When Virtual Feels Real: Comparing Emotional Responses and Presence in Virtual and Natural Environments

SafeVRwards: Designing a complementary virtual reality module to the Safewards framework intended to relax and manage conflict in mental health wards

BACKGROUND

Aggression and negative activation in mental health inpatient units pose significant challenges for both patients and staff with severe physical and psychological ramifications. The Safewards model is an evidence-based conflict-containment framework including 10 strategies, such as 'Calm Down Methods'. As virtual reality (VR) scenarios have successfully enhanced anxiolytic and deactivating effects of therapeutic interventions, they are increasingly considered a means to enhance current models, like Safewards.

OBJECTIVES

The present participatory design investigates the feasibility and user experience of integrating VR therapy as an add-on strategy to the Safewards model, gathering preliminary data and qualitative feedback from bedside staff in an adult inpatient mental health unit.

METHODS

An exploratory within-subjects design combining qualitative observations, self-report questionnaires and semistructured interviews is employed with four nurse champions from the mental health unit at Michael Garron Hospital (Toronto, Canada).

RESULTS

A chronological overview of the design process, adaptations and description of the user experience is reported.

CONCLUSION

'SafeVRwards' introduces VR as a promising conflic-containment strategy complementary to the Safewards model, which can be optimised for deployment through user-oriented refinements and enhanced customisation capacity driven by clinical staff input.

Virtual reality, face-to-face, and 2D video conferencing differently impact fatigue, creativity, flow, and decision-making in workplace dynamics

Digital communication technologies are rapidly evolving, and understanding their impact on group dynamics and cognitive performance in professional settings becomes central. This study investigates the psychological impact of different interaction settings-two-dimensional Video Conferencing (VC), Face-To-Face (FTF), and Virtual Reality (VR)-on group dynamics, cognitive performance, and aspects of well-being in a professional context. Utilizing a sample of 40 participants from a large Italian electricity transmission company, the study employs a within-subjects design to explore various metrics, including flow, creativity, fatigue and aspects of interaction. The results indicate that FTF interactions are optimal for idea generation and task absorption. VR, although initially more fatiguing for first-time users, fosters a more collaborative and peaceful environment, encouraging participants to engage more openly with each other. VC was found to be the least fatiguing, but also the least engaging in terms of task absorption and idea generation. Additionally, age-related differences were observed, particularly in the perception of motivational and emotional fatigue in the VR setting. The study provides empirical evidence supporting the integration of VR in professional settings for specific types of meetings, while also highlighting the limitations and areas for future research. These findings have implications for organizational well-being, cognitive ergonomics, and the evolving landscape of remote work technologies.

Susceptibility to stress and nature exposure: Unveiling differential susceptibility to physical environments; a randomized controlled trial

BACKGROUND

Emerging epidemiological evidence indicates nature exposure could be associated with greater health benefits among groups in lower versus higher socioeconomic positions. One possible mechanism underpinning this evidence is described by our framework: (susceptibility) adults in low socioeconomic positions face higher exposure to persistent psychosocial stressors in early life, inducing a pro-inflammatory phenotype as a lifelong susceptibility to stress; (differential susceptibility) susceptible adults are more sensitive to the health risks of adverse (stress-promoting) environments, but also to the health benefits of protective (stress-buffering) environments.

OBJECTIVE

Experimental investigation of a pro-inflammatory phenotype as a mechanism facilitating greater stress recovery from nature exposure.

METHODS

We determined differences in stress recovery (via heart rate variability) caused by exposure to a nature or office virtual reality environment (10 min) after an acute stressor among 64 healthy college-age males with varying levels of susceptibility (socioeconomic status, early life stress, and a pro-inflammatory state [inflammatory reactivity and glucocorticoid resistance to an in vitro bacterial challenge]).

RESULTS

Findings for inflammatory reactivity and glucocorticoid resistance were modest but consistently trended towards better recovery in the nature condition. Differences in recovery were not observed for socioeconomic status or early life stress.

DISCUSSION

Among healthy college-age males, we observed expected trends according to their differential susceptibility when assessed as inflammatory reactivity and glucocorticoid resistance, suggesting these biological correlates of susceptibility could be more proximal indicators than self-reported assessments of socioeconomic status and early life stress. If future research in more diverse populations aligns with these trends, this could support an alternative conceptualization of susceptibility as increased environmental sensitivity, reflecting heightened responses to adverse, but also protective environments. With this knowledge, future investigators could examine how individual differences in environmental sensitivity could provide an opportunity for those who are the most susceptible to experience the greatest health benefits from nature exposure.

Assessing alexithymia: the proposal of a psychometric tool based on spheric videos

The present perspective introduces a novel psychometric tool designed to enhance the evaluation of alexithymia. Alexithymia, a condition marked by difficulties in recognizing and expressing emotions, along with a propensity to direct attention outside rather than toward one's own interior experiences, is commonly investigated through self-report questionnaires. These instruments assume that individuals have sufficient self-awareness and abstraction capabilities, which restricts the understanding of the underlying mechanisms of emotional recognition in individuals who do not possess these capacities. To address this lack, emerging technologies like virtual reality (VR) and 360° videos facilitate the recreation of immersive contexts, enabling subjects to engage with scenarios even remotely. Our innovative tool employs spherical video technology to recreate social and non-social scenarios that elicit emotions. Psychophysiological measures are collected during video observation; then, questions are asked to investigate how the subject consciously processes the emotions they experienced. This multimodal approach aims to capture both implicit and explicit emotion processing, providing a comprehensive assessment. Overall, the proposed psychometric tool offers the potential for a more nuanced understanding of alexithymic traits and their real-life impact, empowering clinicians to tailor treatment processes to individual needs based on a richer set of information.

Do you feel up when you go up? A pilot study of a virtual reality manic-like mood induction paradigm

OBJECTIVES

In order to understand the working mechanisms of mania, it is necessary to perform studies during the onset of manic (-like) mood states. However, clinical mania is difficult to examine experimentally. A viable method to study manic mood like states is mood induction, but mood induction tasks thus far show variable effectiveness.

METHODS

In this pilot study, a new paradigm to induce mood through virtual reality (VR) is examined. Both state characteristics, namely changes in emotion, and trait characteristics, such as high and low scores on the hypomanic personality scale (HPS), were measured in 65 students. These students participated in either a neutral VR mood induction or an activating VR mood induction in which excitement, goal directedness, and tension (being aspects of mania) were induced. All participants performed a risk-taking behavioural task, Balloon Analogue Risk Task (BART).

RESULTS

The experimental VR task induced excitement and tension. In participants with higher sensitivity to hypomanic personality (HPS), irritation increased in response to activation whereas it decreased in the low HPS group, and excitement increased more steeply in the low HPS group. There were no effects on the behavioural task.

CONCLUSIONS

The VR task is effective in inducing relevant state aspects of hypomania and is suitable as a paradigm for future experimental studies. Activation of dual affective states (excitement and tension) is an essential aspect in manic-like mood induction paradigms.

Does increasing biodiversity in an urban woodland setting promote positive emotional responses in humans? A stress recovery experiment using 360-degree videos of an urban woodland

Green spaces can support human stress reduction and foster positive emotional well-being. Previous research has suggested that biodiversity (i.e. the variety of species of plants and animals in a given location) can enhance recovery from stress even further. However, there is limited experimental evidence testing this hypothesis and results, to date, have been mixed. This study aimed to provide further understanding of the role of biodiversity (actual or perceived) on human well-being by experimentally manipulating species richness and stress. Participants (372 in total) took part in an online experiment, where they received an episode of mild stress before watching a 360-degree video to recover. The video showed the same location, an urban woodland, but at one of four artificially manipulated levels of biodiversity. The participants reported their Positive and Negative Affect before and after the stress induction and after watching the video, providing a measure of their stress and well-being throughout the experiment. Participants also reported their perceptions of biodiversity (i.e. how diverse they thought the location was) and elaborated on their responses with brief comments. Repeated Measure Analysis of Variance revealed that exposure to all levels of biodiversity reduced the participants' Negative Affect, but with no significant difference between the conditions. However, the analysis showed higher Positive Affect in those participants who perceived the environment as more biodiverse. Comments from participants indicated that those who reported noticing flowers and trees in the environment also showed higher Positive Affect. This suggests that perceiving biodiversity promotes more positive emotions, but critically one needs to actually notice (engage with) the components of biodiversity to elicit these extra benefits.

Personalized Virtual Reality Compared With Guided Imagery for Enhancing the Impact of Progressive Muscle Relaxation Training: Pilot Randomized Controlled Trial

BACKGROUND

Empirical evidence has shown that virtual reality (VR) scenarios can increase the effects of relaxation techniques, reducing anxiety by enabling people to experience emotional conditions in more vivid settings.

OBJECTIVE

This pilot randomized controlled study aims to investigate whether the progressive muscle relaxation technique (PMRT) associated with a personalized scenario in VR promotes psychological well-being and facilitates the recall of relaxing images more than the standard complementary intervention that involves the integration of PMRT and guided imagery (GI).

METHODS

On the basis of a longitudinal, between-subject design, 72 university students were randomly exposed to one of two experimental conditions: (1) standard complementary procedure (PMRT and GI exposure) and (2) experimental procedure (PMRT and personalized VR exposure). Individuals were assessed by a therapist before and after 7 training sessions based on measures investigating anxiety, depression, quality of life, coping strategies, sense of presence, engagement, and side effects related to VR exposure. Heart rate data were also collected.

RESULTS

Differences in changes between the 2 groups after the in vivo PMRT session conducted by the psychotherapist (T1) were statistically significant for state anxiety (F1,67=30.56; P<.001) and heart rate (F1,67=4.87; P=.01). Individuals in the VR group obtained lower scores both before (t67=-2.63; P=.01; Cohen d=0.91) and after (t67=-7.23; P<.001; Cohen d=2.45) the relaxation session when it was self-administered by participants (T2). A significant reduction in perceived state anxiety at T1 and T2 was observed for both groups (P<.001). After the VR experience, individuals reported feeling higher engagement in the experience than what was mentioned by participants in the GI group (F1,67=2.85; P=.03; ηp2=0.15), and they experienced the environment as more realistic (F1,67=4.38; P=.003; ηp2=0.21). No differences between groups regarding sense of presence were found (F1,67=1.99; P=.11; ηp2=0.11). Individuals exposed before to the VR scenario (T1) referred to perceiving the scenario recalled in-imagination at T2 as more realistic than what those in the GI group experienced (F1,67=3.21; P=.02; ηp2=0.12). The VR group had lower trait anxiety levels than the GI group after the relaxation session during session 7 (T2; t67=-2.43; P=.02).

CONCLUSIONS

Personalized relaxing VR scenarios can contribute to improving relaxation and decreasing anxiety when integrated with PMRT as a complementary relaxation method.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05478941; https://classic.clinicaltrials.gov/ct2/show/NCT05478941.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/44183.

Virtual vs. real: exploring perceptual, cognitive and affective dimensions in design product experiences

BACKGROUND

Virtual Reality (VR) has already emerged as an effective instrument for simulating realistic interactions, across various domains. In the field of User Experience (UX), VR has been used to create prototypes of real-world products. Here, the question is to what extent the users' experience of a virtual prototype can be equivalent to that of its real counterpart (the real product). This issue particularly concerns the perceptual, cognitive and affective dimensions of users' experiences.

METHODS

This exploratory study aims to address this issue by comparing the users' experience of a well-known product, i.e., the Graziella bicycle, presented either in Sumerian or Sansar VR platform, or in a physical setting. Participants' Emotional Engagement, Sense of Presence, Immersion, and Perceived Product Quality were evaluated after being exposed to the product in all conditions (i.e., Sumerian, Sansar and Physical).

RESULTS

The findings indicated significantly higher levels of Engagement and Positive Affect in the virtual experiences when compared to their real-world counterparts. Additionally, the sole notable distinction among the VR platforms was observed in terms of Realism.

CONCLUSIONS

This study suggests the feasibility and potential of immersive VR environments as UX evaluation tools and underscores their effectiveness in replicating genuine real-world experiences.

Effects of virtual heights, dual-tasking, and training on static postural stability

Working at altitudes, dual-tasking (DT), and lack of experience cause falls. This study aimed to investigate the impact of virtual heights, DT, and training on static postural stability. Twenty-eight volunteers' balance at seven virtual environments [VE; ground (G), altitude 1 (A1), edge 1 (E1), altitude 2 (A2), edge 2 (E2), altitude 3 (A3), and edge 3 (E3)] were recorded during single-tasking (ST) and DT over three days. Independent variables were analyzed using a 7 (VE) x 3 (DAY) x 2 (TASK) factorial repeated measures ANOVA. Greater postural sway was observed in A3 and E1, on DAY 1, and during DT. The study demonstrated static postural stability deteriorates at higher virtual altitudes and during DT and improves with training. The findings of the study suggest that virtual reality is a great altitude simulator, which could be used as a potential balance training tool in ergonomic settings.

Telepresence robots as facilitators of physical exercise during COVID-19: a feasibility and acceptance study

The COVID-19 pandemic and associated restrictions on mobility and access to green space have disrupted exercise habits worldwide. According to the World Health Organization (WHO), approximately 1.4 billion adults were insufficiently physically active in 2016, with detrimental impacts on health. The proposed study investigated the use of telepresence-robot-based personal trainers to facilitate remote exercise during the pandemic-related lockdowns. Several adults aged 18-65 were recruited for a four-week intervention and thorough research investigation. The intervention involved one-hour outdoor exercise sessions held three times per week in a local park with a human instructor connected via a telepresence robot. Surveys assessed perceptions of social presence, usability, the intention to use the robot and the psychological benefits of access to green space. System logs tracked participation and technical errors. At baseline, 30% of the participants met the WHO physical activity (PA) recommendations, compared to 80% after the intervention. The study shows significant increases in many parameters. These are perceived in social presence (p < 0.021), usability (p < 0.04), intentions for long-term use (p < 0.05), and the mental health benefits of accessing green spaces (p < 0.013). Attendance was found to be 90%, with a 7% technical failure rate. This investigation demonstrates the promise of telepresence robots for safely providing remote access to green spaces. They can be used to facilitate exercise during public health crises, overcoming the barriers to maintaining PA.

Effects of Using Guided Deep Breathing Exercises in a Virtual Natural Environment to Reduce Stress during Pediatric Treatment

There exists a need for new methods to address treatment anxiety in pediatrics-at the same time, deep breathing exercises and virtual natural environments have both been known to have stress-reducing qualities. This article reports the combined effect of these two methods in a pediatric setting. A feasibility study was conducted in a local hospital. The study had a within-subjects design, and it included 21 child patients aged 8 to 12 years old, who used a virtual reality (VR) relaxation application developed for this purpose during an intravenous cannulation procedure related to their treatment. The key findings highlight a statistically very significant stress reduction associated with the utilized VR intervention, demonstrated by heart rate variability measurements (SDNN, p < 0.001; RMSSD, p = 0.002; Stress Index, p < 0.001; LF/HF ratio, p = 0.010). This effect was consistent regardless of the level of general anxiety or the level of needle phobia of the patient, and no adverse effects were observed. The results show the strong potential of using deep breathing exercises in virtual natural environments for addressing treatment anxiety related to invasive pediatric procedures.

Design and User Experience of VirNE Application: Deep Breathing Exercise in a Virtual Natural Environment to Reduce Treatment Anxiety in Pediatrics

Treatment anxiety is a serious problem among child patients. A few studies have addressed this issue with virtual reality solutions, with promising results; however, the applications used have generally been designed for entertainment instead of this purpose. This article studies the potential of using deep breathing exercises in a virtual natural environment to address this issue, with a focus on design approach and user experience. It presents the VirNE-Virtual Natural Environments relaxation application, which is based on known stress-reduction methods, and a feasibility study conducted with it in a local hospital. The study had a within-subjects design, and it included 21 eight to twelve-year-old child patients, who used the application during an intravenous cannulation procedure related to their treatment. The study found good user acceptance and user experience both among the child patients and pediatricians, with the perceived usefulness of the method being higher among the patients with increased levels of anxiety or needle phobia. In addition, a clear stress-reducing effect was found. This offers proof-of-concept for the multidisciplinary design approach based on existing scientific knowledge regarding the desired effect for pediatric virtual reality applications for this use context.

Investigating and acquiring motor expertise using virtual reality

After just months of simulated training, on January 19, 2019 a 23-year-old E-sports pro-gamer, Enzo Bonito, took to the racetrack and beat Lucas di Grassi, a Formula E and ex-Formula 1 driver with decades of real-world racing experience. This event raised the possibility that practicing in virtual reality can be surprisingly effective for acquiring motor expertise in real-world tasks. Here, we evaluate the potential of virtual reality to serve as a space for training to expert levels in highly complex real-world tasks in time windows much shorter than those required in the real world and at much lower financial cost without the hazards of the real world. We also discuss how VR can also serve as an experimental platform for exploring the science of expertise more generally.

Efficacy of exposure and response prevention therapy in mixed reality for patients with obsessive-compulsive disorder: study protocol for a randomized controlled trial

Many patients with obsessive-compulsive disorder (OCD) do not receive cognitive behavioral therapy with exposure and response prevention (first line treatment for OCD), for example, due to patients' fear of the exposure and reservations of the therapists. Technology-supported exposure (e.g., exposure therapy with response prevention in mixed reality [MERP]) for patients with OCD may help to overcome this obstacle. Building upon findings of our pilot study objectives of this study are to evaluate the efficacy, expectations of treatment success, feasibility, and acceptance of MERP as well as to identify possible limitations. In total, 64 outpatients with contamination-related OCD will be recruited and randomized to one of two conditions: MERP (six sessions in six weeks) and self-guided exposure therapy (six exercises in six weeks). Participants will be assessed before (baseline), after the six-week intervention period (post), as well as three months after post assessment (follow-up) regarding symptomatology (Yale-Brown Obsessive Compulsive Scale; Y-BOCS), their subjective evaluation of MERP (acceptance) and sense of presence. The planned study is the first to investigate MERP in patients with OCD.

Using 360-degree immersive videos to assess multiple transdiagnostic symptoms: A study focusing on fear of negative evaluation, paranoid thoughts, negative automatic thoughts, and craving

Over the last 20 years, virtual reality (VR) has gained a great interest for both assessment and treatment of various psychopathologies. However, due to high costs and material specificity, VR remains disadvantageous for clinicians. Adopting a multiple transdiagnostic approach, this study aims at testing the validity of a 360-degree immersive video (360IV) for the assessment of five common psychological symptoms (fear of negative evaluation, paranoid thoughts, negative automatic thoughts, craving for alcohol and for nicotine). A 360IV was constructed in the Darius Café and included actors behaving naturally. One hundred and fifty-eight adults from the general population were assessed in terms of their proneness towards the five symptoms, were then exposed to the 360IV and completed measures for the five state symptoms, four dimensions of presence (place, plausibility, copresence and social presence illusions) and cybersickness. Results revealed that the five symptoms occurred during the immersion and were predicted by the participants' proneness towards these symptoms. The 360IV was also able to elicit various levels of the four dimensions of presence while producing few cybersickness. The present study provides evidence supporting the use of the 360IV as a new accessible, ecological, and standardized tool to assess multiple transdiagnostic symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10055-023-00779-y.

Examining the impact of experiencing auditory verbal hallucinations from a first-person perspective on the degree of empathy and stigmatization in a group of psychology students: A study using 360° immersive videos

BACKGROUND

Stigmatization toward psychosis is persistent among mental health professionals (MHPs) and negatively impacts the patients' outcomes. One suggested way of reducing stigmatization is to expose MHPs to simulations of psychotic symptoms. This approach has been associated with an increase in empathy, but also with an increase in the desire of social distance. The addition of an empathic task (ET) has been suggested to neutralize this effect on social distance. The present study aims to (1) examine the effect of a remotely administered 360° immersive video (360IV) simulation on empathy and stigma among psychology students and (2) replicate the neutralizing effect of an ET on social distance. Finally, the potential role of immersive properties on changes will also be explored.

METHODS

A 360IV simulating auditory hallucinations was constructed in collaboration with patient partners. 121 psychology students were allocated to one of three conditions: (i) exposure to the 360IV, (ii) exposure to the 360IV and to an ET (360IV + ET), and (iii) no exposure (control). Measures of empathy and stigma (stereotypes and social distance) were collected before and after the interventions.

RESULTS

An increase of empathy was observed in the 360IV and 360IV + ET conditions compared to the control condition. There was an increase of stereotypes in all conditions and no effect on social distance.

CONCLUSIONS

This study confirms the effectiveness of a 360IV simulation intervention in increasing empathy in psychology students but questions its efficacy in reducing stigma.

Immersive medium for early clinical exposure - knowledge acquisition, spatial orientation and the unexpected role of annotation in 360° VR photos

AIM

360° VR photos could be a low-threshold possibility to increase early clinical exposure. Apart from granting insights into local routines and premises, the medium should facilitate knowledge acquisition and spatial orientation depending on its design. This assumption, however, is not yet substantiated empirically. Thus, three hypotheses were tested in consideration of Mayer's modality principle: 1) Providing 360° VR photos as visual reference improves retention and comprehension of information. 2) The annotation of text boxes in 360° VR photos compromises spatial orientation and presence. 3) Annotated audio commentary is superior to annotated text boxes in terms of cognitive load and knowledge acquisition.

METHODS

Using head-mounted displays, students of human (N=53) and dental medicine (N=8) completed one of three virtual tours through a surgical unit, which were created with 360° VR photos. In the first two variants, information about the facilities, medical devices and clinical procedures was annotated either as text boxes or audio commentary comprising 67 words on average (SD=6.67). In the third variant, the same information was given separately on a printed handout before the virtual tour. Taking user experience and individual learner characteristics into account, differences between conditions were measured regarding retention, comprehension, spatial orientation, cognitive load, and presence.

RESULTS

Concerning retention and comprehension of information, annotated text boxes outperformed annotated audio commentary and the handout condition. Although annotated audio commentary exhibited the lowest knowledge test scores, students preferred listening over reading. Students with an interest in VR and 360° media reported higher levels of enjoyment and presence. Regarding spatial orientation and presence, no significant group differences were found.

CONCLUSIONS

360° VR photos can convey information and a sense of spatial orientation effectively in the same learning scenario. For students, their use is both enjoyable and instructive. Unexpectedly, the ideal mode of annotation is not dictated by Mayer's modality principle. For information like in this study, annotated text boxes are better for knowledge acquisition than the subjectively preferred audio commentary. This finding is probably contingent on the length and the quality of the annotated text. To identify boundary conditions and to validate the findings, more research is required on the design and educational use of 360° VR photos.

Daily exposure to virtual nature reduces symptoms of anxiety in college students

Exposure to natural environments offers an array of mental health benefits. Virtual reality provides simulated experiences of being in nature when outdoor access is limited. Previous studies on virtual nature have focused mainly on single "doses" of virtual nature. The effects of repeated exposure remain poorly understood. Motivated by this gap, we studied the influence of a daily virtual nature intervention on symptoms of anxiety, depression, and an underlying cause of poor mental health: rumination. Forty college students (58% non-Hispanic White, median age = 19) were recruited from two U.S. universities and randomly assigned to the intervention or control group. Over several weeks, anxious arousal (panic) and anxious apprehension (worry) decreased with virtual nature exposure. Participants identifying as women, past VR users, experienced with the outdoors, and engaged with the beauty in nature benefited particularly strongly from virtual nature. Virtual nature did not help symptoms of anhedonic depression or rumination. Further research is necessary to distinguish when and for whom virtual nature interventions impact mental health outcomes.

Effects of immersion in a simulated natural environment on stress reduction and emotional arousal: A systematic review and meta-analysis

Background

Although the mental health benefits of exposure to simulated natural environments are well established by researchers from environmental psychology, landscape architecture, and public health, it is unclear whether and to what extent technological immersion affects these benefits.

Methods

Systematical literature searches were conducted in May 2022 from six databases. The risk of bias was evaluated using the Cochrane's Risk of Bias tool 2.0 and the Risk of Bias in Non-randomized Studies of Interventions tool. We performed a random-effects meta-regression to investigate the heterogeneity. The immersion levels of included studies were classified by projection devices and motion capture, and then subgroup analysis was conducted.

Results

Twenty-six publications were included. Exposure to simulated nature was confirmed to be associated with increased positive affect 0.40 [95% confidence interval (CI): 0.22, 0.58], vigor 0.58 (95% CI: 0.30, 0.86), calmness 0.54 (95% CI: 0.17, 0.92) and decreased perceived stress -0.38 (95% CI: -0.71, -0.06), total mood disturbance -0.87 (95% CI: -1.17, -0.57), tension -0.70 (95% CI: -0.99, -0.41), fatigue -0.60 (95% CI: -0.91, -0.28), anxiety -0.72 (95% CI: -1.43, -0.02), depression -0.33 (95% CI: -0.52, -0.14), confusion -0.79 (95% CI: -1.19, -0.40), and anger -0.54 (95% CI: -0.76, -0.31). Gender, health status, study design, mean age, and single exposure duration were not significant when entered in a meta-regression. For positive affect, medium immersion was observed to produce a larger effect than low and high immersion. All included studies had a moderate to high risk of bias.

Conclusion

Audio-visual exposure to simulated nature contributes to stress relief and emotional arousal. The immersion level explains the heterogeneity of positive affect triggered by simulated nature. Focusing on the technical features will open up new possibilities for combining actual and simulated nature's mental health benefits.

Effects of exposure to immersive computer-generated virtual nature and control environments on affect and cognition

Previous research has shown that exposure to immersive virtual nature environments is able to induce positive affective and physiological effects. However, research on the effects on cognitive performance is scarce. Additionally, the effects of virtual nature exposure compared to a virtual control environment with a comparable amount of virtual objects have not been examined so far. Therefore, we conducted an experiment with 27 participants to study the psychological effects of such exposure. The virtual nature consisted of a 3D model of a typical forest environment, whereas the control environment was an abstract replication of the virtual forest environment. In both environments, a virtual wooden cart was used to transport the users from the start to the end of the virtual road. The typical background noise of moving such a cart was integrated into both environments as well. In addition, the virtual nature environment included typical forest sounds in the background, whereas the control condition did not have such background sounds. Both environments were compared with regard to their effects on cognitive performance (using trail making tests (TMTA, TMTB, and TMTB-A) as well as digit span forward and digit span backward tests), perceived restorativeness, mood, stress, sense of presence, and simulator sickness. The results showed that in comparison to the control environment, exposure to the virtual nature resulted in significantly higher cognitive performance, higher perceived restorativeness, higher positive affect, higher sense of presence, lower perceived stress, and lower simulator sickness.

A reliable and robust online validation method for creating a novel 3D Affective Virtual Environment and Event Library (AVEL)

This paper describes the development and validation of 3D Affective Virtual environments and Event Library (AVEL) for affect induction in Virtual Reality (VR) settings with an online survey; a cost-effective method for remote stimuli validation which has not been sufficiently explored. Three virtual office-replica environments were designed to induce negative, neutral and positive valence. Each virtual environment also had several affect inducing events/objects. The environments were validated using an online survey containing videos of the virtual environments and pictures of the events/objects. They survey was conducted with 67 participants. Participants were instructed to rate their perceived levels of valence and arousal for each virtual environment (VE), and separately for each event/object. They also rated their perceived levels of presence for each VE, and they were asked how well they remembered the events/objects presented in each VE. Finally, an alexithymia questionnaire was administered at the end of the survey. User ratings were analysed and successfully validated the expected affect and presence levels of each VE and affect ratings for each event/object. Our results demonstrate the effectiveness of the online validation of VE material in affective and cognitive neuroscience and wider research settings as a good scientific practice for future affect induction VR studies.

Seasonal Variations in the Effectiveness of Immersive Virtual Nature

AIM

The aim of this study was to assess whether the outcomes of immersive virtual nature (IVN) varies between seasons.

BACKGROUND

IVN has received increased interest in recent years due to its potential applications within health and design. However, factors influencing people's responses to IVN are largely unknown. Seasons affect a variety of human processes and behaviors including levels of affect and blood pressure, also in the context of human-nature interactions. These seasonal variations might influence how people interact and respond to IVN, especially since IVN allow for representations of nature that are not representative of the current real-life season.

METHODS

A secondary analysis of data retrieved from two previous studies, which included three IVN conditions, was conducted. All IVNs represented late spring conditions. Measures included perceived environmental restorativeness, affect, enjoyment, heart rate, and blood pressure. A meta-analytic approach was used to assess whether there were consistent differences between participants who were exposed to the IVN in spring/summer (early June to mid-September) and autumn/winter (mid-September to December) across the three different conditions.

RESULTS

There was a consistent effect of season only for one component of affect (fatigue), with larger reductions in fatigue when exposed to IVN during autumn/winter compared to spring/summer. No other significant effects of season were observed.

CONCLUSION

IVNs are feasible to use across all seasons but might be more effective in reducing the feeling of fatigue during autumn and winter compared to other seasons.

The reality of virtual reality

Virtual reality (VR) has become a popular tool for investigating human behavior and brain functions. Nevertheless, it is unclear whether VR constitutes an actual form of reality or is more like an advanced simulation. Determining the nature of VR has been mostly achieved by self-reported presence measurements, defined as the feeling of being submerged in the experience. However, subjective measurements might be prone to bias and, most importantly, do not allow for a comparison with real-life experiences. Here, we show that real-life and VR height exposures using 3D-360° videos are mostly indistinguishable on a psychophysiological level (EEG and HRV), while both differ from a conventional 2D laboratory setting. Using a fire truck, three groups of participants experienced a real-life (N = 25), a virtual (N = 24), or a 2D laboratory (N = 25) height exposure. Behavioral and psychophysiological results suggest that identical exogenous and endogenous cognitive as well as emotional mechanisms are deployed to process the real-life and virtual experience. Specifically, alpha- and theta-band oscillations in line with heart rate variability, indexing vigilance, and anxiety were barely indistinguishable between those two conditions, while they differed significantly from the laboratory setup. Sensory processing, as reflected by beta-band oscillations, exhibits a different pattern for all conditions, indicating further room for improving VR on a haptic level. In conclusion, the study shows that contemporary photorealistic VR setups are technologically capable of mimicking reality, thus paving the way for the investigation of real-world cognitive and emotional processes under controlled laboratory conditions. For a video summary, see https://youtu.be/fPIrIajpfiA.

Investigating the role of auditory and visual sensory inputs for inducing relaxation during virtual reality stimulation

Stress is a part of everyday life which can be counteracted by evoking the relaxation response via nature scenes presented using immersive virtual reality (VR). The aim of this study was to determine which sensory aspect of immersive VR intervention is responsible for the greatest relaxation response. We compared four conditions: auditory and visual combined (audiovisual), auditory only, visual only, and no artificial sensory input. Physiological changes in heart rate, respiration rate, and blood pressure were recorded, while participants reported their preferred condition and awareness of people, noise, and light in the real-world. Over the duration of the stimulation, participants had the lowest heart rate during the audiovisual and visual only conditions. They had the steadiest decrease in respiration rate and the lowest blood pressure during the audiovisual condition, compared to the other conditions, indicating the greatest relaxation. Moreover, ratings of awareness indicated that participants reported being less aware of their surroundings (i.e., people, noise, light, real environment) during the audiovisual condition versus the other conditions (p < 0.001), with a preference for audiovisual inputs. Overall, the use of audiovisual VR stimulation is more effective at inducing a relaxation response compared to no artificial sensory inputs, or the independent inputs.

Visual post-occupancy evaluation of a restorative garden using virtual reality photography: Restoration, emotions, and behavior in older and younger people

Natural environments have a restorative effect from mental/attentional fatigue, prevent stress, and help to revitalize psychological and physical resources. These benefits are crucial for promoting active aging, which is particularly relevant given the phenomenon of population aging in recent decades. To be considered restorative, green spaces have to meet specific requirements in ecological and psychological terms that can be assessed through Post-Occupancy Evaluation (POE), a multimethod approach commonly used by environmental psychologists and landscape architects after construction to evaluate the design outcomes from the users’ perspective. Generally, POEs consist of surveys and/or interviews accompanied by more or less structured observations of onsite users’ behavior. Despite this, various practical constraints can prevent physical access to the renovated area (e.g., weather conditions, time/resources limits, health issues, bureaucratic constraints). Exploiting digital tools for such an assessment can be a crucial support in such circumstances. The current study presents the visual POE of a restorative garden for older adults in Milan, Italy. We developed a web application, that includes the exp-EIA© patented method, which allows participants to virtually explore a visual simulation of the environment and provide their feedback. We identified 3 representative viewpoints in the redeveloped garden differing from each other for the functions and the design principles that inspired the transformation. For each point of view, we created 360° Virtual Reality photographs, that can be navigated by looking around, i.e., panning, from the standing point of each view. In connection to each virtual scene, a survey was conducted (N = 321). The focus was the psychological experience related to each viewpoint, assessed with two psychometric scales investigating the constructs of emotions (pleasure and arousal) and restoration (fascination, being away, coherence, scope, and environmental preference); such information is integrated with behavioral aspects, including the main activities prefigured by participants and their visual exploration of the VR photography. The results of the virtual exploration show that the garden is perceived as restorative, with a more intense effect in a spot purposely designed. The emotions experienced in the garden are positive and a mild level of arousal is observed. The behavioral dimension is characterized by predominantly contemplative activities and contact with nature. A cartographic representation of the psychological and behavioral data is developed, to support the maintenance of the garden.

Facial Expressions and Self-Reported Emotions When Viewing Nature Images

Many studies have demonstrated that exposure to simulated natural scenes has positive effects on emotions and reduces stress. In the present study, we investigated emotional facial expressions while viewing images of various types of natural environments. Both automated facial expression analysis by iMotions' AFFDEX 8.1 software (iMotions, Copenhagen, Denmark) and self-reported emotions were analyzed. Attractive and unattractive natural images were used, representing either open or closed natural environments. The goal was to further understand the actual features and characteristics of natural scenes that could positively affect emotional states and to evaluate face reading technology to measure such effects. It was predicted that attractive natural scenes would evoke significantly higher levels of positive emotions than unattractive scenes. The results showed generally small values of emotional facial expressions while observing the images. The facial expression of joy was significantly higher than that of other registered emotions. Contrary to predictions, there was no difference between facial emotions while viewing attractive and unattractive scenes. However, the self-reported emotions evoked by the images showed significantly larger differences between specific categories of images in accordance with the predictions. The differences between the registered emotional facial expressions and self-reported emotions suggested that the participants more likely described images in terms of common stereotypes linked with the beauty of natural environments. This result might be an important finding for further methodological considerations.

The Validity of Virtual Courage for Trainees in High-Risk Occupations

Background

Employees in high-risk occupations are exposed to tremendous work stress that hinders organizational effectiveness and personal mental health. Based on positive psychology, courage can be considered a protective factor that buffers the adverse effect of high-risk surroundings on employees. However, little is known about the way courage is simulated or evaluated in response to safety concerns. Virtual reality (VR) is an accessible tool for courage simulation due to its immersive qualities, presence and interactive features and may provide a promising pathway to achieve a scientific, accurate and ecologically valid evaluation of high-risk employees.

Methods

The sample consisted of 51 high-risk employees who were recruited voluntarily. Before and after experiencing the VR courage scenarios, the participants completed the VR features questionnaire, the Physical Courage at Work Scale (PCWS), the Courage Measure (CM), and the Positive and Negative Affect Scale (PANAS). During the process of watching the VR courage scenarios, the participants’ heart rate and skin conductance at resting-state baseline and during virtual courage scenarios were recorded through HTC VIVE Pro Eye and BioGraph Infiniti 8.

Results

The results support the hypothesis and reveal that the interaction, immersion and presence scores of the scenarios were all significantly higher than the median 4 points. The score for the CM in the posttest was significantly higher than that in the pretest. The scared and afraid scores for the posttest were significantly higher than those for the pretest. The heart rate and skin conductance of each scenario showed an increase compared with the baseline. The Pearson’s correlation between physiological indicators and the score of the PCWS was 0.28~0.54.

Conclusion

This study developed virtual courage for high-risk occupations based on well-established theory and VR technology. Experimental data revealed that the paradigm conformed to the requirements of VR features and was able to activate fear and evoke the quality of courage. Thus, the virtual courage paradigms have good validity in simulating scenarios for high-risk employees, which might accelerate organizational effectiveness while buffering working stress.

Biophilic Experience-Based Residential Hybrid Framework

There has been increasing academic interest in biophilic design in response to recent environmental and climate change issues, including the COVID-19 pandemic. However, discussions of the utilization of digital technology in providing universal access to nature, and opportunities to experience more diverse nature, are lacking. This study aimed to compare and analyze major theoretical systems for biophilic experiences in a residential environment, and to propose a hybrid framework that combines physical and digital design techniques for comparison and analysis. This paper discusses framework application strategies in line with scales of residential environments. Based on a systematic literature review, this study integrated and derived key elements of biophilic experience for a better quality of life in a modern residential environment and proposed a hybrid framework and strategy based on this. As a result, a hybrid framework of 15 integrated factors for three biophilic experiences was derived, and various strengths and potential opportunities were identified in terms of application depending on the scales. At the unit scale, it was found that the well-being and health of residents improved; at the building scale, the potential for sustainability was highlighted; at the complex scale, there was a contribution to higher residential competitiveness in multi-dimensional aspects. In particular, the biophilic experience-based hybrid framework in this study provided insights into addressing the weaknesses and threats discussed in the existing biophilic design.

The Role of Personalization in the User Experience, Preferences and Engagement with Virtual Reality Environments for Relaxation

Virtual Reality Environments (VREs) are widely deployed in mental health treatments, often associated with relaxation techniques. The personalization of natural VR-based scenarios is a key element that can further facilitate users’ sense of presence and relaxation. This study explored the role of VREs’ personalization in the user experience with an environment supporting relaxation, by deploying mixed methods. Methods: A non-clinical sample of 20 individuals participated in exposure to a supportive body-scan-guided relaxation VRE. In the personalized conditions, the participants had the option of choosing the context (e.g., sea, mountain, or countryside) and including in the scenario different types of sounds, visual elements, and changing the time of day and weather. In the standard conditions, individuals were exposed to a relaxing VRE, but they could choose neither the context nor the auditory and visual elements. The order of presentation of the personalized vs non-personalized environments was randomized. Measures regarding relaxation, state-anxiety perceived levels, VRE-related symptoms, the usability of the Virtual Reality (VR) setting, sense of presence, pleasure, activation, engagement, and level of immersion experienced were collected before and after exposure to the VR environments. Results: Findings showed that personalized VREs were preferred by users. Participants generally preferred to experience a greater immersivity, pleasure, engagement, and relaxation in the personalized virtual settings. Conclusion: The study further confirms the role of personalization as a component positively contributing to relaxation and engagement. Future research may further assess this effect in the context of large-scale controlled studies involving clinical and non-clinical populations.

Experimental Study on Panic during Simulated Fire Evacuation Using Psycho- and Physiological Metrics

Under circumstances of fire, panic usually brings uncertainty and unpredictability to evacuation. Therefore, a deep understanding of panic is desired. This study aims to dig into the underlying mechanism of fire evacuation panic by measuring and analysing psycho- and physiological indicators. In the experiment, participants watched a simulated train station within which three sets of stimuli were triggered separately. Eye movement and brain haemodynamic responses were collected during the watch, while questionnaires and interviews of emotions were conducted after. The analysed physiological indicators include the amplitude of pupil dilation, the time ratios of fixation and saccade, the binned entropy of gaze location, and the brain activation coefficients. The results of this research indicate that fire evacuation panic can be broken down into two elements. (1) Unawareness of situation: less knowledge of the situation leads to a higher level of panic; (2) Intensity of visual stimulation: the panic level is escalated with increased severity of fire that is perceived.

Virtual Reality Behavioral Activation for Adults With Major Depressive Disorder: Feasibility Randomized Controlled Trial

BACKGROUND

Major depressive disorder (MDD) is a global crisis with increasing incidence and prevalence. There are many established evidence-based psychotherapies (EBPs) for depression, but numerous barriers still exist; most notably, access and dissemination. Virtual reality (VR) may offer some solutions to existing constraints of EBPs for MDD.

OBJECTIVE

We aimed to examine the feasibility, acceptability, and tolerability of using VR as a method of delivering behavioral activation (BA) for adults diagnosed with MDD during a global pandemic and to explore for signs of clinical efficacy by comparing VR-enhanced BA (VR BA) to a standard BA treatment and a treatment as usual control group for individuals diagnosed with MDD.

METHODS

A feasibility trial using a 3-armed, unblinded, randomized controlled pilot design was conducted. The study took place remotely via Zoom telehealth visits between April 8, 2020, and January 15, 2021. This study used a 3-week, 4-session protocol in which VR BA participants used a VR headset to complete their BA homework. Feasibility was measured using dropout rates, serious adverse events, completion of homework, an adapted telepresence scale, the Simulator Sickness Questionnaire, the Brief Agitation Measure, and an adapted Technology Acceptance Model. Efficacy was assessed using the Patient Health Questionnaire-9.

RESULTS

Of the 35 participants assessed for eligibility, 13 (37%) were randomized into VR BA (n=5, 38%), traditional BA (n=4, 31%), or a treatment as usual control (n=4, 31%). The mean age of the 13 participants (5/13, 38% male; 7/13, 54% female; and 1/13, 8% nonbinary or third gender) was 35.4 (SD 12.3) years. This study demonstrated VR BA feasibility in participants with MDD through documented high levels of acceptability and tolerability while engaging in VR-induced pleasurable activities in conjunction with a brief BA protocol. No adverse events were reported. This study also illustrated that VR BA may have potential clinical utility for treating MDD, as the average VR BA participant's clinical severity decreased by 5.67 points, signifying a clinically meaningful change in severity from a moderate to a mild level of depression as per the Patient Health Questionnaire-9 score.

CONCLUSIONS

The findings of this study demonstrate that VR BA is safe and feasible to explore for the treatment of MDD. This study documented evidence that VR BA may be efficacious and justifies further examination in an adequately powered randomized controlled trial. This pilot study highlights the potential utility that VR technology may offer patients with MDD, especially those who have difficulty accessing real-world pleasant activities. In addition, for those having difficulty accessing care, VR BA could be adapted as a first step to help people improve their mood and increase their motivation while waiting to connect with a health care professional for other EBPs.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04268316; https://clinicaltrials.gov/ct2/show/NCT04268316.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/24331.

‘That is a place where I would want to go’: investigating digital nature to enhance social wellbeing among older adults

Feelings of disconnectedness and social isolation among older adults are increasingly recognised as important challenges of our times. Interestingly, nature interaction can stimulate social connectedness and enhance perceived social support, indicating that nature can contribute to social wellbeing. However, nature may not always be around or accessible for older adults. In such cases, digital nature could provide an alternative means for enjoying nature's benefits. To identify limitations and restrictions that older adults experience with respect to nature interaction, and to explore preferences with respect to digital nature and their potential for influencing social wellbeing, two studies are reported: a qualitative study comprising focus groups with Dutch care centre residents (N = 26) and a subsequent quantitative study (N = 200) testing effects of digital landscapes on social wellbeing measures. Findings from the focus groups indicate that opportunities for nature interaction and preferences for digital nature vary with mobility restrictions, whereas findings from the quantitative study testify to the potential of digital nature for enhancing social wellbeing and related emotions. These findings extend research on how (digital) nature interventions can contribute to the social wellbeing of older adults and pinpoint essential nature characteristics important for doing so.

Nature videos for PTSD: protocol for a mixed-methods feasibility study

Background: Given the prevalence of post-traumatic stress disorder (PTSD), particularly among military personnel, new treatment approaches are needed. One may be virtual relaxation interventions, especially 360-degree nature videos, since studies have demonstrated their relaxation effects for healthy participants. If these relaxation effects can be reproduced in patients with PTSD, they may offer a viable tool to reduce distress and hyperarousal. Objective: This research protocol describes a planned study that will examine the relaxation effects of 360-degree nature videos for patients with PTSD. It will also investigate whether these relaxation effects differ depending on the hardware immersion level (head-mounted display [HMD] vs. PC screen) in comparison to a control condition in which patients only listen to natural sounds and do not view a video. Finally, the effect of each intervention's dose duration (five vs. ten minutes) will be explored. Method: A counterbalanced, randomised, controlled, within-subject experiment will be conducted (sample size N = 36). Only soldiers aged 18 years or older with a primary diagnosis of PTSD will be included. Those with psychosis, substance dependence, a change in psychiatric medication within the last month, suicidal intent, and motion sickness will be excluded. All patients will experience the HMD, PC, and control conditions once for five or ten minutes. Self-reported relaxation measures will be collected before and after, and patients' skin conductance level, heart rate, and heart rate variability will be assessed during each condition. Semi-structured interviews will be conducted to examine the patients' experiences in detail. Conclusions: This feasibility study will provide initial evidence of whether viewing 360-degree nature videos via HMD or PC screen is relaxing for patients with PTSD and whether the effects are greater compared with the control condition. The study will also validate the dose duration and thereby informing a subsequent confirmatory interventional trial. Trial registration: DRKS00020277.

HIGHLIGHTS

This randomised controlled feasibility study will examine whether 360-degree nature videos are a suitable relaxation intervention for military personnel with post-traumatic stress disorder.

Development of an affective database made of interactive virtual environments

Despite the great potential of Virtual Reality (VR) to arouse emotions, there are no VR affective databases available as it happens for pictures, videos, and sounds. In this paper, we describe the validation of ten affective interactive Virtual Environments (VEs) designed to be used in Virtual Reality. These environments are related to five emotions. The testing phase included using two different experimental setups to deliver the overall experience. The setup did not include any immersive VR technology, because of the ongoing COVID-19 pandemic, but the VEs were designed to run on stereoscopic visual displays. We collected measures related to the participants’ emotional experience based on six discrete emotional categories plus neutrality and we included an assessment of the sense of presence related to the different experiences. The results showed how the scenarios can be differentiated according to the emotion aroused. Finally, the comparison between the two experimental setups demonstrated high reliability of the experience and strong adaptability of the scenarios to different contexts of use.

Access to Nature via Virtual Reality: A Mini-Review

Nature exposure is known to promote physical and mental health. However, actual nature exposure may be difficult to achieve for the population of people with physical disabilities or chronic conditions. Therefore, many attempts have been made to duplicate nature exposure via media devices, and virtual reality (VR) is deemed as a promising technology due to its advantage in creating a sense of immersion. Generally, current studies suggest that being exposed to virtual nature may contribute to psychological and physiological relaxation. Besides, some pieces of evidence indicate that virtual nature may improve attentional resources, cognitive performance, and pain experience. Although VR is deemed as an advanced media, insufficient evidence was found concerning the advantages of VR over traditional two-dimensional media when it comes to simulated nature exposure. On the other hand, computer-generated (CG) scenarios were found to be more beneficial than 360° videos, and mini-games may be useful in creating an interactive VR format for simulated nature exposure. Further research is needed because of the limited relevant studies.

Research Directions in the Study of Gaming-Related Escapism: a Commentary to Melodia, Canale, and Griffiths (2020)

Escapism motivations and related processes (e.g., avoidance, dissociation, relaxation, and emotion dysregulation) have been identified as risk factors for problematic gaming. However, the escapism construct has often been poorly conceptualized and operationalized in assessment instruments. In their systematic review, Melodia et al. (2020) proposed that conceptualizing escapism as an avoidant coping strategy could provide a sound basis for further study of problematic gaming. In this commentary, we critically examine some terminological and conceptual issues in relation to escapism to guide future research.

Skepticism towards advancing VR technology - student acceptance of VR as a teaching and assessment tool in medicine

Objective: The high didactic potential of Virtual Reality (VR) contrasts with the point of view of students that the technology only has a relatively low significance for current and future teaching. This discrepancy was studied in a differentiated manner in order to gear the further development and implementation of VR towards the target group. Methods: From January 2020 to July 2020, medical students (N=318) were asked to watch ten videos online and rate them on the basis of acceptance indicators (e.g., fun and fairness). Using obstetrics as an example, the videos demonstrated five levels of VR technology functionality (e.g., haptic and adaptive feedback), some of which were visionary, in two use scenarios (teaching and the OSCE). The individual and aggregate indicators were compared with non-parametric testing procedures across application scenarios, functional levels and genders. In addition, correlations between the acceptance and the factors of semester, age, computer affinity, and previous VR experience were analyzed. Results: Across all functional levels, VR was more likely to be accepted in the classroom than in the OSCE. Comparisons across functional levels also revealed that the VR ready to be marketed was significantly more accepted than the visionary functions. This skepticism toward advancing VR technology was most pronounced with regard to the vision of autonomous VR examinations and among female students with a low computer affinity. Conclusion: The results suggest that the students' reservations are due to a lack of experience with the VR technology. In order for young physicians to become familiar with the technology and to be able to use it competently in the everyday clinical practice in the future, VR should not only be used as a teaching tool but also be part of the curriculum. Practical examinations using VR, on the other hand, are only recommended once the technology has become established in teaching and has been proven to be reliable.

Viewing Natural vs. Urban Images and Emotional Facial Expressions: An Exploratory Study

There is a large body of evidence that exposure to simulated natural scenes has positive effects on emotions and reduces stress. Some studies have used self-reported assessments, and others have used physiological measures or combined self-reports with physiological measures; however, analysis of facial emotional expression has rarely been assessed. In the present study, participant facial expressions were analyzed while viewing forest trees with foliage, forest trees without foliage, and urban images by iMotions’ AFFDEX software designed for the recognition of facial emotions. It was assumed that natural images would evoke a higher magnitude of positive emotions in facial expressions and a lower magnitude of negative emotions than urban images. However, the results showed only very low magnitudes of facial emotional responses, and differences between natural and urban images were not significant. While the stimuli used in the present study represented an ordinary deciduous forest and urban streets, differences between the effects of mundane and attractive natural scenes and urban images are discussed. It is suggested that more attractive images could result in more pronounced emotional facial expressions. The findings of the present study have methodological relevance for future research. Moreover, not all urban dwellers have the possibility to spend time in nature; therefore, knowing more about the effects of some forms of simulated natural scenes surrogate nature also has some practical relevance.

Application of Virtual Environments for Biophilic Design: A Critical Review

Biophilic design as a new design approach promotes the integration of natural elements into the built environment, leading to a significant impact on human health, well-being, and productivity. On the other hand, scholars have explored Virtual Environment (VE) to create virtual nature and provide a complex experience of exposure to natural elements virtually. However, there is a lack of understanding about such studies in general, which use VE as a reliable tool to support biophilic design. Thus, the authors conducted a literature review on the applications, capabilities, and limitations of VE for biophilic design. The literature review shows that VE is capable of supporting critical features of biophilic design studies such as representing combinations of biophilic patterns, providing multimodal sensory inputs, simulating stress induction tasks, supporting required exposure time to observe biophilic patterns, and measuring human’s biological responses to natural environment. However, factors affecting user’s experience of a virtual biophilic environment exist, such as VE experience dimensions, user-related factors, cybersickness, navigational issues, and possible limitations of VE sensory input. Overall, biophilic design studies in VEs are still limited. Nevertheless, there are many opportunities for further research in this field.

Nature versus art as elicitors of the sublime: A virtual reality study

The sublime–the mixed aesthetic experience of uplift and elevation in response to a powerful or vast object that otherwise is experienced as menacing–has nurtured philosophical discourse for centuries. One of the major philosophical issues concerns whether the sublime is best thought of as a subjective response or as a stimulus. Recently, psychology has conceived of the sublime as an emotion, often referred to as awe, arising from natural or artistic stimuli that are great, rare, and/or vast. However, it has not yet been empirically demonstrated whether two major elicitors of the sublime–nature and art–differ in inducing this state. In order to experimentally compare nature and art, we exposed 50 participants to sublimity-inducing content in two different formats (nature-based and art-based) using 360° videos. We compared Vincent Van Gogh’s The Starry Night with a photorealistic version of the actual place depicted in the painting, Saint-Rémy-de-Provence. We measured participants’ emotional responses before and after each exposure, as well as the sense of presence. The nature-based format induced higher intensity emotional responses than the art-based format. This study compares different sublime stimuli (nature vs. art) for eliciting the sublime.

Virtual Terroir and the Premium Coffee Experience

With its origin-centric value proposition, the specialty coffee industry seeks to educate consumers about the value of the origin of coffee and how the relationship with farmers ensures quality and makes coffee a premium product. While the industry has widely used stories and visual cues to communicate this added value, research studying whether and how these efforts influence consumers' experiences is scarce. Through three experiments, we explored the effect of images that evoke the terroir of coffee on the perception of premiumness. Our results revealed that online images that resembled the broad origin of coffee (i.e., a farm) could influence premiumness expectations of coffee (Experiment 1). Similarly, a virtual reality environment that depicted this broad origin (vs. a control but not a city atmosphere) could enhance the perception of coffee premiumness for non-expert consumers (Experiment 2) and the enjoyment of the experience for coffee professionals (Experiment 3). Importantly, we found that congruence between the coffee and the virtual reality (VR) atmospheres mediated how much non-experts enjoyed the experience (Experiment 2). VR atmospheres also influenced expectations of sweetness and acidity for non-experts (Experiment 2). These findings serve as a steppingstone for further exploration of the effects of congruence between visual cues and product/brand attributes on premiumness expectations and perception, and more generally on consumer experience. From a practical standpoint, this study provides insights into key aspects for the development of immersive virtual product experiences.

Effects of Visual Flow Alterations on Psychophysiological Responses to Virtual Reality Exercise

Virtual reality (VR) technology combined with exercise, called VR exercise, is believed to have beneficial effects on mood; but VR factors contributing to improved mood remain ambiguous. The purpose of this study was to examine the effect of visual flow speed on psychophysiological responses (i.e., physiological responses, ratings of perceived exertion or RPE, and mood) to immersive VR exercise in a simulated natural environment. Eighteen male participants (Mage =23.1, SD = 1.9 years) cycled an ergometer at 80 watts for 5 minutes on three separate occasions while watching a first-person VR movie through VR goggles at three different speeds of visual flow, corresponding to 7.5 km.h^-1, 15 km.h^-1, and 22.5 km.h^-1. The order of the three speeds was randomized in a counterbalanced design. We measured heart rate, oxygen uptake, minute ventilation, respiratory rate, and cadence during the exercise, and we recorded ratings of perceived exertion (RPE) and mood immediately after the exercise. We evaluated mood states with the Two-Dimensional Mood Scale. One-way repeated measures analysis of variance or the Friedman test revealed no significant effects on any physiological variables, RPE or cadence as a result of altered visual flow speed during VR exercise (p > .05). However, speed of visual flow significantly influenced participant ratings of Vitality (p = 0.01) and Pleasure (p = 0.02), with the faster speed resulting in a more positive mood state. As these findings showed that VR exercise with faster visual flow induced positive mood states, we recommend faster visual flow to induce better mood states in VR exercise.

Effects of exposure to immersive videos and photo slideshows of forest and urban environments

A large number of studies have demonstrated the benefits of natural environments on people's health and well-being. For people who have limited access to nature (e.g., elderly in nursing homes, hospital patients, or jail inmates), virtual representations may provide an alternative to benefit from the illusion of a natural environment. For this purpose and in most previous studies, conventional photos of nature have been used. Immersive virtual reality (VR) environments, however, can induce a higher sense of presence compared to conventional photos. Whether this higher sense of presence leads to increased positive impacts of virtual nature exposure is the main research question of this study. Therefore, we compared exposure to a forest and an urban virtual environment in terms of their respective impact on mood, stress, physiological reactions, and cognition. The environments were presented via a head-mounted display as (1) conventional photo slideshows or (2) 360[Formula: see text] videos. The results show that the forest environment had a positive effect on cognition and the urban environment disturbed mood regardless of the mode of presentation. In addition, photos of either urban or forest environment were both more effective in reducing physiological arousal compared to immersive 360[Formula: see text] videos.

Mindfulness-based Virtual Reality Intervention in Hemodialysis Patients: A Pilot Study on End-user Perceptions and Safety

Background

Virtual reality (VR) is an evolving technology that is becoming a common treatment for pain management and psychologic phobias. Although nonimmersive devices (e.g., the Nintendo Wii) have been previously tested with patients on hemodialysis, no studies to date have used fully immersive VR as a tool for intervention delivery. This pilot trial tests the initial safety, acceptability, and utility of VR during maintenance hemodialysis treatment sessions-particularly, whether VR triggers motion sickness that mimics or negatively effects treatment-related symptoms (e.g., nausea).

Methods

Patients on hemodialysis (n=20) were enrolled in a phase 1 single-arm proof-of-concept trial. While undergoing hemodialysis, participants were exposed to our new Joviality VR program. This 25-minute program delivers mindfulness training and guided meditation using the Oculus Rift head-mounted display. Participants experienced the program on two separate occasions. Before and immediately after exposure, participants recorded motion-related symptoms and related discomfort on the Simulator Sickness Questionnaire. Utility measures included the end-user's ability to be fully immersed in the virtual space, interact with virtual objects, find hardware user friendly, and easily navigate the Joviality program with the System Usability Scale.

Results

Mean age was 55.3 (±13.1) years; 80% male; 60% Black; and mean dialysis vintage was 3.56 (±3.75) years. At the first session, there were significant decreases in treatment and/or motion-related symptoms after VR exposure (22.6 versus 11.2; P=0.03); scores >20 indicate problematic immersion. Hemodialysis end-users reported high levels of immersion in the VR environment and rated the software easy to operate, with average System Usability Scale scores of 82.8 out of 100.

Conclusions

Patients on hemodialysis routinely suffer from fatigue, nausea, lightheadedness, and headaches that often manifest during their dialysis sessions. Our Joviality VR program decreased symptom severity without adverse effects. VR programs may be a safe platform to improve the experience of patients on dialysis.

What is the best way of delivering virtual nature for improving mood? An experimental comparison of high definition TV, 360° video, and computer generated virtual reality

Exposure to 'real' nature can increase positive affect and decrease negative affect, but direct access is not always possible, e.g. for people in health/care settings who often experience chronic boredom. In these settings 'virtual' forms of nature may also have mood-related benefits (e.g. reducing boredom) but it has been difficult to separate effects of nature content from those of delivery mode. The present laboratory-based study explored whether exposure to three different delivery modes of virtual nature could reduce negative affect (including boredom) and/or increase positive affect. Adult volunteer participants (n = 96) took part in a boredom induction task (to simulate the emotional state of many people in health/care settings) before being randomly assigned to view/interact with a virtual underwater coral reef in one of three experimental conditions: (a) 2D video viewed on a high-definition TV screen; (b) 360⁰ video VR (360-VR) viewed via a head mounted display (HMD); or (c) interactive computer-generated VR (CG-VR), also viewed via a HMD and interacted with using a hand-held controller. Visual and auditory content was closely matched across conditions with help from the BBC's Blue Planet II series team. Supporting predictions, virtual exposure to a coral reef reduced boredom and negative affect and increased positive affect and nature connectedness. Although reductions in boredom and negative affect were similar across all three conditions, CG-VR was associated with significantly greater improvements in positive affect than TV, which were mediated by greater experienced presence and increases in nature connectedness. Results improve our understanding of the importance of virtual nature delivery mode and will inform studies in real care settings.

Extended Reality for the Clinical, Affective, and Social Neurosciences

Brain science research often involves the use of low-dimensional tools and stimuli that lack several of the potentially valuable features of everyday activities and interactions. Although this research has provided important information about cognitive, affective, and social processes for both clinical and nonclinical populations, there is growing interest in high-dimensional simulations that extend reality. These high-dimensional simulations involve dynamic stimuli presented serially or concurrently to permit the assessment and training of perceivers' integrative processes over time. Moreover, high-dimensional simulation platforms can contextually restrain interpretations of cues about a target's internal states. Extended reality environments extend assessment and training platforms that balance experimental control with emotionally engaging background narratives aimed at extending the affective experience and social interactions. Herein, we highlight the promise of extended reality platforms for greater ecological validity in the clinical, affective, and social neurosciences.