Proof of Concept of an Eclectic, Integrative Therapeutic Approach to Mental Health and Well-Being Through Virtual Reality Technology

Abstract

Across three studies, we provide a proof-of-concept evaluation of an integrative psychotherapeutic application of virtual reality (VR) technology. Study 1 (n = 36) evaluated an unguided "safe-place" imagery task, where participants were instructed "to create a safe space… [such as] a scene, item, design, or any visual representation that makes you feel safe" using either the Google Tilt Brush application (VR condition), the standard Microsoft Paint application (2-D condition), or via eyes-closed mental imagery alone (IMG condition). Study 2 (n = 48) evaluated a narrative episodic recall task, where participants viewed their childhood and adult homes and places of schooling either using either the Google Earth VR application (VR condition) or the standard Google Earth application (2-D condition) or recalled these places with their eyes closed via mental imagery alone (IMG condition). Finally, Study 3 (n = 48) evaluated a guided wilderness imagery task, during which different scripts were narrated, specifically, a trail walk in autumn, a spring meadow, and a hillside walk in snowy winter, while either these same scenes were visually presented using the Nature Treks VR application (VR condition), the scenes were presented using the same software but shown on standard computer monitor (2-D condition), or participants' eyes were closed (IMG condition). Order of intervention format was randomized across participants. Across all three studies, quantitative survey ratings showed that the VR format of intervention delivery produced greater positive affect and satisfaction and perceived credibility ratings as an intervention for trauma- and stressor-related disorders and psychological well-being as rated by university students who varied in traumatic and stressful life event history and symptoms of posttraumatic stress disorder, whereas qualitative findings revealed additional themes of experiential response including increased experience of presence and vividness in the VR condition. Future research directions and clinical applications are discussed.

Keywords: dissociative experiences; integrative psychotherapy; positive affect (PA); posttraumatic stress disorder (PTSD); virtual reality; wellbeing.

FIGURE 1

Completion of the IMG (noncomputerized) format of each task is thought to be mediated by eyes-closed imagery and/or episodic recall rather than perception and therefore subjectively experienced with lower vividness at least among certain participants. Nevertheless, participants were expected to typically experience the IMG format of each task from an egocentric frame of reference or sense of “presence” during the task. In comparison, in the 2-D format, participants were expected to experience each task less from the egocentric point of view and rather more so from a third-person perspective; as a result, the 2-D format of the task was thought to be experienced with a lower level of presence. Finally, the VR format of each task, by comparison to the others, was expected to be experienced with high vividness of perception and high egocentricity (presence). IMG, imagery; 2-D, two-dimensional; VR, virtual reality.

FIGURE 2

Bars illustrate the mean ratings obtained on a 0- to 5-point scale for the VR (green), 2-D (purple), and IMG (orange) formats of the task, also written in the embedded table below. Error bars illustrate the standard error of measurement. Asterisks denote the 8 of 10 ratings in which the mean rating for the VR condition significantly exceeded the mean rating for both of the 2-D and IMG conditions. Any other statistically significant pairwise comparisons are described in the text. IMG, imagery; 2-D, two-dimensional; VR, virtual reality.

FIGURE 3

Bars illustrate the mean ratings obtained on a 0- to 10-point scale for the VR (green), 2-D (purple), and IMG (orange) formats of the task, also written in the embedded table below. Error bars illustrate the standard error of measurement. Asterisks denote the 9 of 10 ratings in which the mean rating for the VR condition significantly exceeded the mean rating for both of the 2-D and IMG conditions. Any other statistically significant pairwise comparisons are described in the text. IMG, imagery; 2-D, two-dimensional; VR, virtual reality.

FIGURE 4

Bars illustrate the mean ratings obtained on a 0- to 10-point scale for the VR (green), 2-D (purple), and IMG (orange) formats of the task, also written in the embedded table below. Error bars illustrate the standard error of measurement. In the absence of a significant ANOVA, no pairwise comparisons were conducted but rather all are assumed to be nonsignificant. See text for further description. IMG, imagery; 2-D, two-dimensional; VR, virtual reality.

FIGURE 5

The radar figure further depicts the pattern of the correlations noted in the table below between PTSD symptoms (measured by the PCL-5), on the one hand, and the various negative affect ratings (measured by the mDES), on the other. Asterisks denote the 8 of 30 ratings in which the correlation is statistically significant at p < 0.05 (1-tailed). See text for further description. IMG, imagery; 2-D, two-dimensional; VR, virtual reality.

FIGURE 6

Bars illustrate the number of participants in the sample with probable PTSD (i.e., the subsample scoring above 33 on the PCL-5) whose average score across the 10 negative affect ratings on the MDES exceeded the values indicated on the x axis. It can be seen that very few scored above even a relatively low value of 3 on the 0- to 10-point scale for any of the task formats: VR (green), 2-D (purple), and IMG (orange). See text for further description. IMG, imagery; 2-D, two-dimensional; VR, virtual reality.

FIGURE 7

Bars illustrate the mean ratings obtained on a 0- to 5-point scale for the VR (green), 2-D (purple), and IMG (orange) formats of the task, also written in the embedded table below. Error bars illustrate the standard error of measurement. Asterisks denote the 8 of 10 ratings in which the mean rating for the VR condition significantly exceeded the mean rating for both of the 2-D and IMG conditions. Any other statistically significant pairwise comparisons are described in the text. IMG, imagery; 2-D, two-dimensional; VR, virtual reality.

FIGURE 8

Bars illustrate the mean ratings obtained on a 0- to 10-point scale for the VR (green), 2-D (purple), and IMG (orange) formats of the task, also written in the embedded table below. Error bars illustrate the standard error of measurement. Asterisks denote the 8 of 10 ratings in which the mean rating for the VR condition significantly exceeded the mean rating for both of the 2-D and IMG conditions. Any other statistically significant pairwise comparisons are described in the text. IMG, imagery; 2-D, two-dimensional; VR, virtual reality.

FIGURE 9

Bars illustrate the mean ratings obtained on a 0- to 10-point scale for the VR (green), 2-D (purple), and IMG (orange) formats of the task, also written in the embedded table below. Error bars illustrate the standard error of measurement. In the absence of a significant ANOVA, no pairwise comparisons were conducted, but rather all are assumed to be nonsignificant. See text for further description. IMG, imagery; 2-D, two-dimensional; VR, virtual reality.

FIGURE 10

The radar figure further depicts the pattern of the correlations noted in the table below between PTSD symptoms (measured by the PCL-5), on the one hand, and the various negative affect ratings (measured by the mDES), on the other. Asterisks denote the 29 of 30 ratings in which the correlation is statistically significant at p < 0.05 (1-tailed). See text for further description. IMG, imagery; 2-D, two-dimensional; VR, virtual reality.

FIGURE 11

Bars illustrate the number of participants in the sample with probable PTSD (i.e., the subsample scoring above 33 on the PCL-5) whose average score across the 10 negative affect ratings on the MDES exceeded the values indicated on the x axis. It can be seen that very few scored above even a relatively low value of 3 on the 0- to 10-point scale for any of the task formats: VR (green), 2-D (purple), and IMG (orange). See text for further description. IMG, imagery; 2-D, two-dimensional; VR, virtual reality.

FIGURE 12

Bars illustrate the mean ratings obtained on a 0- to 5-point scale for the VR (green), 2-D (purple), and IMG (orange) formats of the task, also written in the embedded table below. Error bars illustrate the standard error of measurement. Asterisks denote the 8 of 10 ratings in which the mean rating for the VR condition significantly exceeded the mean rating for both of the 2-D and IMG conditions. Any other statistically significant pairwise comparisons are described in the text. IMG, imagery; 2-D, two-dimensional; VR, virtual reality.

FIGURE 13

Bars illustrate the mean ratings obtained on a 0- to 10-point scale for the VR (green), 2-D (purple), and IMG (orange) formats of the task, also written in the embedded table below. Error bars illustrate the standard error of measurement. Asterisks denote the 10 of 10 ratings in which the mean rating for the VR condition significantly exceeded the mean rating for both of the 2-D and IMG conditions. Any other statistically significant pairwise comparisons are described in the text. IMG, imagery; 2-D, two-dimensional; VR, virtual reality.

FIGURE 14

Bars illustrate the mean ratings obtained on a 0- to 10-point scale for the VR (green), 2-D (purple), and IMG (orange) formats of the task, also written in the embedded table below. Error bars illustrate the standard error of measurement. In the absence of a significant ANOVA, no pairwise comparisons were conducted but rather all are assumed to be nonsignificant. See text for further description. IMG, imagery; 2-D, two-dimensional; VR, virtual reality.

FIGURE 15

The radar figure further depicts the pattern of the correlations noted in the table below between PTSD symptoms (measured by the PCL-5), on the one hand, and the various negative affect ratings (measured by the mDES), on the other. Asterisks denote the 20 of 30 ratings in which the correlation is statistically significant at p < 0.05 (1-tailed). See text for further description. IMG, imagery; 2-D, two-dimensional; VR, virtual reality.

FIGURE 16

Bars illustrate the number of participants in the sample with probable PTSD (i.e., the subsample scoring above 33 on the PCL-5) whose average score across the 10 negative affect ratings on the MDES exceeded the values indicated on the x axis. It can be seen that very few scored above even a relatively low value of 3 on the 0- to 10-point scale for any of the task formats: VR (green), 2-D (purple), and IMG (orange). See text for further description.

FIGURE 17

This schematic of a Venn diagram illustrates commonalities and differences between two psychological interventions, namely, exposure therapy (in blue) versus mindfulness therapy (in yellow). Commonalities between the interventions when delivered without use of VR are illustrated as the concept of integrative psychotherapy (in orange), whereas commonalities between the interventions when delivered through VR are illustrated as the concept of integrative VR therapy (in green). Commonalities between each of the independent non-VR versus VR formats of each of the independent interventions are illustrated in their respective same-colored insets. Finally, the notion of integrative therapy as commonalities across the different interventions that are in turn across the different formats of delivery is illustrated at the center of the figure (in red). See text for further description. VR, virtual reality; VRET, virtual reality exposure therapy; VRMT, virtual reality mindfulness therapy.

FIGURE 18

Schematic of a multiple mediation model that suggests the experience of absorption as a highly immersive state may be partially the product of the experience of vivid perception and presence (egocentricity). When stimuli are positively valenced, this schematic predicts a highly immersive experience of such stimuli should produce increased positive affect. See text for further description.