The influence of virtual reality exposure on social and phobic behaviours

Background: For decades, researchers and therapists have attempted to utilize virtual reality (VR) technologies for therapeutic use, most notably for treatments regarding specific phobias and anxiety disorders, but implementation of VR-based therapies was largely held back due to factors such as cost, accessibility, and technological limitations. Modern VR, however, appears to address many of the issues from older VR models, making the technological medium more affordable, accessible, and powerful than any previous VR iteration. While modern VR was largely designed for entertainment purposes, the features inherent in modern VR systems, such as online storefronts, stereoscopic displays, and tracking capabilities, may prove to be invaluable to advancing the implementation and delivery of VR-based therapies. Objective: The aim of this thesis was to evaluate the influence of repeated VR exposure on both phobic and social behaviours to inform the development of a self-directed VR exposure therapy (VRET) procedure that appropriates VR programs that were not specifically designed for therapeutic purposes, such as VR games, for therapeutic purposes. Methodology: A systematic review and three experimental studies were conducted as part of the present thesis. The systematic review examined a total of 88 studies obtained through multiple databases, with findings from the review serving to inform the efficacy of VRET, application of VR technology in therapeutic and experimental settings, and the advantages and disadvantages of utilizing VR technologies. The first experimental study (N = 3) was a case study that examined the effectiveness of a self-directed VRET in which patients were randomly assigned to either a Pure Self-Help (PSH), Guided Self-Help (GSH), or Waiting List group. Both PSH and GSH patients were allotted up to 12 1-hour treatment sessions, with the only difference between the groups being the amount of interaction with the lead experimenter during the treatment sessions. The second experimental study (N = 21) sought to examine the influence of repeated VR gaming on cyberaggression, with participants being randomly assigned to either a Violent, Non-Violent, or No Game group. Participants in the Violent and Non-Violent group played a selection of three games related to their group category over the course of six weekly sessions, with measures for aggression being conducted through questionnaires and a YouTube commenting task. Lastly, the third experimental study (N = 20) was conducted to reinforce findings from the second study by evaluating potential changes in prosocial behaviours. Participants were randomly assigned to either a Violent Competitive or Non-Violent Cooperative group, each playing a single game over the course of two weekly sessions, and prosocial behaviours were measured via a questionnaire. Results: Findings from the first experimental study showed promise towards the effectiveness of self directed VRET, but with a few caveats. While both the PSH and GSH patients experienced improvements at the post-treatment phase, the PSH patient was still within the clinical average across each measure for acrophobia. Objective measures such as heart rate and self-report questionnaires did not appear to indicate significant improvement for the PSH patient, but the patient believed significant improvement had been made during post-treatment and 6-month follow-up interviews. As for the experimental studies regarding VR gaming’s influence on aggression and prosocial behaviours, there were no significant differences in behaviours between each group. Contribution to Knowledge: The present thesis has created a foundation to build a self-directed VRET procedure by appropriating non-therapeutic VR applications for therapeutic use, while also demonstrating that while repeated exposure to VR experiences can reduce acrophobia-related fear and anxiety, it cannot amplify or diminish the individual’s aggression and prosocial behaviours, respectively