Virtual reality exposure therapy for social phobia

This thesis presents researches and experiments performed in collaboration with a psychiatrist in order to validate and improve the use of virtual reality in social phobia psychotherapy. Cognitive and behavioral therapies are strongly based on the exposure to anxiety provoking stimuli. Virtual reality seems to be appropriate for such exposures as it allows for on-demand reproduction of reality. The idea has been validated for the treatment of various phobias but is more delicate in the case of social phobia; whereas the sense of presence provoked by the immersion in a virtual environment supports the emergence of fears linked to a location, we had to verify that we can reproduce social phobia related anxiety-provoking stimuli by simulating virtual humans. Therefore, and in order to provide therapists with an efficient virtual reality system dedicated to the exposure to social situations, we have developed software solutions supporting different immersion setups and enabling realistic simulations of inhabited virtual environments. We have experimented with public speaking scenarios within a preliminary study, three clinical case studies and a validation study on 200 subjects. We have been able to confirm that our virtual reality platform fulfilled therapeutic exposure requirements for social phobia. Moreover, we have been able to show that virtual reality exposure has additional advantages such as the possibility to improve clinical assessment with embedded monitoring tools. Our experiments with physiological measurements and eye tracking technology during immersion leaded to the validation of systems for objective and reliable assessment of patients' safety behaviors. The observation of such phobic reactions has confirmed the simulation impact and may provide therapists with enhanced pathological progression monitoring. During our experiments, we have also been able to observe that subjects' reactions during immersion were so much influenced by their sensitivity to fearful stimuli that their cognitive reactions were 'overloaded' by the arousal of anxiety and emotions. This has allowed us to consider that the sense of presence was more importantly related to the subjective impact of the content than to the technological process.

Coding gaze tracking data with chromatic gradients for VR exposure therapy

Pablo Stanislaw De Heras Ciechomski, Helena Stephanie Grillon Le Gallennec, Bruno Herbelin, Daniel Thalmann

This article presents a simple and intuitive way to represent the eye-tracking data gathered during immersive virtual reality exposure therapy sessions. Eye-tracking technology can be used to observe gaze avoidance behaviors to provide cognitive and behavioral therapists with valuable information on the severity of a phobic disorder. However, basic eye-tracking systems only supply 2D gaze point coordinates on the recorded video images of the subject’s view. The use of eye-tracking during virtual reality sessions allows to directly associate the gaze behavior to the 3D environment. The gaze-map color coding presented here uses a color picking technique and a specific data representation which provides precise visual gaze information per 3D object. This article presents our technological solution and its relevance for therapeutic needs, as well as the experiments performed to demonstrate its usability in a medical context. Results show that the gaze-map technique is fully compatible with different VR exposure systems and provides clinically meaningful data.

2007

Use of Virtual Reality as Therapeutic Tool for Behavioral Exposure in the Ambit of Social Anxiety Disorder Treatment.

Helena Stephanie Grillon Le Gallennec, Bruno Herbelin, Daniel Thalmann

We hereby present a study whose aim is to evaluate the efficiency and flexibility of virtual reality as a therapeutic tool in the confines of a social phobia behavioural therapeutic program. Our research protocol, accepted by the ethical commission of the cantonal hospices’ psychiatry service, is identical in content and structure for each patient. This study’s second goal is to use the confines of virtual exposure to objectively evaluate a specific parameter present in social phobia, namely eye contact avoidance, by using an eye-tracking system. Analysis of our results shows that there is a tendency to improvement in both the questionnaires and eye contact avoidance.

2006

Simulating interactions with virtual characters for the treatment of social phobia

Helena Stephanie Grillon Le Gallennec

Virtual Reality (VR) has nowadays become a very useful tool for therapists in the treatment of phobias. Indeed, it allows the simulation of scenarios which are difficult to reproduce in real life. It also allows for a situation to be repeated as much as one wants. Moreover, it allows for a complete control over the situation. The simulation can be stopped if the patient cannot handle it. It can also be tweaked for gradual exposure. Virtual Reality Exposure Therapy (VRET) has proven to be efficient in the context of phobias such as acrophobia or the fear of flying. Social phobia, however, are much harder to deal with. Indeed, as humans, we are experts in human representations and behaviors; it makes it much harder to obtain credible and immersive environments. In this thesis, we describe a set of tools and applications which we have developed to be used in VRET of social phobia and agoraphobia with crowds. We first describe how we create different scenarios for VRET of social phobia. We then expose the application we have developed which allows for elaborate interactions between a user and virtual characters. In particular, we have designed and implemented a software which allows for virtual characters to change behavior depending on the user's eye contact behavior. It allows them to seem interested when being looked at and distracted when not. We then describe the model we have implemented to simulate gaze attention behaviors for crowds of virtual characters. This consists of a method that automatically detects where and when each virtual character in a crowd should look. Secondly, it consists of a dedicated gaze Inverse Kinematics (IK) solver in order for the virtual characters to satisfy the constraints defined by the automatically detected points to be looked at. This allows for the characters to perform the looking motion in a natural and human like way. We then describe the architecture we have developed to combine the work we have done in the domain of social phobia and this model of attention behaviors for crowd characters. We thus use our model of looking behaviors to allow for crowd characters to look at each other. We also use eye-tracking and optical motion capture to determine where a user is looking in a CAVE environment. The virtual characters then respond by either looking at the user, looking at what the user is looking at, or looking at other characters in the crowd. We thus obtain an immersive and interactive environment for VRET in the domain of agoraphobia with crowds. The third part of this thesis describes various experiments we have conducted in order to validate our applications. Our first study consists of using VR in a head-mounted display (HMD) for the treatment of social phobia. In this study, we also use eye-tracking in order to analyze eye contact avoidance behaviors before and after therapy. We then discuss the use of eye-tracking as a tool to help assess and diagnose social phobia. Since eye contact avoidance behaviors are frequent in people suffering from such phobias, eye-tracking can certainly be a helpful tool. We describe an experiment in which we tested eye-tracking as a diagnosis and assessment tool on a phobic population and on a control group. We also describe an experiment to evaluate the potential of our proposed interaction loop in the context of social phobia. Finally, we describe the experiment we have conducted to evaluate our application in the context of agoraphobia with crowds.

EPFL2009

Simulating interactions with virtual characters for the treatment of social phobia

Helena Stephanie Grillon Le Gallennec

EPFL2009