Creating state of the art,next-generation Virtual Reality exposure therapies for anxiety disorders using consumer hardware platforms: design considerations and future directions

Decades of research and more than 20 randomized controlled trials show that Virtual Reality exposure therapy (VRET) is effective in reducing fear and anxiety. Unfortunately, few providers or patients have had access to the costly and technical equipment previously required. Recent technological advances in the form of consumer Virtual Reality (VR) systems (e.g. Oculus Rift and Samsung Gear), however, now make widespread use of VRET in clinical settings and as self-help applications possible. In this literature review, we detail the current state of VR technology and discuss important therapeutic considerations in designing self-help and clinician-led VRETs, such as platform choice, exposure progression design, inhibitory learning strategies, stimuli tailoring, gamification, virtual social learning and more. We illustrate how these therapeutic components can be incorporated and utilized in VRET applications, taking full advantage of the unique capabilities of virtual environments, and showcase some of these features by describing the development of a consumer-ready, gamified self-help VRET application for low-cost commercially available VR hardware. We also raise and discuss challenges in the planning, development, evaluation, and dissemination of VRET applications, including the need for more high-quality research. We conclude by discussing how new technology (e.g. eye-tracking) can be incorporated into future VRETs and how widespread use of VRET self-help applications will enable collection of naturalistic “Big Data” that promises to inform learning theory and behavioral therapy in general.     

Introducing a new age-and-cognition-sensitive measurement for assessing spatial orientation using a landmark-less virtual reality navigational task

Age-related impairments during spatial navigation have been widely reported in egocentric and allocentric paradigms. However, the effect of age on more specific navigational components such as the ability to drive or update directional information has not received enough attention. In this study we investigated the effect of age on spatial updating of a visual target after a series of whole–body rotations and transitions using a novel landmark-less virtual reality (VR) environment. Moreover, a significant number of previous studies focused on measures susceptible to a general decline in motor skills such as the spent time navigating, the distance traversed. The current paper proposes a new compound spatial measure to assess navigational performance, examines its reliability and compares its power with those of the measures of duration and traversed distance in predicting participants' age and cognitive groups assessed by Montreal Cognitive Assessment (MoCA) scores. Using data from 319 adults (20–83 years), our results confirm the reliability, the age sensitivity, and the cognitive validity of the designed spatial measure as well as its superiority to the measures of duration and traversed distance in predicting age and MoCA score. In addition, the results show the significant effect of age cognitive status on spatial updating.     

Virtual personalities: Using computational modeling to understand within-person variability

How can the same underlying psychological/neurobiological system result in both stable between-individual differences and high levels of within-individual variability in personality states over time and situations? We argue that both types of variability result from a psychological system based on structured, chronic motivations, where behavior at a specific point in time is a joint function of the current availability of motive affordances in the situation, current motivationally relevant bodily or interoceptive states, and the result of the competition among alternative active motives. Here we present a biologically-based theoretical framework, embodied in two different computational models, that shows how individuals with stable personality characteristics, can nevertheless exhibit considerable within-person variability in personality states across time and situations.     

Do kinematic metrics of walking balance adapt to perturbed optical flow?

Visual (i.e., optical flow) perturbations can be used to study balance control and balance deficits. However, it remains unclear whether walking balance control adapts to such perturbations over time. Our purpose was to investigate the propensity for visuomotor adaptation in walking balance control using prolonged exposure to optical flow perturbations. Ten subjects (age: 25.4 ± 3.8 years) walked on a treadmill while watching a speed-matched virtual hallway with and without continuous mediolateral optical flow perturbations of three different amplitudes. Each of three perturbation trials consisted of 8 min of prolonged exposure followed by 1 min of unperturbed walking. Using 3D motion capture, we analyzed changes in foot placement kinematics and mediolateral sacrum motion. At their onset, perturbations elicited wider and shorter steps, alluding to a more cautious, general anticipatory balance control strategy. As perturbations continued, foot placement tended toward values seen during unperturbed walking while step width variability and mediolateral sacrum motion concurrently increased. Our findings suggest that subjects progressively shifted from a general anticipatory balance control strategy to a reactive, task-specific strategy using step-to-step adjustments. Prolonged exposure to optical flow perturbations may have clinical utility to reinforce reactive, task-specific balance control through training.     

The use of virtual reality in the study, assessment, and treatment of body image in eating disorders and nonclinical samples: a review of the literature

This article reviews research into the use of virtual reality in the study, assessment, and treatment of body image disturbances in eating disorders and nonclinical samples. During the last decade, virtual reality has emerged as a technology that is especially suitable not only for the assessment of body image disturbances but also for its treatment. Indeed, several virtual environment-based software systems have been developed for this purpose. Furthermore, virtual reality seems to be a good alternative to guided imagery and in vivo exposure, and is therefore very useful for studies that require exposure to life-like situations but which are difficult to conduct in the real world. Nevertheless, review highlights the lack of published controlled studies and the presence of methodological drawbacks that should be considered in future studies. This article also discusses the implications of the results obtained and proposes directions for future research.     

To be or not to be trusted: The influence of media richness on defection and deception

When business transactions take place between strangers, individuals rely on the cues during communication to determine whether they can trust others’ intentions. How that process occurs in the context of computer-mediated, video-mediated, and face-to-face interactions is still somewhat unknown. We examine how media richness influences both affective-based and cognitive-based trust in the context of two studies with two different social dilemma scenarios. Further, we explore how these two types of trust influence not only non-cooperative behavior (defection) but also lying (deception). Results from the first study suggest cognitive-based trust mediates the relationship between media richness and defection, while results from both studies suggest that affective-based trust mediates the relationship between media richness and deception. Video-mediated communication solves some, but not all, of the problems inherent when interacting via communication technology.     

Environmental cue saliency influences the vividness of a remote spatial memory in rats

The Morris water maze is frequently used to evaluate the acquisition and retrieval of spatial memories. Few experiments, however, have investigated the effects of environmental cue saliency on the strength or persistence of such memories after a short vs. long post-acquisition interval. Using a Morris water maze, we therefore tested in rats the effect of the saliency of distal cues on the vividness of a recent (5 days) vs. remote (25 days) memory. Rats trained in a cue-enriched vs. a cue-impoverished context showed a better overall level of performance during acquisition. Furthermore, the probe trials revealed that the rats trained and tested in the cue-impoverished context (1) spent less time in the target quadrant at the 25-day delay, and (2) swam shorter distances in the target area, with fewer crossings at both 5- and 25-day delays, as compared to their counterparts trained and tested in the cue-enriched context. Thus, the memory trace formed in the cue-enriched context shows better resistance to time, suggesting an implication of cue saliency in the vividness of a spatial memory.     

Rapid spatial learning in a velvet ant (<Emphasis Type="Italic">Dasymutilla coccineohirta</Emphasis>)

Spatial learning has been examined in a variety of animals to determine what cues are used to navigate through a complex environment. A common feature of previously studied vertebrates and invertebrates is their need to return to a previously visited site for mating, nesting, foraging or predator avoidance. Velvet ants (Hymenoptera: Mutillidae) are cursorial parasitoids with flightless females that must walk through complex terrain to find ground dwelling host larvae burrows. Velvet ants are not central-place foragers (they do not return to an established nest site) so much of the previous work on spatial learning does not directly apply in this context. It was assumed that females primarily use chemosensory cues for navigation and burrow location instead of visual learning. This study, however, demonstrates that velvet ant females are able to use visual landmarks to find an inconspicuous exit in an aversion-motivation spatial learning task. A significant number of velvet ants learned to locate the exit after seven training trials and went to the previous location of the exit even after the maze had been rotated, showing that landmarks external to the maze were used to learn the escape location.     

Life-long environmental enrichment differentially affects the mnemonic response to estrogen in young, middle-aged, and aged female mice

The present study was designed to examine whether life-long exposure to standard or enriched housing affects the ability of estrogen to improve spatial and object memory throughout the lifespan. Three-week-old female mice were maintained in standard or enriched housing up to and through ovariectomy and behavioral testing at 5, 17, or 22 months of age. Spatial memory was tested in the Morris water maze and object memory was tested using an object recognition task. Immediately after training each day, mice were injected intraperitoneally with vehicle or 0.2 mg/kg 17beta-estradiol. Among young females, object recognition was enhanced by estradiol alone, an effect that was reduced by enrichment. In contrast, spatial water maze performance was impaired by estradiol alone, but improved by the combination of both estradiol and enrichment. At middle-age, object recognition was enhanced by estradiol or enrichment alone, and the combination of both treatments. Spatial memory in the water maze was also improved by both treatments at middle-age, but the beneficial effects of estradiol were limited to standard-housed females. Finally, whereas enrichment in aged females significantly enhanced performance in both tasks, estradiol had no effect at this age in either task. In total, the data indicate that life-long enrichment can significantly alter the extent to which estradiol affects memory in mice throughout the lifespan. Importantly, the interaction between these treatments is highly dependent on age and type of memory tested.     

A model of working memory capacity in the radial-arm maze task

The radial arm maze is one of the most commonly used tests for assessing working memory in laboratory animals. However, to date, there exists no quantitative method of estimating working memory capacity from performance on this task. Here, we present a mathematical model of performance on the radial arm maze from which we can derive estimates of capacity. We derive explicit results for the two most commonly used measures of performance as functions of number of arms in the maze and memory capacity, assuming a uniform random search. We simulate random non-uniform search strategies. Comparing our model to previous experiments, we show that our model predicts a working memory capacity in the range of 3-9 at the level of performance observed in these experiments. This estimate is within the typical estimate of human working memory capacity. Performance of rats on large mazes (e.g. 48 arms) has been used as evidence that the working memory capacity of rats may be significantly larger than that of humans. We report that memory capacity in the range 3-9 is sufficient to explain the performance of rats in very large radial mazes. Furthermore, when we simulate non-uniform random search strategies observed in the experiments, the resulting estimates do not differ significantly from those assuming a uniform random search. We conclude that a list-based model of working memory with modest capacity is more powerful than previously expected.