Use of Virtual Reality in Psychology

Use of Virtual Reality in Psychology Arhum Hakim1(B) and Sadaf Hammad2 1 School of Social Sciences and Humanities, National University of Sciences and Technology (NUST), Islamabad, Pakistan [email protected] 2 Video Surveillance Lab PNEC-NUST, Karachi, Pakistan Abstract. The field of psychology is advancing with incorporation of immersive technologies and Virtual Environments (VE) in research, treatment, assessment and learning etc. Virtual Reality (VR) is one of the focused sub-domains of immersive technologies that is being used vastly in psychology. This also comes under the paradigm of cyberpsychology. The advancements reported in this area bring the need to understand the benefits provided by virtual reality with respect to human interaction and behavior etc. The published literature available discusses the development and evolution of cyber psychology specifically with respect to virtual reality. To the best of our knowledge the latest developments due to virtual reality in various sub fields of psychology have not been collectively documented so far. This paper provides highlights of the developments and transformations linked with the usage of virtual reality with recommendations about future studies and provides the reader a broader and informed view of this cross-disciplinary area. Moreover, the paper also provides limitations that exist, and considerations required while using VR for a specific treatment or experimentation. Keywords: Immersive technology · Virtual Reality · Cyberpsychology · Psychology 1 Introduction Psychology is a vast discipline involving scientific investigation of mind and behavior. It includes the understanding of mind and how it affects a person’s behavior. Overtime, the field has been expanded into multiple sub-domains including clinical, experimental, educational, child, rehabilitation, sports, and social psychology etc. Similarly, the field of psychology consists of multiple professionals who mainly assess and treat mental health issues, counselors who counsel individuals, and professionals who work for the betterment of a team/organization. Psychology as a field has further progressed with the application of immersive technologies and Virtual Environments (VE). Virtual Reality (VR) is one of the focused sub-domains of immersive technologies that is being used vastly in psychology. In VR the user operates through three dimensional VE and interacts with the environment using sensory inputs from especially designed head and hand gears. The VR headsets are wearable devices having display optic for each eye leveraging 360° view and have onboard or off-board/wired processing options. VR usage in the field of © The Author(s) 2022 C. Biele et al. (Eds.): MIDI 2021, LNNS 440, pp. 208–217, 2022. https://doi.org/10.1007/978-3-031-11432-8_21 Use of Virtual Reality in Psychology 209 psychology has enhanced not only the interaction between people but has also facilitated the researchers to conduct studies that are impossible to carry out in the real world. This research paper highlights the usage of VR and related advancements in major sub-fields of psychology. The rest of the paper is organized as follows. Section 2 briefly represents the background research reported in the area. Applications of VR in various psychology subdomains are presented in Sect. 3. Section 4 highlights some limitations. Section 5 provides the discussion with some future research dimensions and Sect. 6 the conclusion. 2 Background The advancements in the field of psychology in relation to technology has been discussed in literature by the research community. Findings reveal that, in current times, virtual reality appear to be one of the beneficial tools for obtaining effective outcomes with respect to therapy and rehabilitation among patients [1]. Different studies have also highlighted the developments in specific areas of psychology like assessment, diagnosis, treatment, research, and training of trainees etc. [2, 3]. Keeping in view the structure of the paper, we have discussed the related applications in Sect. 3. To the best of our knowledge, there is still a requirement of a document providing a broader spectrum of current developments in psychology with respect to VR. Such a document can facilitate the readers and researchers to acquire a broader picture and significance of incorporating the emerging technologies in the field linked to humans and their mental health. In this paper, we have tried to emphasize the overall usage and benefits that VR has provided in different sub-domains of psychology. Adding to it, gaps in previous studies with recommendations have also been discussed. 3 Application of VR in Major Sub-domains of Psychology 3.1 Clinical Psychology 3.1.1 Application in Therapy Majority of the researchers have documented developments specifically in the domain of mental health. Effective and progressive work regarding VR is being done in treating various mental health issues. The overall treatment aided by VR involves traditional treatment coupled with VR exposure based on the individual needs of the subject. The individualized aspect is determined by thorough and detailed assessment of the individual’s concern, its intensity and overall condition [2]. The effectiveness of VR in terms of satisfaction of individuals has also been assessed through a survey conducted on US Soldiers. The findings of the survey revealed that most of the individuals prefer technology-aided therapy for mental health as compared to the traditional ones [20]. Brief summary of the applications of VR in therapy are appended below: Height Phobia. Literature indicates effectiveness of virtual environments for exposure therapy to treat phobias. An experimental study conducted by Emmelkamp et al. [5] explored the efficacy of utilizing virtual environments coupled with exposure therapy for 210 A. Hakim and S. Hammad treating height phobia. Findings reveal that VR based exposure therapy is very effective compared to traditional exposure therapy as it corroborates the safety of client and doesn’t lead to fear responses that are generally experienced and high in intensity in non-virtual scenarios. It also enables the therapist to facilitate clients with weak imagination. Further, it is found to be cost effective and convenient [3]. Similar experiments and analysis was also indicated by other researchers. For example, in a recent Korean society based systematic review, effectiveness of VR psychotherapy has been analyzed for fear of height with some considerations like cyber sickness and the level of presence felt during the process [4–6]. Anxiety Disorders. Clients having anxiety disorders like Social Anxiety Disorder (SAD), Panic Disorder and Generalized Anxiety Disorder have also benefitted from VR based therapy [2, 7–9]. Further, VR is also being used for alleviating anxiety symptoms through relaxation and mindfulness techniques including breathing exercises [2]. A recent study revealed that VR is also providing stress management and social support to general public during pandemic by screening 3D movie (The Secret Garden) using mobile enabled cardboard VR headsets [10]. Eating Disorders. Studies on eating disorders indicate that VR scenarios and VR based therapy bring more improvement in symptoms of patients compared to traditional therapy. In this domain, the virtual scenarios primarily focus on cravings, body image, and emotional regulation skills [11, 12]. Moreover, Exergames involving various exercises use digital gaming for treating obesity [13]. Addictions. Combined with traditional therapy, VR has been found facilitative in reducing and preventing relapse among clients having substance addiction [14–16]. It majorly focuses on cue exposure and craving of substance [17]. Pain Management. Medicines for pain management can lead to side effects, over usage and dependence in patients [18]. VR is being recently studied for pain management as well. It introduces management of pain through virtual scenarios that facilitate distraction, shifting focus and developing skills to manage pain [19]. Post Traumatic Stress Disorder (PTSD). Literature indicates favorable outcomes in case of PTSD as the symptoms experienced due to traumatic event are found to be reduced with the use of VR [9, 21, 22]. Though more extensive research is required as studies so far have included small sample size, lack of randomization and control groups [8, 23]. False Sensory Experience and Reduced Behavioral Functioning. VR is also being researched for psychotic disorders in which the client has no contact with reality and experience delusions (false beliefs) and hallucinations (false sensory experience) with negative symptoms like reduced emotional and behavioral functioning [9]. Also some related studies conducted reveal that VR with a combination of traditional therapies can help schizophrenic patients to improve their social skills and problem solving linked to daily routine [24, 25]. Further, it is also found to be effective for reducing hallucinations and delusions [26]. Use of Virtual Reality in Psychology 211 3.1.2 Application in Psychological Assessment It is quite difficult to assess individual’s experience, cognitions and behavior with paper and pencil tests. VR enables the professionals to assess the patient under real life situations and provides authentic understanding. This includes individual’s current state based on his/her age and real life experiences thereby making the assessment as accurate as possible. Further, executive functioning of individuals can also be evaluated using VR. This relates to disorders linked with memory issues like Alzheimer’s, Parkinson’s, and traumatic brain injury [27]. A recent experimental study presents that VR based assessment is equally effective compared to the classical way of testing. It provides the clinician to monitor patient’s physiological changes smoothly and helps make the overall assessment comprehensive and accurate [28]. 3.1.3 Application in Clinical Training VR technology is also being applied for training clinical professionals. Skill development can be improved with the help of Virtual Environment (VE) as it can replicate participants and patients virtually and can provide feedback to the trainee therapist. Similarly, system generated virtual practitioners can be offered to the participants using VR and Artificial Intelligence (AI). The virtual practitioner bot can facilitate in recording non-verbal expressions and verbal communication of participant that can further aid in communication with client [29]. 3.2 Experimental Psychology VR has facilitated the researchers in studying psychological phenomenas by simulating real life situations that include cognitive functions like attention, memory, perception, and problem solving etc. Virtual Environment here aids in formulating ecologically valid and flexible settings. It also helps generate varying stimuli and can be used to evaluate multiple responses of the subject. This in-turn enables to evaluate complex behaviors of subjects under different situations [30]. Similarly, a recent review of 2019 about episodic memory research also supports the contribution of VR [31]. 3.3 Child/Developmental Psychology Neuro developmental disorders are common in children. This involves impairment/disturbance in child’s overall functioning related to social life, personal life, education life and motor behavior [32]. In case of neurodevelopmental disorders like autism, intellectual disability, and communication disorders, the focus of intervention is primarily on communication skills. VR has been used to facilitate children with autism in gaining emotional understanding and social conversation as indicated by the studies of Cheng et al. [33] and Horace et al. [34]. Some researchers have tried to assess effectiveness of VR for children with specific developmental issues though due mixed opinions, it requires further studies to evaluate its effectiveness [35]. 212 A. Hakim and S. Hammad 3.4 Educational Psychology The VR technology is also being researched for learning and educational purposes. It can facilitate teachers to make the trainee therapists and students understand complex topic [36]. Prong et al. reports that students studying biology lesson using Virtual Environment indicate high motivation and interest as compared to group of students who are taught using conventional multimedia slides [37]. Overall, VR aided learning boosts motivation, attention and interest [37, 38]. VR further facilitates in visualizing the concepts in a better way that leads to enhanced understanding of concepts. 3.5 Rehabilitation Psychology Rehabilitation psychology is a process that tends to retain plasticity of human brain. The clinical diseases specifically related to brain lead to reduced plasticity. This requires regular training to support creation of new neural pathways [39]. VR is being utilized for numerous medical conditions like stroke, cerebral palsy, traumatic brain injury, and spinal cord injury etc. [40]. Some rehabilitation VR based solutions such as Timocco have been introduced that enables the user to practice rehabilitation at home [41]. 3.6 Sports Psychology VR technology is being used for training of athletes by giving feedback about their performance during practice. Literature indicates that performance of players trained in VR is comparable to players trained in real life environment [42]. A recent study by Farlet et al. indicates that players’ sensory and motor coordination are enhanced using virtual settings [43]. 3.7 Social Psychology VR is also being used in social psychology which includes social and behavioral constructs that are quite difficult to assess in real life [44]. The social constructs include prosocial, aggressive, and discriminating behaviors etc. These social constructs/phenomenas are being studied in depth using Virtual Environments. VR based research provides full control to the observer making it ecologically valid. Behavioral tracing is one of the techniques being used to quantify and understand the construct. In a study by Rizzo et al, head rotation was observed with respect to the construct of attention in a virtual classroom and the symptoms of inattention and hyperactivity were assessed [45]. Further, in [46] author have used virtual settings to evaluate the influence of proxemics (distance among individuals affecting comfort level) and gender of instructor on learning of students [47]. 4 Limitations VR is quite effective for treatment and research purposes but it’s usage can also impact the individuals negatively. Literature reveals some of the possible effects like sickness Use of Virtual Reality in Psychology 213 caused by motion (disturbance in balance), seizures caused by light, physical injuries and fatigue due to prolonged usage, migraines, nausea, trauma, decline in cognitive performance and feelings of physical discomfort [48]. In addition to negative emotions, issues like VR simulation cost, patients getting addicted to VR experience, awareness and attitude of clinicians toward VR are also noteworthy [49]. Therefore, it is crucial for the professionals and researchers to keep the adverse impacts in mind while using VR as an augmenting tool. 5 Discussion Over the years, VR usage has expanded among different areas of psychology making it a promising and revolutionary tool. In this paper, the benefits and advancements with respect to VR in psychology from assessment, treatment and research perspective have been discussed. The literature indicates numerous advantages, for example in clinical and developmental domain, studies indicate that use of VR has effective outcomes with respect to assessment, clinician training and treatment of various mental health disorders. Similarly, VR has been very beneficial in experimental psychology. It helps better understand and study complex phenomenas in relatively efficient way compared to traditional research by making it ecologically valid. In addition, VR has transformed research in the domain of social psychology as it is practically impossible to study implicit constructs in real life situations. VR benefits have also been expanded to the field of sports. Similarly, VR is also effective for teaching and learning purposes as it enables to visualize the concepts. VR has also been instrumental in rehabilitation domain as it facilitates the patients in gaining functional ability and enhanced quality of life. The published literature provides a pool of studies catering VR and its application in major domains of psychology but there are some gaps that can be addressed in future research. Some of the major gaps are appended below for quick reference: • In clinical area, there is inadequate expertise of clinicians in using VR and lack of understanding about the suitability of VR for different individuals. Attitude of patients and professional regarding VR also adds to the gap [50]. • Using VR with children having developmental issues indicate mixed results [51] and the studies have mostly focused on treatment of specific disorders [52, 53]. • Mixed results have been reported for using VR after treatment and at follow up in rehabilitation [54]. • There is a need of standardization (psychometric properties) of VR based assessment method for generalizable results [55]. • Some gaps linked to experiments are indication of mixed results and their relation to factors like presence felt in virtual scenario of an experiment [28]. • For social constructs, issues in construct validity (definition and assessment of construct) and oversimplification of observations noted during research are indicated [47]. • Studies conducted on VR based learning indicate use of inadequate methods to assess learning outcomes [56]. • Few number of studies on skill acquisition of athletes have been reported involving old VR devices. 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