Believing Is Seeing: A Proof-of-Concept Semiexperimental Study on Using Mobile Virtual Reality to Boost the Effects of Interpretation Bias Modification for Anxiety

Abstract

Background: Cognitive Bias Modification of Interpretations (CBM-I) is a computerized intervention designed to change negatively biased interpretations of ambiguous information, which underlie and reinforce anxiety. The repetitive and monotonous features of CBM-I can negatively impact training adherence and learning processes.

Objective: This proof-of-concept study aimed to examine whether performing a CBM-I training using mobile virtual reality technology (virtual reality Cognitive Bias Modification of Interpretations [VR-CBM-I]) improves training experience and effectiveness.

Methods: A total of 42 students high in trait anxiety completed 1 session of either VR-CBM-I or standard CBM-I training for performance anxiety. Participants' feelings of immersion and presence, emotional reactivity to a stressor, and changes in interpretation bias and state anxiety, were assessed.

Results: The VR-CBM-I resulted in greater feelings of presence (P<.001, d=1.47) and immersion (P<.001, η_p²=0.74) in the training scenarios and outperformed the standard training in effects on state anxiety (P<.001, η_p²=0.3) and emotional reactivity to a stressor (P=.03, η_p²=0.12). Both training varieties successfully increased the endorsement of positive interpretations (P<.001, d_{repeated measures} [d_rm]=0.79) and decreased negative ones. (P<.001, d_rm=0.72). In addition, changes in the emotional outcomes were correlated with greater feelings of immersion and presence.

Conclusions: This study provided first evidence that (1) the putative working principles underlying CBM-I trainings can be translated into a virtual environment and (2) virtual reality holds promise as a tool to boost the effects of CMB-I training for highly anxious individuals while increasing users' experience with the training application.

Keywords: anxiety; cognitive bias modification; emotional reactivity; head mounted display; immersion; interpretation bias; presence; virtual reality.

Figure 1

Representation of the standard Cognitive Bias Modification of Interpretation (CBM-I) and virtual reality Cognitive Bias Modification of Interpretation (VR-CBM-I) trainings: (A) Standard CBM-I training; (B) VR-CBM-I training (participant’s point of view on the computer room virtual environment on the top right corner); (C) Examples of virtual environments: classroom on the left side, living room in the middle, and book shop on the right side.

Figure 2

(A) Mean (and SE) state anxiety scores from pre to post-training for the virtual reality Cognitive Bias Modification of Interpretation (VR-CBM-I) and standard Cognitive Bias Modification of Interpretation (CBM-I) groups. (B) Mean (and SE) VAS anxiety scores from pre- to post-stressor for the VR-CBM-I condition and standard CBM-I condition.