research indicate that virtual reality (VR) experiences are more vividly memorized as compared to conventional laboratory events. In contrast to the latter, VR experiences are highly immersive, simulating the multimodality, vividness and inclusiveness of real-life experiences. Therefore, VR might enable researchers to identify memory processes underlying events which participants have actually experienced, in contrast to conventional on-screen experiences. To differentiate the electrophysiological correlates of memory processes underlying VR experiences as compared to conventional laboratory experiences, participants watched videos either in a PC condition or in a VR condition, followed by an unannounced recognition memory test. As hypothesized, we replicated the well-established theta old/new effect for the PC condition, but remarkably, this effect was absent in the VR condition. Additionally, the latter was accompanied by significantly lower alpha activity as compared to the PC condition. As increases in theta-band responses are related to top-down control on, and memory load during retrieval, the observed theta responses might rather relate to retrieval effort than to retrieval success per se. Congruently, higher alpha activity measured over occipital sensor areas in the PC condition reflect visually guided search processes within episodic memory. The VR condition comes in with lower alpha activity, reflecting immediate and effortless memory access. Hence, our findings indicate that the retrieval of VR experiences promotes autobiographical  retrieval mechanisms, whereas recalling conventional laboratory events comes in with higher effort, which might not reflect the mechanisms of everyday memory.

A matter of time: how does emotion influence temporal aspects of remembering?

Spatiotemporal context is an intrinsic aspect of episodic memory. Although a large literature has demonstrated that emotion enhances episodic memory, less research has considered whether and how emotion affects memory for the timing of an experience, despite theoretical and practical importance. In this review, we bridge three heavily researched cognitive domains - memory, emotion, and time - by discussing findings from a burgeoning literature on their intersection. We identify and review two broad ways in which memory for time has been conceptualised in the emotional memory literature, namely (1) memory for relative aspects of event timing ("when" an event detail occurred), which includes studies of temporal-order and source memory; and (2) memory for the time that elapsed during an event ("how long"), which includes studies of retrospective duration estimation. Emerging trends demonstrate that although temporal-order memory can be impaired or enhanced by emotion depending on study demands, temporal source memory, instead, is usually enhanced. Studies of duration memory show that the remembered duration of negative experiences is dilated, but it is less clear how duration memory is affected for positive events. These findings are considered under the lens of broader emotional memory literature theories, and directions for future research are proposed.

Presence, flow, and narrative absorption: an interdisciplinary theoretical exploration with a new spatiotemporal integrated model based on predictive processing

Presence, flow, narrative absorption, immersion, transportation, and similar subjective phenomena are studied in many different disciplines, mostly in relation to mediated experiences (books, film, VR, games). Moreover, since real, virtual, or fictional agents are often involved, concepts like identification and state empathy are often linked to engaging media use. Based on a scoping review that identified similarities in the wording of various questionnaire items conceived to measure different phenomena, we categorize items into the most relevant psychological aspects and use this categorization to propose an interdisciplinary systematization. Then, based on a framework of embodied predictive processing, we present a new cognitive model of presence-related phenomena for mediated and non-mediated experiences, integrating spatial and temporal aspects and also considering the role of fiction and media design. Key processes described within the model are: selective attention, enactment of intentions, and interoception. We claim that presence is the state of perceived successful agency of an embodied mind able to correctly enact its predictions. The difference between real-life and simulated experiences ("book problem," "paradox of fiction") lays in the different precision weighting of exteroceptive and interoceptive signals.

Memory for a virtual reality experience in children and adults according to image quality, emotion, and sense of presence

Numerous studies have explored the effects of virtual reality (VR) on adults' cognition. Little is known, however, of these effects in children. The aim of this study was to explore, in both children and adults, the respective roles of the specific factors of VR, such as immersion, sense of presence and emotion, on memory performance. To do so, we used a head-mounted display to present a VR experience in which we manipulated immersion by varying 3D asset quality (High and Low) and emotion by presenting negative, neutral and positive stimuli. 48 adults (M _age = 20.65) and 40 children (M _age = 11.63) were both divided into two experimental groups (High vs. Low 3D model quality). Valence, arousal, and sense of presence were self-assessed by means of questionnaires, while memory of the presented stimuli was assessed using a free recall task. We also performed physiological measurements to provide objective support for our data. Results showed that memory performance was better for emotional than for neutral stimuli regardless of age group, even though children seemed to avoid looking at negative stimuli compared to neutral ones. Memory was predicted by arousal and presence in adults and only by arousal in children. Memory was not impaired by using poor image quality when highly arousing content was displayed. This study revealed that, contrary to adults, the use of poor image quality did not protect children from strong emotional experiences in VR. The roles of familiarity and arousal are discussed to help explain these results.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10055-021-00537-y.

The physiological signature of sadness: A comparison between text, film and virtual reality

Studies focused on the ubiquitous emotion of sadness demonstrate substantial variability in physiological responses during sadness elicitation, with no consensus regarding the physiological pattern of sadness. Variability in findings could be attributed to (a) the use of different induction techniques across studies or (b) the existence of subtypes of sadness with distinct physiological activation patterns. Typically, studies have used text and film to elicit sadness. However, virtual reality (VR) confers advantages over more traditional methods by allowing individuals a subjective sense of "being there" or presence. We compared participants' physiological responses to the same narrative presented via VR, Film and Story (n = 20 each) and collected their subjective responses to the stimuli. Results confirmed that participants in all conditions experienced the discrete emotion of sadness. Moreover, participants in the VR condition experienced the highest degree of presence. Regarding psychophysiological responses, participants in the VR condition had the lowest degree of baseline-adjusted parasympathetic activation in comparison to participants in the Film condition. Furthermore, while participants in the VR group showed diminished baseline-adjusted respiration rate and parasympathetic activation with an increase in presence, the opposite pattern was true for participants in the other conditions. The data suggest that the VR condition may elicit an activating pattern of sadness; whereas Film and Story conditions may elicit a deactivating pattern of sadness. Our results have implications for research using the discrete model of emotion, highlighting that different emotion elicitation techniques may result in differing expressions of what is considered a unitary emotion.

Memories for third-person experiences in immersive virtual reality

We typically experience the world from a first-person perspective (1PP) but can sometimes experience events from a third-person perspective (3PP) much as an observer might see us. Little is known about how visual perspective influences the formation of memories for events. We developed an immersive virtual reality paradigm to examine how visual perspective during encoding influences memories. Across two studies, participants explored immersive virtual environments from first-person and third-person avatar perspectives while wearing an Oculus Rift headset. Memory was tested immediately (Study One and Study Two) and following a one-week delay (Study Two). We assessed the accuracy of visual memory using cued recall questions and spatial memory by asking participants to draw maps of the layout of each environment (Study One and Study Two). Additional phenomenological ratings were included to assess visual perspective during remembering (Study Two). There were no differences in the accuracy of visual information across the two studies, but 3PP experiences were found to increase spatial memory accuracy due to their wider camera field of view when compared to 1PP experiences. Our results also demonstrate that 3PP experiences create 3PP memories, as reflected by an increase in subjective ratings of observer-like perspectives during remembering. In sum, visual perspective during memory formation influences the accuracy of spatial but not visual information, and the vantage point of memories during remembering.

CLASSIE teaching - using virtual reality to incorporate medical ethics into clinical decision making

BACKGROUND

Teaching medical ethics (ME) in the clinical environment is often difficult, uncalibrated and medical students get variable exposure to skilled educators. Explicit discussion of ethical dimensions of patient management is often neglected, as clinical teachers may feel inadequately skilled to do this.

METHODS

We developed a suite of online modules. Each consisted of a clinical scenario filmed using virtual reality (VR) technology, linked to an adaptive, interactive, online tutorial which explicitly discussed the relevant ethical issues and guidelines. These were embedded in clinical placements of students to encourage the transfer of knowledge from these modules to clinical skill competency. We conducted a pilot study to evaluate these modules which examined student engagement, knowledge gains (self-perceived and measured) and user experience. We also reviewed reflections to assess the incorporation of these modules and transfer of knowledge into the clinical learning and skill development of the students.

RESULTS

Engagement and self-perceived knowledge gains were extremely high. Students found these modules realistic, interesting and helpful. The measured knowledge gains (module exit quiz) were moderate. User experience was positive overall, although students were intolerant of any technical glitches. There was mixed feedback on whether the VR aspect of the clinical scenarios added value. Student reflections showed high level incorporation of these modules into clinical practice of the students and evidence of knowledge transfer (level 3 Kirkpatrick model of evaluation) in over ¾ of students.

CONCLUSIONS

This study showed that the use VR clinical scenarios combined with interactive online learning modules resulted in demonstrable high-level student engagement and learning gains in medical ethics and transfer of knowledge to clinical application. It standardised and ensured the student experience of high-quality educational deliverables in clinical years of medical education. This use of VR and online technology can be adapted for use in many areas of the medical curricula where we need to ensure the delivery of well calibrated, high quality, educational deliverables at scale for students.

Being in the Past and Perform the Future in a Virtual World: VR Applications to Assess and Enhance Episodic and Prospective Memory in Normal and Pathological Aging

The process of aging commonly features a gradual deterioration in cognitive performance and, in particular, the decline of memory. Despite the increased longevity of the world’s population, the prevalence of neurodegenerative conditions, such as dementia, continues to be a major burden on public health, and consequently, the latest research has been focused on memory and aging. Currently, the failure of episodic and Prospective memory (PM) is one of the main complaints in the elderly, considered among the early symptoms of dementia. It is therefore increasingly important to define more clearly the boundaries between normal and pathological aging. Recently, researchers have begun to build and apply Virtual Environments (VE) to the explicit purpose of better understanding the performance of episodic and PM in complex and realistic contexts, with the perspective of further developing effective training procedures that depend on reliable cognitive assessment methods. Virtual technology offers higher levels of realism than “pen and paper” testing and at the same time more experimental control than naturalistic settings. In this mini-review article, we examine the outcomes of recently available studies on virtual reality technology applications developed for the assessment and improvement of episodic and/or PM. To consider the latest technology, we selected 29 articles that have been published in the last 10 years. These documents show that VR-based technologies can provide a valid basis for screening and treatment and, through increased sensory stimulation and enriched environments reproducing the scenarios of everyday life, could represent effective stimulating experiences even in pathological aging.

The Use of Virtual Reality Alone Does Not Promote Training Performance (but Sense of Presence Does)

Virtual reality (VR) offers novel ways to develop skills and learning. This technology can be used to enhance the way we educate and train professionals by possibly being more effective, cost-efficient, and reducing training-related risks. However, the potential benefits from virtual training assume that the trained skills can be transferred to the real world. Nevertheless, in the current published scientific literature, there is limited empirical evidence that links VR use to better learning. The present investigation aimed to explore the use of VR as a tool for training procedural skills and compare this modality with traditional instruction methods. To investigate skill development using the two forms of training, participants were randomly divided into two groups. The first group received training through an instructional video, while the second group trained in VR. After the training session, the participants performed the trained task in a real setting, and task performance was measured. Subsequently, the user's experienced sense of presence and simulator sickness (SS) was measured with self-report questionnaires. There were no significant differences between groups for any of the performance measures. There was no gender effect on performance. Importantly, the results of the present study indicate that a high sense of presence during the VR simulation might contribute to increased skill learning. These findings can be used as a starting point that could be of value when further exploring VR as a tool for skill development.

Multidimensional Evaluation of Virtual Reality Paradigms in Clinical Neuropsychology: Application of the VR-Check Framework

Virtual reality (VR) represents a key technology of the 21st century, attracting substantial interest from a wide range of scientific disciplines. With regard to clinical neuropsychology, a multitude of new VR applications are being developed to overcome the limitations of classical paradigms. Consequently, researchers increasingly face the challenge of systematically evaluating the characteristics and quality of VR applications to design the optimal paradigm for their specific research question and study population. However, the multifaceted character of contemporary VR is not adequately captured by the traditional quality criteria (ie, objectivity, reliability, validity), highlighting the need for an extended paradigm evaluation framework. To address this gap, we propose a multidimensional evaluation framework for VR applications in clinical neuropsychology, summarized as an easy-to-use checklist (VR-Check). This framework rests on 10 main evaluation dimensions encompassing cognitive domain specificity, ecological relevance, technical feasibility, user feasibility, user motivation, task adaptability, performance quantification, immersive capacities, training feasibility, and predictable pitfalls. We show how VR-Check enables systematic and comparative paradigm optimization by illustrating its application in an exemplary research project on the assessment of spatial cognition and executive functions with immersive VR. This application furthermore demonstrates how the framework allows researchers to identify across-domain trade-offs, makes deliberate design decisions explicit, and optimizes the allocation of study resources. Complementing recent approaches to standardize clinical VR studies, the VR-Check framework enables systematic and project-specific paradigm optimization for behavioral and cognitive research in neuropsychology.

Stress- and trauma-related blockade of episodic-autobiographical memory processing

Memory disorders without a direct neural substrate still belong to the riddles in neuroscience. Although they were for a while dissociated from research and clinical arenas, risking becoming forgotten diseases, they sparked novel interests, paralleling the refinements in functional neuroimaging and neuropsychology. Although Endel Tulving has not fully embarked himself on exploring this field, he had published at least one article on functional amnesia (Schacter et al., 1982) and ignited a seminal article on amnesia with mixed etiology (Craver et al., 2014). Most importantly, the research of Endel Tulving has provided the researchers and clinicians in the field of dissociative or functional amnesia with the best framework for superiorly understanding these disorders through the lens of his evolving concept of episodic memory and five long term memory systems classification, which he developed and advanced. Herein we use the classification of long-term memory systems of Endel Tulving as well as his concepts and views on autonoetic consciousness, relationships between memory systems and relationship between episodic memory and emotion to describe six cases of dissociative amnesia that put a challenge for researchers and clinicians due to their atypicality. We then discuss their possible triggering and maintaining mechanisms, pointing to their clinical heterogeneity and multifaceted causally explanatory frameworks.

Virtual reality in episodic memory research: A review

Although virtual reality (VR) is a promising tool for the investigation of episodic memory phenomena, to date there has been relatively little examination of how learning mechanisms operate in VR and how these processes might compare (or contrast) with learning that occurs in real life. Moreover, the existing literature on this topic is spread across several disciplines and uses various distinct apparatuses, thus obscuring whether the differences that exist between studies might be due to genuine theoretical discrepancies or may be more simply explained by accounting for methodological variations. The current review is designed to address and elucidate several issues relevant to psychological researchers interested in understanding and/or using this technological approach to study episodic memory phenomena. The principle objectives of the review are as follows: (a) defining and discussing the various VR systems currently used for research purposes, (b) compiling research of episodic memory effects in VR as they have been studied across several disciplines, and (c) surveying major topics in this body of literature (e.g., how virtual immersion has an impact on memory; transfer effects from VR to the real world). The content of this review is designed to serve as a resource for psychologists interested in learning more about the current state of research in this field and is intended to highlight the capabilities (and constraints) associated with using this technological approach in episodic memory research.

The effect of immersive virtual reality on proximal and conditioned threat

Virtual reality lets the user be immersed in a 3-dimensional environment, which can enhance certain emotional responses to stimuli relative to experiencing them on a flat computer screen. We here tested whether displaying two different types of threats in immersive virtual reality enhanced threat related autonomic responses measured by skin conductance responses (SCRs). We studied innate and learned threat responses because these types of threats have been shown to depend on different neural circuits in animals. Therefore, it is possible that immersive virtual reality may modulate one of these threats but not the other. Innate threat responses were provoked by the sudden appearance of characters at proximal egocentric distance, which were compared to the sudden appearance of distant characters (proximal threat). Learned threat responses were studied by conditioning two of the characters to an electric shock (conditioned threat) and contrasting SCRs to these characters with SCRs to two other characters that were never paired with shock. We found that displaying stimuli in immersive virtual reality enhanced proximal threat responses but not conditioned threat responses. Findings show that immersive virtual reality can enhance an innate type of threat responses without affecting a learned threat response, suggesting that separate neural pathways serve these threat responses.

Immersive Versus Non-immersive Experience: Exploring the Feasibility of Memory Assessment Through 360° Technology

Episodic memory is essential to effectively perform a number of daily activities, as it enables individuals to consciously recall experiences within their spatial and temporal environments. Virtual Reality (VR) serves as an efficacious instrument to assess cognitive functions like attention and memory. Previous studies have adopted computer-simulated VR to assess memory, which realized greater benefits compared to traditional procedures (paper and pencil). One of the most recent trends of immersive VR experiences is the 360° technology. In order to evaluate its capabilities, this study aims to compare memory performance through two tasks: immersive task and non-immersive task. These tasks differ based on the participant's view of the 360° picture: (1) head-mounted display (HMD) for immersive task and (2) tablet for non-immersive task. This study seeks to compare how memory is facilitated in both the 360° immersive picture as well as the non-immersive 360° picture. A repeated measure design was carried out in a sample of 42 participants, randomized into two groups of 21. Group 1 first observed Picture A (immersive) followed by Picture B (non-immersive) while Group 2 began with Picture B and then looked at Picture A. Each 360° picture contains specific items with some items appearing in both. Memory evaluation is assessed immediately after the exposure (recall task), then again after a 10-min delay (recognition task). Results reveal that Group 1, which began with the immersive task, demonstrated stronger memory performance in the long term as compared to Group 2, which began with the non-immersive task. Preliminary data ultimately supports the efficacy of the 360° technology in evaluating cognitive function.

Virtual reality and the transformation of medical education

Medical education is changing. Simulation is increasingly becoming a cornerstone of clinical training and, though effective, is resource intensive. With increasing pressures on budgets and standardisation, virtual reality (VR) is emerging as a new method of delivering simulation. VR offers benefits for learners and educators, delivering cost-effective, repeatable, standardised clinical training on demand. A large body of evidence supports VR simulation in all industries, including healthcare. Though VR is not a panacea, it is a powerful educational tool for defined learning objectives and implementation is growing worldwide. The future of VR lies in its ongoing integration into curricula and with technological developments that allow shared simulated clinical experiences. This will facilitate quality interprofessional education at scale, independent of geography, and transform how we deliver education to the clinicians of the future.

Episodic Memory Assessment and Remediation in Normal and Pathological Aging Using Virtual Reality: A Mini Review

Life expectancy is constantly increasing in developed countries. Unfortunately, a longer life does not always correspond to a healthier life, as even normal aging is associated with cognitive decline and increased risk factors for neurodegenerative diseases. Episodic memory (EM) is one of the most vulnerable cognitive functions in aging, and its decline is the hallmark of typical Alzheimer's disease. This memory system is defined as the ability to acquire and recollect personally experienced episodes associated with a specific affective, spatial, and temporal context. However, most of the neuropsychological and experimental tasks currently employed to assess EM consist in learning simple material (e.g., list of words) in highly stereotyped contexts. In the same vein, classical paper-and-pencil or numeric remediation tools have shown their limitations in the transfer of acquired skills to daily life. Virtual reality (VR), thanks to its immersive properties, and the possibility of delivering realistic and complex scenarios, seems a promising tool to address the limitations of the assessment and remediation of EM. Here, we review existing studies employing VR in normal and pathological aging to assess and reeducate EM. Overall, we show that VR has been mainly used via non-immersive systems. Further studies should, therefore, test the impact of different degrees of immersion. Moreover, there is a lack of VR remediation tools specifically targeting EM. We propose that future studies should fill this gap, addressing in particular the adaptivity of VR remediation protocols.

Phenomenal, bodily and brain correlates of fictional reappraisal as an implicit emotion regulation strategy

The ability to modulate our emotional experience, depending on our current goal and context, is of critical importance for adaptive behavior. This ability encompasses various emotion regulation strategies, such as fictional reappraisal, at stake whenever one engages in fictional works (e.g., movies, books, video games, virtual environments). Neuroscientific studies investigating the distinction between the processing of real and fictional entities have reported the involvement of brain structures related to self-relevance and emotion regulation, suggesting a threefold interaction between the appraisal of reality, aspects of the Self, and emotions. The main aim of this study is to investigate the effect of implicit fictional reappraisal on different components of emotion, as well as on the modulatory role of autobiographical and conceptual self-relevance. While recording electrodermal, cardiac, and brain activity (EEG), we presented negative and neutral pictures to 33 participants, describing them as either real or fictional. After each stimulus, the participants reported their subjective emotional experience, self-relevance of the stimuli, as well as their agreement with their description. Using the Bayesian mixed-modeling framework, we showed that stimuli presented as fictional, compared with real, were subjectively appraised as less intense and less negative, and elicited lower skin conductance response, stronger heart-rate deceleration, and lower late positive potential amplitudes. Finally, these phenomenal and physiological changes did, to a moderate extent, rely on variations of specific aspects of self-relevance. Implications for the neuroscientific study of implicit emotion regulation are discussed.

Complexities of human memory: relevance to anaesthetic practice

Mechanisms of anaesthetic actions on memory have largely focused on easily definable aspects of episodic memory, with emphasis on particular drug interactions on specific memory processes. However, the memory landscape of the perioperative experience includes many facets that lie outside these conceptualisations. These include patient recall of preoperative conversations, patient beliefs regarding allergies and unusual/uncommon anaesthetic events, memories of awareness, and particularly vivid dreams during anaesthesia. In no small part, memories are influenced by a patient's interpretations of events in light of their own belief systems. From the practitioner's point of view, relating fully to the patient's experience requires some framework of understanding. The purpose of this review is to highlight research over the previous decades on belief systems and their interactions with autobiographical memory, which organises episodic memories into a personally relevant narrative. As a result, memory is a set of continuously malleable processes, and is best described as a (re)constructive rather than photographic instantiation. Belief systems are separate but closely interacting processes with autobiographical memory. The interaction of a constantly evolving set of memories with belief systems can explain phenomena such as illusions, distortions, and (re)constructions of factitious events. How anaesthetics and our patient interactions influence these behaviours, and vice versa, will be important questions to explore and define with future research.

New Trends in Episodic Memory Assessment: Immersive 360° Ecological Videos

How best to measure memory in a reliable and valid way has been intensely debated in neuropsychological literature. Specifically, classical neuropsychological tests often fail to predict real-life performance or capture the multifaceted nature of memory function. To solve these issues, there has been a growing emphasis on the use of more ecological memory assessment. In this scenario, several virtual reality based tools have been developed to evaluate memory function. The aim of the current perspective is to discuss critically the possibilities offered for episodic memory assessment by one of the most innovative trends in the technology field, i.e., 360° videos. Immersivity, egocentric view and realism appear to be crucial features of 360° videos enabling them to enhance the ecological validity of classical assessment tools of memory abilities.