Social phobia is one of the most commonly occurring anxiety disorders; estimated to affect, within the age range of 20-65 years, close to a million people during their lifetime and almost half a million at any one time in the Netherlands alone. People with a social phobia have a strong fear of social situations, such as talking in public, entering a room with other people, ordering food in a restaurant etc. Social phobia is associated with depression, substance abuse (e.g. alcoholism, drug abuse), estricted socialisation, and poor employment and education performance. In the western world, social phobia leads to intensive use of (mental) health services. When persons with social fears seek professional help, they do it most often after a long period of increasing complaints (on average 15 year) and are being treated with exposure in vivo (i.e. exposure to actual real-life situations). Although effective, this treatment has a number of serious drawbacks such as high costs, drop outs, and fundamental constrains in the scope, control and duration of the exposure.
Research on Virtual Reality Exposure Therapy (VRET), an exciting and promising new type of phobia treatment, shows VRET as an effective, efficient and flexible treatment compared to traditional treatment in vivo. Importantly patients are much more willing to undergo VRET treatment and are less likely to refuse the treatment compared to the often dreaded exposure in vivo. Furthermore, VRET may provide a substantial improvement in the control of the treatment, both by the therapist (i.e. control of the fear-inducing scenes) and patient (treatment at home). Although still inconclusive, a number of insightful explorative studies have already reported on some of these advantages of virtual reality for the treatment of social phobia. This project will study the related advantages in combination. Showing how creative game designs, models and methods of virtual social scenes can be tailored to current brain & cognition insights and methods on therapy at home.
To realize the required improvements, further development on two key aspects is required. First, the virtual social scenes with their characters or avatars should invoke the required user experiences (i.e., social, cognitive, affective and perceptual aspects of presence) and accommodate adequate reactions to user input. To realize this we will rely on recent developments in the areas of serious gaming, virtual reality and automated dialogue systems as well as on research in human cognition, emotion and perception. Second, a computer assistant that mediates the therapist’ supervised session is needed, which monitors patients’ behaviour and responses in the virtual world, such as their fear level (e.g., based on physiological measures, emotion recognition from voice information and facial expressions). Given the therapeutic protocol and momentary fear level this assistant can, in a feedback loop, change the behaviour of the system, send a message to the therapist, and/or provide persuasive feedback to the user. To validate the models and methods of both key aspects, and to convince the field and thus get accepted as a validated treatment among therapists, a solid empirical evaluation of the solution is required, i.e. prove that the VRET treatment works for treatment of social phobia patients and show the added value, both for therapist and patient. In addition, the ICT solution should help and persuade potential patients to seek this help by providing an interactive self-diagnostic tool for at home.
In short, the project consists out of five ambitious but achievable research challenges: 1) establishing virtual social scenes with elements that can be manipulated to evoke different levels of anxiety such as natural speech dialogue with the intelligent avatars, the avatars’ behaviour, avatars’ perceived personality etc; 2) establishing a (semi-)autonomous feedback loop, whereby the system monitors the anxiety level of the patient and sets the appropriate anxiety evoking level in the virtual social scenes which can be used as input for the virtual coach of the patient (part of self-diagnostic and treatment), and for the computer assistant of the therapist (part of supervision via Internet); 3) establishing a therapist user interface for setting treatment parameters and monitor patient progress remotely; 4) comparing the effectiveness of VRET treatment with in vivo for social phobia; 5) examining the effectiveness of VRET in a home setting.