title: Learning aptitude, spatial orientation and cognitive flexibility tested in a virtual labyrinth after virtual stress induction.
abstract: BACKGROUND
  Under stressful conditions such as in an emergency situation, efficient information processing is essential for reasonable responses.
  
  
  OBJECTIVE
  Virtual Reality (VR) technology is used to induce stress and to test three main cognitive functions for decision making in stressful situations.
  
  
  METHODS
  A VR task was developed to induce stress following the Trier Social Stress Test (TSST) protocol and two VR cognitive performance tests to measure learning aptitude, spatial orientation and cognitive flexibility. Participants (N = 31) gave a public speech in front of a virtual audience (TSST) and later had to find their way out of different VR labyrinths. The first exercise tested spatial orientation and learning aptitude where participants had to learn aspects of the ground layout and geometric icons had to be identified as correct in order to be able to exit. The second labyrinth tested cognitive flexibility on the background of the Wisconsin Card Sorting Test.
  
  
  METHODS
  Correlations were analyzed using Kendall Tau Correlation (One-tailed tests with p set to 0.05 for all analyses). Heart rate (HR) was calculated from the RR time values and averaged across the TSST- speech and the post-stress period. Autonomic nervous system reactivity was defined as the deviation of HR during TSST- speech condition from post-stress baseline measurement. A repeated-measures t-test was used to analyze differences.
  
  
  RESULTS
  The newly developed virtual stress test was successfully adapted from the original TSST. Participants perceived the task as stressful and scored an average of 5.7 points on a 1-8 Likert Scale. As a physiological stress parameter, increased heart rates of the participants showed that they were more stressed during the TSST procedure compared to the post-stress period. Also, the subjective stress perception, has a strong correlation with the results of the cognitive tasks performed after the stress induction.
  
  
  CONCLUSIONS
  The more a participant experienced the TSST as stressful, the lower their learning aptitude and spatial orientation were found to be at the end of the study. On the other hand, if someone perceived the virtual TSST as "unexpected", as an indicator for a mild stress response, their cognitive flexibility was improved. Potential Implications: The findings indicate that both, the VR stress induction scenario using TSST, as well as the VR cognitive tests, are a first successful step towards a better ecological validity in neuropsychological testing.
authors.affiliation: Universitaere Psychiatrische Kliniken (UPK) Basel, Wilhelm Klein Str. 27, 4012, Basel, Switzerland.
authors.forename: Marcel
authors.initials: M
authors.lastname: Delahaye
authors.affiliation: Universitaere Psychiatrische Kliniken (UPK) Basel, Wilhelm Klein Str. 27, 4012, Basel, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Lemoine
authors.affiliation: Universitaere Psychiatrische Kliniken (UPK) Basel, Wilhelm Klein Str. 27, 4012, Basel, Switzerland.
authors.forename: Shanique
authors.initials: S
authors.lastname: Cartwright
authors.affiliation: Universitaere Psychiatrische Kliniken (UPK) Basel, Wilhelm Klein Str. 27, 4012, Basel, Switzerland.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Deuring
authors.affiliation: Universitaere Psychiatrische Kliniken (UPK) Basel, Wilhelm Klein Str. 27, 4012, Basel, Switzerland.
authors.forename: Johannes
authors.initials: J
authors.lastname: Beck
authors.affiliation: Universitaere Psychiatrische Kliniken (UPK) Basel, Wilhelm Klein Str. 27, 4012, Basel, Switzerland.
authors.forename: Marlon
authors.initials: M
authors.lastname: Pflueger
authors.affiliation: Universitaere Psychiatrische Kliniken (UPK) Basel, Wilhelm Klein Str. 27, 4012, Basel, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Graf
authors.affiliation: Universitaere Psychiatrische Kliniken (UPK) Basel, Wilhelm Klein Str. 27, 4012, Basel, Switzerland.
authors.forename: Henning
authors.initials: H
authors.lastname: Hachtel
keywords: Cognitive flexibility; Learning aptitude; Spatial orientation; Stress; TSST; Virtual Reality