The Virtual Freud

We are not few who would save a coin or two by being able to be our own psychologist. In a very concrete sense, this is the topic of today’s entry — how Virtual Reality (VR) can allow us another perspective on ourselves, and how this may better our mental health. At Matrise, we have previously discussed how VR can benefit anxiety sufferers through virtual reality exposure therapy. We have also discussed how the medium can facilitate Mindfulness meditation. In this entry, however, we will discuss a VR application that lets you have a conversation with Dr. Sigmund Freud. Oh, but there’s a twist!

Sigmund Freud, oil on linen. Mathieu Laca (2015).

In 2015, Sofia Adelaide Osimo, Rodrigo Pizarro, Bernhard Spanlag and Mel Slater published a paper called “Conversations between self and self as Sigmund Freud — A virtual body ownership paradigm for self-counseling“. The paper discusses an application where you sit in a chair facing Dr. Sigmund Freud. Upon entering the virtual environment, you do not float in empty space as one often does in VR — rather, you notice you have a virtual body that responds to your movements. This may lead you to identify the virtual body as your own, a magical feature commonly referred to as Virtual Embodiment. We have written extensively on this subject in a previous entry — but put shortly, the effect, apart from being very interesting in itself, has many practical applications. Self-identification with a virtual body can be exploited to, for instance, reduce implicit racial bias and make offenders of domestic violence get better in noticing the fear in victims.

Self as Other

Seeing outside into the inner

When you sit in your new virtual body, facing Sigmund Freud, you are asked to tell him about a problem. Sometime after you have emptied your heart, the virtual environment fades to black, before you once again are placed in a body, but this on the other side of the room. You are now Dr. Sigmund Freud and your patient, who looks remarkably like you, starts talking. You hear a recording of what you just said minutes ago, but you get to view your statement in a ‘new dress’: a 3D model of yourself is saying it, while you are virtually embodied elsewhere.

As humans, we know ourselves inside-out (or at least we believe we do). This may lead us to be more critical towards ourselves than others, as we compare our worst to the others best, our shame to their facade. We know all our terrible, dirty secrets, and talking to ourselves we do not have to adhere to any sort of social norms or even any general courtesy for that matter. This may lead to our inner voice becoming quite … crude. If we could focus on our own problems, in the form of the problems of others, it may be easier to be more loving towards ourselves, by utilizing the love we usually give to others. The technology can have remarkable results in affecting our selves.

In their paper abstract, Osimo et. al. write:

…this form of embodied perspective taking can lead to sufficient detachment from habitual ways of thinking about personal problems, so as to improve the outcome, and demonstrates the power of virtual body ownership to affect cognitive changes”

Internal as External

This detachment from the habitual may be very beneficial, perhaps especially in terms of Self and Identity. We have discussed this previously in our entry called “Inner as Outer: Projecting Mental States as Immersive Virtual Reality“. Apart from the philosophical buildup of the entry, the article discusses an application that, to a certain extent, allows you to view your inner states (measured through pulse and breath), as your encompassing external reality. In our entry on the use of VR in floatation tanks, we also discuss the extreme potential of this — the possibility to be stimulated by only sensory deprivation, of which can be based on your inner phenomena, thus resulting in an experience where there is no separation between the inner and the outer, thus refuting the subject-object dualism that affects our everyday living experience.

Do you have any ideas to this? Feel free to comment below.

Virtual Reality and Exposure Therapy

The most essential feature of VR is its ability to simulate what is not real. This is its core concept, and what causes its radical exclusivity and novelty. The benefits of ‘avoiding reality’ in this sense, is most often that virtuality is more cost-effective than reality. For instance, corporations worldwide train their employees in VR as it saves money to avoid renting a physical location and hiring physical trainers. ‘Money’ in this case, is of course just a measure of effectivity: it takes less resources to achieve certain objectives virtually than physically. The cost is not the only benefit, however; the virtual may also be safer. We see this especially within surgery, where a failed operation on a virtual patient is much preferred than on a real one.

“Scream”, by the expressionist painter Edvard Munch. Want to experience Munch in VR?  Read our entry on Art in Virtual Reality.

Exposure Therapy
Another scenario where virtuality may be preffered  is psychological treatment of anxiety disorders. Anxiety is a terrible disorder in the way it is eating away the lives of the sufferers, and is hard to treat to by non-addictive pharmaceutical medicine. Psychological treatment, however, is in general very successful towards certain anxiety disorders.  Agoraphobia, arachnophobia, glossophobia, etc., can be treated by what we call “exposure therapy”.

Under exposure therapy, the patient usually get together with a psychologist, and is asked to express their fears of the situation of exposure. Here they answer what they think will happen, and how they think they will react. Their fears are pinpointed, and their catastrophic thinking is outlined. In these cases, it is not uncommon that patients believe they will literally stop breathing, or die, etc.: the narrative which operates is something they buy heavily in to, and the key of exposure therapy is to challenge their acceptance of this narrative. To a certain extent, this is a central problem of anxiety disorders: patients very seldom challenge these fears, of obvious reasons, and so their map of how the world works is not challenged and updated by reality. This is, through exposure therapy, systematized.

When the patient has been exposed to their fear scenario — the psychologist confront the patient with their initial fears that were written down prior to the exposure. The patient is then encouraged to reflect on the gap between their fears and what actually happened, something which we refer to as inhibitory learning. This kind of treatment falls under what is depicted as Cognitive Behavioral Therapy (CBT); by actively challenging the patients’ mental model of the world by reflection on facts.

Long story short — exposure therapy works. The largest problem with exposure therapy is, as usual, the cost. Having highly educated psychologists dedicated to the task is expensive enough in itself — but arranging the exposure to a fear scenario is an often greater challenge, practically and economically. It is not really convenient to summon spiders into the psychologist’s office, for instance. Arranging complicated fear scenarios and executing them is not convenient, and at high cost, which is a hinder for an otherwise effective treatment.

Virtual Reality Exposure Therapy can be used to treat, for instance, arachnophobia (fear of spiders). If you are not afraid of spiders, you might need to increase their size. I can recommend trying Farpoint for PSVR, which features giant space spiders similar to those in this illustration by Alphonse de Neuville.

Virtual Reality Exposure Therapy
This is where the concept of VR enters our story, as we start talking of Virtual Reality Exposure Therapy (VREP). By using virtual environments instead of actual physical locations, effective exposure therapy can be offered to more people at lower cost. At the University of Bergen, through the research project INTROMAT, we develop and do research on VR Exposure Therapy for adolescents with fear of public speaking. The INTROMAT project aims to introduce personalized treatment of mental health problems using adaptive technology.

The question that often raises itself when we discuss the concept of VRET, is whether we can fear what we know is not real. Although we know what it is like to be nervous before talks, it is perhaps hard to imagine being afraid of speaking in front of virtual subjects in which ‘nobody’s home’. On this point, however, the research is very clear. As Lindner et. al (2017) writes, “decades of research and more than 20 randomized controlled trials show that [VRET] is effective in reducing fear and anxiety”. The reason why VRET is interesting now, today, is then not necessarily because VR is finally good enough to deliver realistic virtual scenarios. VRET has been shown to be effective with VR technologies far inferior to those setups we have commercially available today.  The reason for its relevance as a research subject now, is because the technologies are finally cheap enough to successfully be used in large scale treatment. It is therefore time to revisit the previous research, and look at how this treatment can be improved further.

Participatory Design of VR Scenarios for Exposure Therapy
We are presenting our paper on VR Exposure Therapy at the ACM CHI Conference on Human Factors in Computing Systems — the premier international conference of Human-Computer Interaction — in May 2019 (Flobak et. al.) The paper is available at ResearchGate, and has in my unbiased opinion two very interesting contributions: 1) it documents prototyping of VR with 360 cameras, which enables less technically skilled persons to produce VR (for exposure therapy, and for other areas), and 2) through the fact that it enables a larger group to produce VR, it simultaneously enables adolescents to communicate their social scenarios through the medium of VR. As we have previously discussed in The Capture of Reality, it easier to avoid the uncanny valley effect and simultaneously maintain high standards of realism when using image capture equipment, than it is to create it with 3D animation. Thus, this approach to creating VR Exposure Therapy has both the benefit of being extremely cost-effective, whilst still being developed based on good sources for the social scenario it should depict.

You can read the paper at ResearchGate. Below is the conclusion of the paper:

Conclusion
This paper has presented a participatory approach to prototyping virtual reality scenarios for exposure therapy for fear of public speaking. In the study, we demonstrate how adolescents can be involved in the design of VR scenarios enabled by 360° videos. We also show how the participants draw on their lived experiences when creating the scenarios. The paper also illustrates how 360° video is a viable tool for making the design of immersive experiences more accessible, as the method involves far less technically demanding skills than you need for constructing CGI-based environments, and is less time- consuming. Further, the expert evaluation highlighted the authenticity and realism of the scenarios, and the scenarios were seen as having a potential for use in a therapeutic context. In addition, we have discussed how this approach can be used to make tailored VR experiences for exposure therapy”

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