title: Is virtual reality always an effective stressors for exposure treatments? Some insights from a controlled trial.
abstract: BACKGROUND
  Several research studies investigating the effectiveness of the different treatments have demonstrated that exposure-based therapies are more suitable and effective than others for the treatment of anxiety disorders. Traditionally, exposure may be achieved in two manners: in vivo, with direct contact to the stimulus, or by imagery, in the person's imagination. However, despite its effectiveness, both types of exposure present some limitations that supported the use of Virtual Reality (VR). But is VR always an effective stressor? Are the technological breakdowns that may appear during such an experience a possible risk for its effectiveness?
  
  
  METHODS
  To answer these questions we compared changes following the exposure to an academic examination, one of the most universal examples of real-life stressors, in a sample of 39 undergraduate students. The same experience was offered using text (TX), audio (AU), video (VD), and VR. However, in the virtual environment we manipulated the experience introducing technological breakdowns. The Post Media Questionnaire (PMQ) and the Slater-Usoh-Steed Presence Questionnaire (SUS) were administered to each participant in order to evaluated self-report measures of anxiety and relaxation and the level of presence experience during media exposure. Electrocardiogram (ECG), Thoracic Respiration Signal (RSP) and Facial corrugator supercilii muscle Electromyography (EMG) were recorded in order to obtain objective measures of subjects' emotional state.
  
  
  RESULTS
  Analyses conducted on PMQ showed a significant increase in anxiety scores and a mirror decrease in relax scores after all our emotional procedures, showing that all the condition were effective in inducing a negative emotional response. Psychometric scores and psychophysiological indexes showed that VR was less effective than other procedures in eliciting stress responses. Moreover, we did not observe significative difference in SUS scores: VR induced a sense of presence similar to that experienced during the exposition to other media.
  
  
  CONCLUSIONS
  Technological breakdowns significantly reduce the possibility of VR eliciting emotions related to complex real-life stressors. Without a high sense of presence, the significant advantages offered by VR disappear and its emotional induction abilities are even lower than the ones provided by much cheaper media.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  NCT01683617.
authors: Istituto Auxologico Italiano IRCCS, Applied Technology for Neuro-Psychology Laboratory, Milan, Italy. f.pallavicini@auxologico.it
authors: Federica
authors: F
authors: Pallavicini
authors: Pietro
authors: P
authors: Cipresso
authors: Simona
authors: S
authors: Raspelli
authors: Alessandra
authors: A
authors: Grassi
authors: Silvia
authors: S
authors: Serino
authors: Cinzia
authors: C
authors: Vigna
authors: Stefano
authors: S
authors: Triberti
authors: Marco
authors: M
authors: Villamira
authors: Andrea
authors: A
authors: Gaggioli
authors: Giuseppe
authors: G
authors: Riva
mesh_terms: D001008:Anxiety Disorders / Q000503:physiopathology / Q000628:therapy*; D004562:Electrocardiography; D004576:Electromyography; D004644:Emotions / Q000502:physiology; D006801:Humans; D011594:Psychometrics; D012119:Respiration; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014584:User-Computer Interface; D063367:Virtual Reality Exposure Therapy / Q000379:methods*; D055815:Young Adult
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