1. Fear of Heights

2. Video Game Mod: Max Payne

3. Controlled Studies: n > 8 AuthorCountryYear # of Pts Test Groups BullingerSwitzerland199913 SG VR, In vivo BullingerSwitzerland199815 Phobic vs. non- phobic Claustrophobia

4. 3-D Virtual Reality as a tool in Cognitive-Behavioral Therapy of Claustrophobic Patients (Bullinger et al. 1998)  Subjects:  13 Healthy subjects  2 claustrophobic patients  Apparatus:  Data Glove  HMD  CAVEEE (Computer-aided virtual environment for engineering and exploration)  Virtual Environment:  Movable front wall  3-D virtual room  Subjects were able to move head around in 3-D environment

5. Measures  Blood pressure  Pulse and O2 saturation Online Measurement

6. Results  Healthy Subjects  45-min exposure cannot be regarded as anxiety- or stress-inducing in itself  Female Patients  Presentation of specific stimulus triggered subjectively disturbance-specific symptoms for the patients  Mild rise of the pulse rate at the time of stimulus presentation

7. Results of Subject Exposures a X = measurement Pulse and Oxygen saturation of the blood were continuously measured and optically displayed

8. Virtual Environment

9. Treatment 8 VR GRADED EXPOSURE SESSIONS CLAUSTROPHOBIA

10. Assessment BAT FEAR & AVOIDANCE SCALES SUBJETIVE UNITS OF DISCOMFORT SCALE CLAUSTROPHOBIA QUESTIONNAIRE FEAR OF CLOSED SPACES MEASURE ATTITUDE TOWARDS TARGET BEHAVIOR SELF-EFFICACY TOWARD TARGET BEHAVIOR PROBLEM-RELATED IMPAIRMENT QUESTIONNAIRE ASI CLAUSTROPHOBIA

11. Scenarios CLAUSTROPHOBIA HOUSE DARK ROOM ELEVATOR

12. Works CASE STUDY (Botella, Baños, Perpiñá, Villa, Alcañiz, and Rey, 1998) CASE STUDY (Botella, Villa, Baños, Perpiñá, and García-Palacios, 1999) MULTIPLE-BASELINE DESIGN (n=4) (Botella, Baños, Villa, Perpiñá, and García-Palacios, 2000) CLAUSTROPHOBIA

13. VR treatment of claustrophobia: a case report (Botella, Baños, Perpiñá, Villa, Alcañiz, and Rey, 1998) PARTICIPANT – 43-YEAR-OLD FEMALE WITH CLAUSTROPHOBIA METHOD – SINGLE CASE STUDY – 8 VR GRADED EXPOSURE SESSIONS – ASSESSMENT: PRE, POST, 1 MONTH FOLLOW-UP RESULTS – VRE ACTIVATE ANXIETY (FEAR STRUCTURE) – ALL CLINICAL MEASURES DECREASE FOLLOWING VRE – MANTENANCE OF IMPROVEMENT AT FOLLOW-UP

14. CLAUSTROPHOBIA: A case report SUDS rating in VR sessions

15. CLAUSTROPHOBIA: A case report Self-report scale pre, post-treatment and follow-up PRIQ: Problem-Related Impairment Questionnaire FAS: Fear and Avoidance Scale TAM: The Attitude towards CTS Measure SETBM: Self-Efficacy towards Target Behaviour Measure FCSM: Fear of Closed Spaces Measure

16. VR in the Treatment of Claustrophobic Fear: A Controlled, Multiple-Baseline Design (Botella, Baños, Villa, Perpiñá, and García-Palacios, 2000) PARTICIPANTS – 1 MALE WITH CLAUSTROPHOBIA, 3 FEMALES WITH PDA (AND CLAUSTROPHOBIC FEAR) METHOD – CONTROLLED, MULTIPLE-BASELINE DESIGN – 8 VR GRADED EXPOSURE SESSIONS FOR CLAUSTROPHOBIC FEAR – ASSESSMENT: PRE, POST, 3 MONTH FOLLOW-UP RESULTS – DECREASES IN CLAUSTROPHOBIC FEAR AND AVOIDANCE – IMPROVEMENT IN BAT – DECREASES IN ASI AND INTERFERENCE – MANTENANCE AT FOLLOW-UP – IMPROVEMENT IN OTHER BEHAVIORS NOT SPECIFICALLY TREATED: AGORAPHOBIA

17. CLAUSTROPHOBIA: A controlled, Multiple-Baseline Design Scores in the Behavior Avoidance Test (BAT)

18. CLAUSTROPHOBIA: A controlled, Multiple-Baseline Design Scores in the Self-Report Measures

19. Conclusions VR was effective in the treatment of claustrophobia. Outcomes were generalized to other behaviors not specifically treated: agoraphobic situations. CLAUSTROPHOBIA

20. AuthorCountryYear # of Pts Tx Grps HoffmanU.S.199736 SG VR w/Tactile VR no Tactile, WLC HollupNorway19998 PC VR, WLC BouchardCanada200012 PC VR, Non-Phobics Tracking Behavior HoffmanU.S.2000423 Forced choice (no tx) 81% VR, 19% in vivo BouchardCanada20019 Videogame VR Garcia-PalaciosSpain200223 VR, WLC BouchardCanada200528 VR, Stroop, In Vivo Arachnophobia Controlled Studies: n > 8

21. Sample Population – 28 individuals diagnosed with arachnophobia – Recruitment through media advertisement (newspapers, publicities in universities and public places) – All participants had to be adults Arachnophobia: Fear of Spiders (Côté & Bouchard, 2005)

22. Measures – The Spider Beliefs Questionnaire (Arntz, Lavy, van der Berg, & Rijsoort, 1993) – The Fear of Spider Questionnaire (Szymanski & O’Donoghue, 1995) – The Perceived Self-Efficacy Towards Spiders Questionnaire (Cˆot & Bouchard, 2003) – State-Trait Anxiety Inventory (Spielberger, 1983) – The Immersion Tendencies Questionnaire (Witmer & Singer, 1998) – The Presence Questionnaire (Witmer & Singer, 1998) – The Simulator Sickness Questionnaire (Kennedy, Lane, Berbaum, & Lilienthal, 1993) Arachnophobia: Fear of Spiders (Côté & Bouchard, 2005)

23. Protocol – Pretest Questionnaires Behavioral avoidance test (BAT) Emotional pictorial Stroop task – Second session Explained the rationale for the treatment of specific phobias according to the cognitive behavioral model Familiarized with the virtual reality equipment Shown how to navigate in the virtual environment with no spider-related stimuli Arachnophobia: Fear of Spiders (Côté & Bouchard, 2005)

24. Protocol (cont’d) – Next five sessions Gradual exposure to spiders in virtual environment – Last session Discussed relapse prevention and self-directed in vivo exposure at home – Posttest Questionnaires Arachnophobia: Fear of Spiders (Côté & Bouchard, 2005)

25. Behavioral Avoidance Test (BAT) – A live tarantula in a case hidden under a box is placed 173 cm away from the participant, who is sitting at the end of a motorized platform – Steps: Researcher lifts the box revealing the tarantula The researcher removes the case’s lid After looking at the spider for 1 min, the participant pushes a button to move the spider closer The participant stops once their anxiety level becomes too high Arachnophobia: Fear of Spiders (Côté & Bouchard, 2005)

26. Behavioral Avoidance Test (BAT) – Steps: (cont’d) Once the platform is as close as possible to the participant (23 cm), he is asked to place his face over the case and look at the spider for 1 minute – The participant is given only 25 seconds each pause to continue moving the tarantula closer. If the time passed 25 seconds, the researcher considers it a total stop and instructs the participant to look at the spider for another 35 seconds. Arachnophobia: Fear of Spiders (Côté & Bouchard, 2005)

27. Behavioral Avoidance Test (BAT) Arachnophobia: Fear of Spiders (Côté & Bouchard, 2005)

28. Results: – Questionnaires Arachnophobia: Fear of Spiders (Côté & Bouchard, 2005)

29. BAT Results: During pretest, no participants were able to reach the last two steps (23 cm and 1 minute of looking into the case) At post-treatment, 60.7% were able to bring the tarantula 23 cm close to them and 46.4% were able to look into the case for 1 minute Arachnophobia: Fear of Spiders (Côté & Bouchard, 2005)

30. Results: – Virtual reality related measures Arachnophobia: Fear of Spiders (Côté & Bouchard, 2005)

31. Results: – Virtual reality related measures Arachnophobia: Fear of Spiders (Côté & Bouchard, 2005)

32. Conclusion: – Positive change in physiological data after treatment suggests decrease in anxiety – Avoidance is significantly reduced after treatment – A clinically and statistically effective treatment, as measured by questionnaires and a BAT, produce a significant decrease in physiological arousal when facing a live spider – In order to provide firm conclusions on the efficacy of virtual reality exposure more physiological parameters can be added, like skin conductance and respiration rate – The impact of the treatment could also be compared to a controlled study Arachnophobia: Fear of Spiders (Côté & Bouchard, 2005)

33. Regression predicting general outcome with beliefs, self-efficacy and information processing. (Côté & Bouchard, 2006) * p <.05 PredictorstB Part sr 2 Part sr 2  Beliefs 1.65.28.23  Self-efficacy -3.50*-.59-.48  Info processing.95.15.13. The regression was significant (Adj R 2 =.52), with a significant increase in variance when entering the predictors [R2 change =.48, F(3,18) = 8.52, p < 0.001]. *

34. Regression predicting avoidance (BAT) with beliefs, self-efficacy and information processing. (Côté & Bouchard, 2006) * p <.05 PredictorstB Part sr 2 Part sr 2  Beliefs -2.30-.38-.30  Self-efficacy 1.52.26.20  Info processing -.22-.04-.03. The regression was significant (Adj R 2 =.53), with a significant increase in variance when entering the predictors [R2 change =.28, F(3,19) = 5.35, p < 0.01]. *

35. Regression predicting physiological response (IBI) with beliefs, self-efficacy and information processing. (Côté & Bouchard, 2006) * p <.05 PredictorstB Part sr 2 Part sr 2  Beliefs 2.14*.45.37  Self-efficacy 2.31*.52.39  Info processing 1.66.34.28. The regression was significant (Adj R 2 = 24.), with a significant increase in variance when entering the predictors [R2 change =.36, F(3,18) = 4.16, p < 0.02]. *

36. Arachnophobia: 36 participants (Hoffman HG, Garcia-Palacios A, Carlin A, Furness TA III, Botella-Arbona C, 2003) 36 Participants  8 clinically phobic students  28 nonclinically phobic students Treatment Conditions  No treatment  VR  VR w/tactile spider Design  Three 1-hr exposure therapy sessions Results for treatment groups  Clinically significant drop in behavioral avoidance. Tactile group showed greater progress.  Clinically significant drop in subjective fear rating.

37. Tactile augmentation could be a useful add-on. (Hoffman et al., 2003) N = 36 (8 phobics) Presence was higher in VR+T Interaction p <.001 TR+T > VR > Ctrl Interaction p <.001 TR+T = VR > Ctrl Interaction p <.001 TR+T = VR > Ctrl

38. In Virtuo Exposure for Children  Children are reluctant to face their fears with in vivo exposure.  Garcia-Palacios et al. (2001) have shown that in VR exposure is more enticing for adults that in vivo.  No study has been conducted for in VR exposure with phobic children.

39. Pilot Study (Bouchard & S-Jacques, in preparation)  Nine children aged between 9 and 14.  Reliably diagnosed with arachnophobia.  Treatment :  one introductory session  three 90-minutes in VR exposure  3 blocs of 20 minutes each except the last session (2)  The study is based on a single case design with multiple baselines across subjects.

40. Questionnaires Data p <.01

41. Arachnophobia Movie Clip

42. AUGMENTED REALITY AR refers to the introduction of virtual elements in the real world. The person is seeing an image composed of a visualization of the real world, and a series of virtual elements that, at that same time, are super- imposed on the real world. The most important aspect of AR is that the virtual elements supply to the person relevant information that is not contained in the real world. AR has an important potential, and has already been used in diverse fields, such as medicine, the army, coaching, engineering, design, and robotics.

43. AUGMENTED REALITY AR Advantages - Like in the classical systems of virtual reality, it is possible to have total control over the virtual elements that are super-imposed on the real world, and how one interacts with those elements. -It can be less expensive since it also uses the real world (this does not need to be modelled), -It can facilitate the feeling of presence and the reality judgment since the environment the user is in, and what he or she is seeing is, in fact the “reality.”

45. AUGMENTED REALITY The first case study in which AR has been used for the treatment of a specific phobia: cockroach phobia. The system allows to conduct exposure to virtual cockroaches that are super-imposed on the real world. In order to carry out the exposure, the Öst’s guidelines with respect to “one-session treatment” were followed. The total duration of the exposure session was 60 min.

46. AUGMENTED REALITY