Different audience atmospheres for VR exposure therapy

Closed Human-Computer Interaction Bachelor Thesis No Affiliation

1. Motivation

Glossophobia is defined as the fear of speaking publically in front of an audience [21]. Given its prevalence of 75\% people affected by nervousness or discomfort when performing public speaking [10][16][24], glossophobia can have significant consequences, e.g. in terms of the well-being of students [15] or the success in the work life [17]. People who stutter are even more likely to be afraid of public speaking situations [5] and rate their self-perceived communicative competence in these situations significantly lower in comparison to people who do not stammer [4]. It is therefore important to provide therapeutical assistance especially for people who stutter to minimize negative impacts and improve public presentation.

One method to do so is the use of exposure therapy. Exposure therapy confronts the patient with negatively perceived stimuli triggering anxiety and other unpleasant emotions in order to decrease the avoidance behaviour in such situations [18]. One modality of presenting these stimuli is by means of virtual reality (VR). The advantage of carrying out exposure therapy in VR is its high acceptance and the absence of a dependency on the patient’s imagination [3]. Meta-analyses show no difference between real and VR exposure therapy while both performed significantly better than a control group [9][19][22]. Hence, VR exposure therapy represents an effective method to treat glossophobia.

The key point of exposure therapy is the triggering of anxiety and unpleasant emotions [3][18]. Given that glossophobia is a social anxiety [21], it is mainly the audience and its behaviour contributing to the emergence of anxiety and stress [2][14]. Furthermore, for the design of a virtual audience used for exposure therapy, it is essential to provide different situations and behaviours to provide an effective therapy and avoid risk of relapses [18].

The goal of this study is therefore to design multiple audience scenarios for VR exposure therapy each with different behavior to increase effectivity and authenticity of the given situation. Expert interviews are to be performed in order to validate the presented atmosphere of each audience scenario.

2. Previous work

Many studies have proven the effectiveness and utility of virtual exposure therapy to treat people who stammer. In terms of the general viability of virtual exposure, Walkom [25] showed an overall increase of anxiety during therapy and a gradual decrease over repeated sessions.
In comparison to a real life therapy method, Anderson and her colleagues [1] evaluated 97 participants diagnosed with social anxiety stating public speaking anxiety as their primary fear. The authors compared a virtual reality exposure to real-life group exposure therapy as well as a waitlist control group. The design of the virtual audience consisted of different group sizes and the ability to manipulate audience reaction to convey either supportive or indifferent behavior. Results showed no significant difference during either pre-test, post-test or 12-month follow-up between the real and virtual therapy method [1]. A similar result was found by Brundage and his colleagues [8] when they tested ten persons who stutter speaking in front of either a live or two different virtual audiences. Correlational analyses suggest that the participants’ reactions in the virtual environment correlate significantly to those in the real scenario [8], therefore underlining the viability of virtual exposure therapy.

In previous studies, the role of the audience mostly differs in two ways. Either the mere presence of a neutrally animated audience [7][12][25] or their behavior expressed in certain extremes, i.e positive, neutral or negative [1][8][20][23] is used to create a realistic atmosphere. However, little effort has been put into the elaborate design of distinctive virtual audience atmospheres in either of the extremes. Hence, this study will focus on developing different audience scenarios for VR exposure therapy to gain further insights of its effects on people who stutter and its synthesis with exposure therapy.

3. Method

The atmospheres will be developed by means of a behaviour plugin for the Unreal Engine project Virtual Elo. The plugin’s current functionality includes switching between a positive, neutral and negative atmosphere created by an audience of ten people in a small classroom. Certain animations in terms of posture, gaze and head movement express the audience’s attitude towards the speaker. Since the emergence of anxiety is essential for a successful exposure therapy [3][18], the focus will lie on developing different negative atmospheres based upon distinctive behavioral characteristics. The diversity of the scenarios ensures long-term therapeutical improvements and effectivity of the therapy [18].

To validate the perceived behavior, guided expert interviews will be conducted. Expert interviews stand out due to the special status of the interviewee. Experts are able to give access to certain knowledge areas and provide factual as well as experiential knowledge without too much effort [11]. The advantage of expert interviews is that elaborate observational processes can be abbreviated as with their knowledge, experts act as a representative example of a variety of people to be asked [6]. A flexible guideline will be used in order to ensure a content-related focus as well as enable independent descriptions and stories [13]. An example for a suitable expert is a research assistant in the area of speech therapy because the combination of scientific and practical knowledge gives useful information about the viability of the atmospheres and the general application.

4. Working plan

5. Literature

[1] Anderson, P. L., Price, M., Edwards, S. M., Obasaju, M. A., Schmertz, S. K., Zimand, E., & Calamaras, M. R. (2013). Virtual reality exposure therapy for social anxiety disorder: A randomized controlled trial. Journal of consulting and clinical psychology, 81(5), 751.

[2] Bassett, R., Behnke, R. R., Carlile, L. W., & Rogers, J. (1973). The effects of positive and negative audience responses on the autonomic arousal of student speakers. Southern Journal of Communication, 38(3), 255-261.

[3] Bentz, D., Michael, T., & Margraf, J. (2009). Konfrontation und Exposition. Psychiatrie und Psychotherapie up2date, 3(06), 409-428.

[4] Blood, G. W., & Blood, I. M. (2004). Bullying in adolescents who stutter: Communicative competence and self-esteem. Contemporary Issues in Communication Science and Disorders, 31(31), 69-79.

[5] Blumgart, E., Tran, Y., & Craig, A. (2010). Social anxiety disorder in adults who stutter. Depression and Anxiety, 27(7), 687-692.

[6] Bogner, A., Littig, B., & Menz, W. (2009). Introduction: Expert interviews—An introduction to a new methodological debate. In Interviewing experts (pp. 1-13). Palgrave Macmillan, London.

[7] Brundage, S. B., Brinton, J. M., & Hancock, A. B. (2016). Utility of virtual reality environments to examine physiological reactivity and subjective distress in adults who stutter. Journal of fluency disorders, 50, 85-95.

[8] Brundage, S. B., & Hancock, A. B. (2015). Real enough: Using virtual public speaking environments to evoke feelings and behaviors targeted in stuttering assessment and treatment. American Journal of Speech-Language Pathology, 24(2), 139-149.

[9] Carl, E., Stein, A. T., Levihn-Coon, A., Pogue, J. R., Rothbaum, B., Emmelkamp, P., … & Powers, M. B. (2019). Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. Journal of anxiety disorders, 61, 27-36.

[10] Hamilton, C. (2013). Communicating for results: A guide for business and the professions. Cengage Learning.

[11] Helfferich, C. (2019). Leitfaden-und Experteninterviews. In Handbuch Methoden der empirischen Sozialforschung (pp. 669-686). Springer VS, Wiesbaden.

[12] Kelly, O., Matheson, K., Martinez, A., Merali, Z., & Anisman, H. (2007). Psychosocial stress evoked by a virtual audience: relation to neuroendocrine activity. CyberPsychology & Behavior, 10(5), 655-662.

[13] Liebold, R., & Trinczek, R. (2009). Experteninterview. In Handbuch Methoden der Organisationsforschung (pp. 32–56). Springer.

[14] MacIntyre, P. D., Thivierge, K. A., & MacDonald, J. R. (1997). The effects of audience interest, responsiveness, and evaluation on public speaking anxiety and related variables. Communication research reports, 14(2), 157-168.

[15] Martin-Lynch, P., Correia, H., & Cunningham, C. (2016). Public speaking anxiety: the SAD implications for students, transition, achievement, success and retention.

[16] McConnell, C. R. (2009). Effective oral presentations: speaking before groups as part of your job. The health care manager, 28(3), 264-272.

[17] McCroskey, J. C., & Richmond, V. P. (1985). Communication: Apprehension, avoidance, and effectiveness. Scottsdale, AZ: Gorsuch Scarisbrick.

[18] Mühlberger, M., & Voderholzer, U. (2015). Konfrontationstherapie im Fokus. InFo Neurologie & Psychiatrie, 17(11), 36-46.

[19] Opriş, D., Pintea, S., García‐Palacios, A., Botella, C., Szamosközi, Ş., & David, D. (2012). Virtual reality exposure therapy in anxiety disorders: a quantitative meta‐analysis. Depression and anxiety, 29(2), 85-93.

[20] Pertaub, D. P., Slater, M., & Barker, C. (2002). An experiment on public speaking anxiety in response to three different types of virtual audience. Presence: Teleoperators & Virtual Environments, 11(1), 68-78.

[21] Perveen, K., Hasan, Y., & Aleemi, A. R. (2018). Glossophobia: The Fear of Public Speaking in Female and Male Students of University of Karachi. Pakistan Journal of Gender Studies, 16(16), 57-70.

[22] Powers, M. B., & Emmelkamp, P. M. (2008). Virtual reality exposure therapy for anxiety disorders: A meta-analysis. Journal of anxiety disorders, 22(3), 561-569.

[23] Slater, M., Pertaub, D. P., & Steed, A. (1999). Public speaking in virtual reality: Facing an audience of avatars. IEEE Computer Graphics and Applications, 19(2), 6-9.

[24] Tse, A. Y. H. (2012). Glossophobia of university students in Malaysia. International Journal of Asian Social Science, 2(11), 2061-2073.

[25] Walkom, G. (2015). Virtual Reality Exposure Therapy.

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