Virtual Reality as a Medium to Elicit Empathy: A Meta-Analysis

Measurement of Empathy in Virtual Reality with Head-Mounted Displays: A Systematic Review

We present a systematic review of 111 papers that measure the impact of virtual experiences created through head-mounted displays (HMDs) on empathy. Our goal was to analyze the conditions and the extent to which virtual reality (VR) enhances empathy. To achieve this, we categorized the relevant literature according to measurement methods, correlated human factors, viewing experiences, topics, and participants. Meta-analysis was performed based on categorized themes, and under specified conditions, we found that VR can improve empathy. Emotional empathy increased temporarily after the VR experience and returned to its original level over time, whereas cognitive empathy remained enhanced. Furthermore, while VR did not surpass 2D video in improving emotional empathy, it did enhance cognitive empathy, which is associated with embodiment. Our results are consistent with existing research suggesting differentiation between cognitive empathy (influenced by environmental factors and learnable) and emotional empathy (highly heritable and less variable). Interactivity, target of empathy, and point of view were not found to significantly affect empathy, but participants' age and nationality were found to influence empathy levels. It can be concluded that VR enhances cognitive empathy by immersing individuals in the perspective of others and that storytelling and personal characteristics are more important than the composition of the VR scene. Our findings provide guiding information for creating empathy content in VR and designing experiments to measure empathy.

Nursing Students' Experiences of Empathy in a Virtual Reality Simulation Game: A Descriptive Qualitative Study

Empathy is significant in nursing, and showing empathy toward a patient positively impacts a patient's health. Learning empathy through immersive simulations is effective. Immersion is an essential factor in virtual reality. This study aimed to describe nursing students' experiences of empathy in a virtual reality simulation game. Data were collected from nursing students (n = 20) from May 2021 to January 2022. Data collection included individual semistructured interviews; before the interviews, the virtual reality gaming procedure was conducted. Inductive content analysis was used. Nursing students experienced compassion and a feeling of concern in the virtual reality simulation game. Students were willing to help the virtual patient, and they recognized the virtual patient's emotions using methods such as listening and imagining. Students felt the need to improve the patient's condition, and they responded to the virtual patient's emotions with the help of nonverbal and verbal communication and helping methods. Empathy is possible to experience by playing virtual reality simulation games, but it demands technique practicing before entering the virtual reality simulation game.

The Dual Importance of Virtual Reality Usability in Rehabilitation: A Focus on Therapists and Patients

Virtual reality (VR) has advanced in medical education and rehabilitation from basic graphical applications due to its ability to generate a virtual three-dimensional (3D) environment. This environment is mostly used to practice professional skills, plan surgery procedures, simulate surgeries, display 3D anatomy, and rehabilitate various disorders. VR has transformed the field of rehabilitation therapy by providing immersive and engaging experiences that go beyond traditional bounds, significantly improving patient care and therapeutic results. Considering the direct impact of VR on the efficacy of the treatment for both therapists and patients, its dual significance for usability and user experience cannot be overstated. The purpose of this article is to determine the synergistic association between VR accessibility and the rehabilitation process, highlighting the significance of VR technology in designing the future of rehabilitation therapy and demonstrating how advancing VR technology can improve therapeutic outcomes despite overcoming obstacles encountered during VR usage. In conclusion, VR offers a personalized, efficient, interesting, and engaging rehabilitative environment for patients, while also assisting therapists in cultivating empathy and efficiency and encouraging innovative approaches in treatment procedures.

Innovative Use of Virtual Reality to Facilitate Empathy Toward Older Adults in Nursing Education

ABSTRACT

Innovative educational interventions that dispel aging myths and promote empathy toward older adults can be used to reduce age bias and health care disparities. Virtual reality (VR) is one intervention that has shown promise in this area. This one-group, pretest-posttest design pilot study examined the effect of a VR experience on empathy with a sample of 121 second-degree, prelicensure nursing students. A significant improvement in empathy was observed. This study adds to the limited evidence that examines the use of VR for immersive storytelling and facilitation of empathy toward older adults in nursing students.

Learning about Victims of Holocaust in Virtual Reality: The Main, Mediating and Moderating Effects of Technology, Instructional Method, Flow, Presence, and Prior Knowledge

The goal of the current study was to investigate the effects of a virtual reality (VR) simulation of Anne Frank’s hiding place on learning. In a 2 × 2 experiment, 132 middle school students learned about the living conditions of Anne Frank, a girl of Jewish heritage during the Second World War, through desktop VR (DVR) and head-mounted display VR (HMD-VR) (media conditions). Approximately half of each group engaged in an explorative vs. an expository learning approach (method condition). The exposition group received instructions on how to explore the hiding place stepwise, whereas the exploration group experienced it autonomously. Next to the main effects of media and methods, the mediating effects of the learning process variables of presence and flow and the moderating effects of contextual variables (e.g., prior technical knowledge) have been analyzed. The results revealed that the HMD-VR led to significantly improved evaluation, and—even if not statistically significant—perspective-taking in Anne, but less knowledge gain compared to DVR. Further results showed that adding instructions and segmentation within the exposition group led to significantly increased knowledge gain compared to the exploration group. For perspective-taking and evaluation, no differences were detected. A significant interaction between media and methods was not found. No moderating effects by contextual variables but mediating effects were observed: For example, the feeling of presence within VR can fully explain the relationships between media and learning. These results support the view that learning processes are crucial for learning in VR and that studies neglecting these learning processes may be confounded. Hence, the results pointed out that media comparison studies are limited because they do not consider the complex interaction structures of media, instructional methods, learning processes, and contextual variables.

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.

Experiencing herd immunity in virtual reality increases COVID-19 vaccination intention: Evidence from a large-scale field intervention study

This study investigates the impact of an immersive virtual reality (VR) simulation of herd immunity on vaccination intentions and its potential underlying mechanisms. In this preregistered field study, N = 654 participants were randomly assigned to one of the three VR conditions: (1) Gamified Herd Immunity; (2) Gamified Herd Immunity + Empathy (with additional narrative elements); (3) Control (gamified with no vaccination-related content). In the Gamified Herd Immunity simulation, participants embodied a vulnerable person and navigated a wedding venue trying to avoid getting infected. A total of 455 participants with below maximum intentions to take a novel vaccine and without severe cybersickness were analyzed. The Gamified Herd Immunity + Empathy and the Gamified Herd Immunity conditions increased vaccination intentions by 6.68 and 7.06 points on a 0-100 scale, respectively, compared to 1.91 for the Control condition. The Gamified Herd Immunity + Empathy condition enhanced empathy significantly more than the Gamified Herd Immunity condition but did not result in higher vaccination intentions. Experienced presence was related to the change in vaccination intentions. The results suggest that VR vaccination communication can effectively increase vaccination intentions; the effect is not solely due to the technological novelty and does not depend on empathy.

Domestic Violence From a Child Perspective: Impact of an Immersive Virtual Reality Experience on Men With a History of Intimate Partner Violent Behavior

Domestic violence has long-term negative consequences on children. In this study, men with a history of partner aggression and a control group of non-offenders were embodied in a child's body from a first-person perspective in virtual reality (VR). From this perspective, participants witnessed a scene of domestic violence where a male avatar assaulted a female avatar. We evaluated the impact of the experience on emotion recognition skills and heart rate deceleration responses. We found that the experience mainly impacted the recognition of angry facial expressions. The results also indicate that males with a history of partner aggression had larger physiological responses during an explicit violent event (when the virtual abuser threw a telephone) compared with controls, while their physiological reactions were less pronounced when the virtual abuser invaded the victim's personal space. We show that embodiment from a child's perspective during a conflict situation in VR impacts emotion recognition, physiological reactions, and attitudes towards violence. We provide initial evidence of the potential of VR in the rehabilitation and neuropsychological assessment of males with a history of domestic violence, especially in relation to children.

Effectiveness of Augmented and Virtual Reality-Based Interventions in Improving Knowledge, Attitudes, Empathy and Stigma Regarding People with Mental Illnesses-A Scoping Review

Interventions adopting augmented and virtual reality (AR/VR) modalities allow participants to explore and experience realistic scenarios, making them useful psycho-educational tools for mental illnesses. This scoping review aims to evaluate the effectiveness of AR/VR interventions in improving (1) knowledge, (2) attitudes, (3) empathy and (4) stigma regarding people with mental illnesses. Literature on published studies in English up till April 2022 was searched within several databases. Sixteen articles were included. The majority of studies were conducted in the West (93.8%), within undergraduates (68.8%) but also amongst high school students, patients, caregivers, public including online community, and covered conditions including psychotic illnesses, dementia, anxiety and depression. A preponderance of these included studies which employed AR/VR based interventions observed improvements in knowledge (66.7%), attitudes (62.5%), empathy (100%) and reduction of stigma (71.4%) pertaining to people with mental illnesses. In the context of relatively limited studies, extant AR/VR based interventions could potentially improve knowledge, attitudes, empathy and decrease stigma regarding people with mental illness. Further research needs to be conducted in larger and more diverse samples to investigate the relatively beneficial effects of different AR/VR modalities and the durability of observed improvements of relevant outcomes of interests over time for different mental conditions.

Virtual reality stimulation and organizational neuroscience for the assessment of empathy

This study aimed to evaluate the viability of a new procedure based on machine learning (ML), virtual reality (VR), and implicit measures to discriminate empathy. Specifically, eye-tracking and decision-making patterns were used to classify individuals according to their level in each of the empathy dimensions, while they were immersed in virtual environments that represented social workplace situations. The virtual environments were designed using an evidence-centered design approach. Interaction and gaze patterns were recorded for 82 participants, who were classified as having high or low empathy on each of the following empathy dimensions: perspective-taking, emotional understanding, empathetic stress, and empathetic joy. The dimensions were assessed using the Cognitive and Affective Empathy Test. An ML-based model that combined behavioral outputs and eye-gaze patterns was developed to predict the empathy dimension level of the participants (high or low). The analysis indicated that the different dimensions could be differentiated by eye-gaze patterns and behaviors during immersive VR. The eye-tracking measures contributed more significantly to this differentiation than did the behavioral metrics. In summary, this study illustrates the potential of a novel VR organizational environment coupled with ML to discriminate the empathy dimensions. However, the results should be interpreted with caution, as the small sample does not allow general conclusions to be drawn. Further studies with a larger sample are required to support the results obtained in this study.

Use Virtual Reality to Enhance Intercultural Sensitivity: A Randomised Parallel Longitudinal Study

Prior studies suggest that emotional empathy is one of the components of intercultural sensitivity - the affective dimension under the concept of intercultural communication competence. Based on existing theories and findings, this paper reports a randomised parallel longitudinal study investigating the use of virtual reality (VR) exposure to enhance intercultural sensitivity. A total of 80 participants (36 females and 44 males) joined the study and were included in the data analysis. The participants were randomly assigned to the VR group, the video group, and the control group. Their intercultural sensitivity was measured three times: one week before the exposure ($T_{1}$), right after the exposure ($T_{2}$), and three weeks after the exposure ($T_{3}$). The results suggested that (1) the intercultural sensitivity of the VR group was significantly enhanced in both within-subject comparisons and between-subject comparisons, (2) there were no significant differences in intercultural sensitivity between the VR group and the video group at $T_{2}$, but the VR group retained the enhancement better at $T_{3}$, and (3) the sense of presence and emotional empathy well predicted the change in intercultural sensitivity of the VR group. The results, together with the participants' feedback and comments, provide new insights into the practice of using VR for intercultural sensitivity training and encourage future research on exploring the contributing factors of the results.

Disrupting the “empathy machine”: The power and perils of virtual reality in addressing social issues

This article looks through a critical media lens at mediated effects and ethical concerns of virtual reality (VR) applications that explore personal and social issues through embodiment and storytelling. In recent years, the press, immersive media practitioners and researchers have promoted the potential of virtual reality storytelling to foster empathy. This research offers an interdisciplinary narrative review, with an evidence-based approach to challenge the assumptions that VR films elicit empathy in the participant—what I refer to as the VR-empathy model. A review of literature from the fields of psychology, computer science, embodiment, medicine, and virtual reality was carried out to question and counter these claims through case studies of both fiction and non-fiction VR experiences. The results reveal that there is little empirical evidence of a correlation between VR exposure and an increase in empathy that motivates pro-social behavior, and a lack of research covering VR films exposure eliciting empathy. Furthermore, the results show an alarming lack of research into the long-term effects of VR films and other VR immersive experiences. This contribution aims to understand and demystify the current “empathy machine” rhetoric and calls for more rigorous, scientific research that can authenticate future claims and systemize ethical best practices.

The effects of embodying wildlife in virtual reality on conservation behaviors

Efforts to mitigate environmental threats are often inversely related to the magnitude of casualty, human or otherwise. This “compassion fade” can be explained, in part, by differential processing of large- versus small-scale threats: it is difficult to form empathic connections with unfamiliar masses versus singular victims. Despite robust findings, little is known about how non-human casualty is processed, and what strategies override this bias. Across four experiments, we show how embodying threatened megafauna-Loggerhead sea turtles (Caretta Caretta)-using virtual reality can offset and reverse compassion fade. After observing compassion fade during exposure to non-human casualty in virtual reality (Study 1; N = 60), we then tested a custom virtual reality simulation designed to facilitate body transfer with a threatened Loggerhead sea turtle (Study 2; N = 98). Afterwards, a field experiment (Study 3; N = 90) testing the simulation with varied number of victims showed body transfer offset compassion fade. Lastly, a fourth study (N = 25) found that charitable giving among users embodying threatened wildlife was highest when exposed to one versus several victims, though this effect was reversed if victims were of a different species. The findings demonstrate how animal embodiment in virtual reality alters processing of environmental threats and non-human casualty, thereby influencing conservation outcomes.

Investigating the Influence of Intergroup Contact in Virtual Reality on Empathy: An Exploratory Study Using AltspaceVR

Virtual Reality (VR) has often been referred to as an "empathy machine." This is mostly because it can induce empathy through embodiment experiences in outgroup membership. However, the potential of intergroup contact with an outgroup avatar in VR to increase empathy is less studied. Even though intergroup contact literature suggests that less threatening and more prosocial emotions are the key to understanding why intergroup contact is a powerful mean to decrease prejudice, few studies have investigated the effect of intergroup contact on empathy in VR. In this study, we developed a between-participants design to investigate how VR can be used to create a positive intergroup contact with a member of a stigmatized outgroup (ethnic minority) and present the results of the effect of intergroup contact in VR on empathy. Sixty four participants experienced either positive contact (i.e., equal intergroup status, collaborative) with a black (experimenter-controlled) avatar (experimental condition) or no intergroup contact (i.e., ingroup contact with a white avatar; control condition), with situational empathy (personal distress and empathic interest) being measured through a self-report questionnaire up to a week before and right after the VR contact experience. The experiment showed that satisfying degrees of body ownership of participants' own avatar and co-presence with the contacted avatar can be achieved in simple and universally accessible virtual environments such as AltspaceVR. The results indicated that while VR intergroup contact had no significant direct effect on empathy, exploratory analyses indicated that post-intervention empathic interest increased with stronger feelings of co-presence in the intergroup contact condition.

Presence and Flow in the Context of Virtual Reality Storytelling: What Influences Enjoyment in Virtual Environments?

Virtual reality (VR) has widely been implemented in a variety of industries, with immersive storytelling now gaining popularity in the field of journalism. In this regard, there are many important questions about which direction modern journalism should take as a whole. To test the feasibility of immersive storytelling, this study developed a cognitive experience model containing paths for presence, flow, credibility, empathy, understanding, and enjoyment. A total of 131 participants were divided into three groups and exposed to either VR, 360-degree videos, or two-dimensional (2D) videos, then asked to rate their experiences. With the exception of understanding, results showed that the VR and 360-degree videos were more highly evaluated in each path when compared with 2D videos. In this case, technical attributes did not greatly affect the study variables. However, presence played a vital role in news promotion, while flow was positively affected by presence; flow also affected other variables when combined with presence. Finally, a structural equation model was tested and the weights of the different influences on the enjoyment impact were presented. In sum, this study found that immersive storytelling improved both presence, flow, and credibility, which jointly and positively affected enjoyment. Understanding negatively affected enjoyment. Empathy had little effect on enjoyment in the model.

Virtual Reality as a Tool for Eliciting Empathetic Behaviour in Carers: An Integrative Review

BACKGROUND

Empathy is an essential behavioural competency required of healthcare providers. It is included in the Canadian National Competency Profile for Medical Radiation Technologists; supporting patient-centered care and the development of therapeutic relationships between carers and care recipients. This review synthesizes evidence on Virtual Reality (VR) as a tool for eliciting empathetic behaviour in carers.

METHODS

Six Electronic databases (PubMed, EMBASE, PsycInfo, ERIC, Academic Search Premier and CINAHL) were searched for studies published from 1997-2020. Studies with MeSH terms "Empathy" and "Virtual Reality", and conducted on adult carers, were eligible for inclusion. The Cochrane risk of bias tool guided the assessment of study quality. Prospero review registration number: CRD42020210049 RESULTS: Seven studies, with 485 carers, were included in this review. Studies were heterogeneous in terms of interventions and tools for collecting outcome measures. All seven studies demonstrated VR could elicit empathetic behaviour in carers. Studies included one randomized controlled trial, three non-randomized controlled trials, two with quasi-experimental designs, and one non-experimental design. All studies had a moderate to high risk of bias.

CONCLUSION

This review suggests that VR may be an appropriate method for eliciting empathetic behaviours in carers. Future studies employing appropriately powered multicentere randomized controlled designs should seek to determine which VR experiences are the most effective in evoking empathetic behaviours.

Virtual reality for the enhancement of emotion regulation

In recent decades, a growing body of literature has focused on emotion regulation (ER), which refers to the ability to implement strategies in order to modulate emotional responses and reach desirable goals. To date, impaired ER (i.e., emotion dysregulation) has been identified as a transdiagnostic factor across a wide range of psychopathological conditions, which shows the importance of improving patients' ability to regulate negative and positive emotions in clinical practice. In addition to the increasing evidence showing its efficacy in the treatment of several clinical conditions, virtual reality (VR) has recently emerged as a potentially powerful tool for enhancing ER, thus breaking new ground in the development of cutting-edge transdiagnostic interventions. In the present narrative review, we will provide an overview of the existing evidence about VR-based interventions in the field of ER, emphasizing the promising findings and the barriers that still have to be addressed. To this aim, the available VR-based literature will be analysed in relation to four categories of ER strategies: situational strategies, attentional strategies, cognitive strategies, and response modulation strategies. Furthermore, new emerging fields of research targeting innovative aspects of ER will be highlighted, including the use of VR to promote positive emotions and interpersonal ER skills. Besides, its cost-effectiveness will be discussed, taking into account the costs for both developers (e.g., clinicians and researchers) and end-users. Finally, future directions in this promising field of research will be outlined.

Zusammenhänge zwischen Empathie, therapeutischer Haltung und Wirkeffizienz

Empathisch sein heißt, fühlen und verstehen können, was andere fühlen. Vermuten zu können, was das Gegenüber fühlt, denkt und wünscht, beruht auf der Fähigkeit, eigene Gefühle und Gedanken als getrennt von jenen anderer wahrnehmen und regulieren zu können. Definierte Therapieerfolge mit adäquatem Aufwand erreichen zu können, verlangt ein Fokussieren auf Wesentliches und Wichtiges. Die Empathie ist im Bereich der Psychotherapie jener Faktor, für den für sich genommen die höchste Effektstärke nachgewiesen werden konnte. Empathietraining ermöglicht eine bessere soziale Performance. Im Falle von Defiziten in sozialer Kompetenz ist störungsunabhängig ein besonders hoher Leidensdruck nachweisbar.

Feasibility of a Computer Role-Playing Game to Promote Empathy in Nursing Students: The Role of Immersiveness and Perspective

Empathy is considered a cornerstone of high-quality health care and a required element of nursing education. Although computer role-playing games (CRPGs) are a promising tool to promote clinical empathy, little is known about how and why it is effective at improving empathy. The goal of the current study is to investigate the feasibility and effectiveness of a CRPG on nursing students' empathy with a focus on immersiveness and perspective. Results from a 2 × 2 (virtual reality [VR] vs. non-VR × patient's family's perspective vs. health care provider's perspective) between-subjects experiment (N = 69) showed that playing the game in VR (vs. non-VR) led to greater spatial presence and empathy. Moreover, playing from the health care provider's (vs. patient's family's) perspective elicited greater empathy. A moderated mediation effect was found, suggesting that users' attention allocation significantly mediated the effect of immersiveness on empathy in the patient's family's perspective condition. These findings show the feasibility of using a role-playing game for nursing education. Both theoretical and practical implications involving empathy training were discussed, along with suggestions for further research.