Automated interaction may reduce emotional reactivity in VR: a randomized study with healthy participants

Julia Elisabeth Diemer^1,2*Magdalena Sich¹Bastian Lange³Mathias Müller³Marius Koller⁴Philip Schäfer^4,5Gerrit Meixner⁴Alexander Brunnauer^1,6Peter Zwanzger^1,6

• ¹kbo Inn Salzach Klinikum, Wasserburg am Inn, Germany
• ²Department of Psychology, Faculty of Psychology and Education, Ludwig Maximilian University of Munich, Munich, Bavaria, Germany
• ³VTplus GmbH, Wuerzburg, Germany
• ⁴UniTyLab, Heilbronn University, Heilbronn, Germany
• ⁵RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany
• ⁶Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Bavaria, Germany

Virtual reality (VR) has been investigated as a psychotherapy tool for three decades, with the most recent developments introducing automated self-help programmes without direct therapeutic assistance. In particular, a number of publications have presented therapist-free VR exposure therapy for anxiety disorders as a way of improving patient access to psychological therapy. However, it is unknown whether the removal of interaction with a real person during VR exposure changes emotional experience. The aim of this study was to test the effect of automated interaction on presence and emotion in VR. Both are important processes in VR-supported exposure therapy, with stronger emotional arousal and greater presence considered necessary for successful therapy. This is a monocentric, randomized study comparing automated (auto) interaction in VR with experimenter-led (live) interaction during emotionally relevant VR scenarios (spiders, public speaking). The presence or absence of a psychophysiological recording device (smartwatch) was included as a second between-subjects factor. N=64 healthy participants gave ratings of subjective emotional arousal and presence in VR.In the spider scenario, arousal, our primary outcome measure, was significantly reduced in the auto condition, with no effect of the factor smartwatch. This effect was not seen in the public speaking scenario. For presence, in both scenarios, an interaction (condition x smartwatch) was significant, with participants in the auto condition reporting greater presence if they wore a smartwatch.We found that design features of our VR system critically influenced presence and emotional effects. In particular, the reduced emotional arousal in the spider scenes means that automated setups might not be as suited for exposure therapy as therapist-led VR scenarios. To our knowledge, a direct comparison between automated and natural communication during emotional exposure in VR has not been done. However, our data indicate the importance of such comparisons. Our study thus addresses an important gap in the current VR literature. Future research will need to establish whether similar effects can be found in the target populations of exposure therapy, i.e. patients with anxiety disorders, and whether such emotional effects might impact therapeutic outcome.