=Paper=
{{Paper
|id=Vol-3100/paper5
|storemode=property
|title=Virtual reality and emotion regulation: a systematic review
|pdfUrl=https://ceur-ws.org/Vol-3100/paper5.pdf
|volume=Vol-3100
|authors=Salvatore Vita,Caterina Morra,Angelo Rega
|dblpUrl=https://dblp.org/rec/conf/psychobit/VitaMR21
}}
==Virtual reality and emotion regulation: a systematic review==
https://ceur-ws.org/Vol-3100/paper5.pdf
Virtual reality and emotion regulation:
a systematic review
Salvatore Vitaa,b, Caterina Morra,b and Angelo Regab
a
AIAS, Via Principale per Comiziano, Nola, 80033, Italy
b
Università degli studi di Napoli Federico II, Corso Umberto I 40, Napoli, 80138, Italy
Abstract
The attention to the emotion dimension, in the context of interventions aimed at promoting psychological
wellbeing as well as the treatment of some psychopathological conditions, allowed the development in recent
decades important studies and reflections both from the point of view of theoretical scientific knowledge
and therapeutic implications.
Starting from the awareness of the important functions that emotions perform in intra and interpersonal
dynamics, the question of emotion regulation becomes central, as a complex and dynamic psychic activity
that allows the achievement of individual well-being and good social functioning.
Experiments and therapeutic interventions based on virtual reality (VR) in recent years have opened new
scenarios and led to new knowledge regarding emotion regulation in both normotypic and pathological
samples.
The aim of the following paper is to offer a review of the scientific literature of the last 10 years regarding
the use of virtual reality in the context of emotion regulation.
Keywords 1
Emotion, Emotion regulation, VR, New Tech
1. Introduction
A number of theorists, starting with Tomkins [1] and Plutchick [2], referring to Charles Darwin's theory,
have postulated the existence of some primary or basic emotions that have developed in order to regulate
behavior and favor the survival of the species, considering them as evolutionarily adaptive responses to
situational needs. Primary emotions are defined by Ekman [3] on the basis of certain characteristics:
they are short-lived, they manifest involuntarily, the cognitive evaluation of the event that triggers it
leads to an almost immediate automatic recognition of the stimulus, the antecedents are universal, the
sensation is accompanied by precise physiological mechanisms and is characterized by universal signals
recognizable in the form of particular expressive manifestations (facial expressions and specific
behaviors).
Although there is not yet full agreement among scholars, we can nevertheless estimate about five
primary emotions by relying on scientific evidence [3] fear, anger, disgust, happiness and sadness.
The Emotion Regulation (ER) is one of the most important emotion capacities and, when it is
dysfunctional, it is implicated in a series of problems that can also cause more or less serious disorders
[4] [5] [6]. For this reason it is a central and widely debated topic in the clinical and rehabilitation field,
especially as regards the improvement of possible treatment programs [7].
In support of this thesis, recent research finds identifying in a good interpersonal regulatory competence
a protective factor against psychopathology [8] and, moreover, people suffering from psychological
disorders have greater difficulties than healthy individuals [9] [10].
Proccedings of the Third Symposium on Psychology-Based Technologies (PSYCHOBIT2021), October 4–5, 2021, Naples, Italy
EMAIL: vita3913mail.com (A. 1); angelo.rega@gmail.com (A. 2); catimorra@gmail.com (A. 3)
ORCID: 0000-0002-2690-5196 (A. 1); 0000-0002-0641-7347 (A. 2);
©️ 2021 Copyright for this paper by its authors.
Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).
CEUR Workshop Proceedings (CEUR-WS.org)
Defining emotion regulation is not a simple task, in fact, literature provides various theoretical
definitions of the construct precisely because of the multiplicity of processes and functions underlying
the various regulation strategies, as well as the lack of concrete and agreed theoretical systems [10].
Virtual reality (VR) can be described through an analysis that takes into consideration purely the
technological aspect, for which it is defined as "computer-generated simulation of a real or imaginary
environment" [10].
The essential aspects, from a technical point of view, that define a virtual reality technology are: a
computer capable of supporting real-time animations, controlled by a series of position trackers; a set
of input information that must be integrated and used to provide the user with an image modification,
possibly in a rapid time to the point of creating an illusion of concomitance; a stereoscopic headset
(head-mounted-display-HDM) for visual output [11].
Despite the importance of this description, it would be simplistic to consider virtual reality as a simple
sum of technologies, its founding element and what makes it such an important scientific frontier is that
it allows a new type of human-machine interaction [12] able to convey experience and knowledge [13].
1.1 Emotion regulation in virtual reality
The impact of emotion regulation interventions on well-being has been extensively documented in the
literature and the positive changes with respect to this process have also been important with regard to
mental health and relationship satisfaction [14] [15]. Despite this, it is only in recent years that virtual
reality technologies have been incorporated into the design of such interventions, both in the clinical
and non-clinical settings, as a means to facilitate and increase the positive outcomes of ER [16] [17].
The application of virtual reality in psychology has a great advantage as it allows researchers and
doctors to create realistic experiences but in a safe environment, such as in the laboratory or in the
clinical setting [13]. Thanks to this, it is possible to measure in real time the cognitive, emotion,
physiological and behavioral responses with respect to different "real life" situations while maintaining
experimental control [18]. The VR system, therefore, has the possibility of creating a rapprochement
between laboratory and daily operation, establishing itself as an environmentally valid environment
[18].
Through virtual reality it was possible to improve the subjects' abilities to recognize and control their
emotions. Lorenzetti et al. created a virtual environment in which it was possible to experience a game
through which participants received sensory feedback in real time whenever they felt tenderness,
distress or neutral emotion states in progress [19]. The neurofeedback system was based on BCI
(neuronal interface based on EEG) for which neuronal activity was connected to the color of the virtual
environment which changed according to the fluctuation of the emotion state experienced by the
subject. In this way, the participants were instructed to feel tenderness or anguish as intensely as
possible and to voluntarily increase the intensity of their emotions in the sense of increasing their neural
activity while experiencing complex emotions [19].
Over the years, some researchers have also investigated the issue of the use of VR in pathological
samples, with the aim of monitoring its effectiveness and usability in therapy [17] [20] [21].
This article offers a review of the last 10 years regarding the use of VR in emotion regulation in different
contexts and with heterogeneous samples.
2. Method
The literature analysis was carried out using the main search engines PubMed and Google Scholar.
Advanced searches were carried out which allowed to direct the bibliographic search towards results
that presented the main keywords "virtual reality" and "emotion regulation" combined with the words
"emotion", " psychological disorders", "gad", "anxiety disorders ", "borderline" emerged after the
bibliographic searches. The words have been searched in the title section and, where possible, among
the key words. The search was carried out in July 2020, including articles published over a period of
time ranging from 2010 to 2020.
Exclusion criteria: No VR studies
3. Results
The results of Table 1 show that virtual reality is a valid tool for implementing treatments aimed at
improving emotion regulation strategies in patients and healthy subjects.
The studies by Lorenzetti et.al, Weerdmeester et al., investigated the use of biofeedback and
neurofeedback within VR and found an improvement in the regulation of the emotion and physiological
response and awareness through these techniques.
Konrad et al. and Bosse et al. both conducted two studies on non-clinical subjects and had satisfactory
results with respect to the possibility of using virtual reality systems in order to generate learning of
more adaptive ER strategies.
A series of VR interventions, carried out by Tarrant et al., Navarro-Haro et al. on the other hand, were
found to be effective in subjects with generalized anxiety disorders by improving the conscious control
of their anxious response using both relaxation techniques and meditation.
A single study was conducted by Navarro-Haro et al on borderline disorder. From this intervention,
through VR, an improvement was seen with respect to the negative emotions generally experienced by
BDP subjects.
With respect to phobic disorders, a review of nine studies presented by Wechsler et al. suggests that
VR exposure shows a greater potential and is no less effective than in vivo exposure in specific phobia
andagoraphobia.
Ultimately Wrzesien et al. they focused their intervention on the possibility of learning emotion
regulation through the use of self-similar avatars in a virtual environment and the results indicate an
improvement in emotion regulation through model observation (VRS).
Table 1
Table title
Authors Year Sample VR activities Evaluation of Outcomes
Characteristics the ER
Tong et 2015 13 patients with Immersive Numerical These findings indicate
al. chronic pain environment Rating Scale that the VMW (VR
(articles) stereoscopic (NRS) paired with
VR display for Self-Report biofeedback for MBSR
Pain Levels training) was
(values 0–10) significantly more
effective than MBSR
alone at reducing
reported pain levels
among
participants
Weerdme 2017 72 healthy Virtual Trier Social Learning to manage
ester et adults reality video Stress Test physiological activity
al. game based
(articles) on
biofeedback
Konrad et 2016 128 healthy Non SHS, SWLS, Generation of more
al. adults immersive RPWB adaptive ER strategies
(articles) web-based
VR
Bosse 2014 34 healthy Virtual subjective Strengthening or
et.al adults scenario with emotion weakening of emotion
(articles) induction of ratings responses to negative
negative stimuli
emotions
Navarro- 2019 42 patients with DBT GAD-7 HADS Improvement of
Haro et GAD immersive FFMQ DERS awareness and anxiety
al. virtual reality MAIA response
(articles)
Navarro- 2016 1 borderline Vr DBT DBT diary card Reduction of negative
Haro et patient emotion and increase
al. of awareness
(articles)
Wrzesien 2014 22 teenagers Vr with self- VAS and SAM Improvement of
et al. like avatars EGG emotion regulation
(articles) (VRS) through model
observation (VRS)
Wechsler 2019 371 phobic Exhibition in Hedges' g VR exposure shows a
et al. disorder pat. VR effect sizes greater potential and is
(articles) no less effective than in
vivo exposure in
specific phobia and
agoraphobia.
Tarrant et 2018 14 patients with VR and Physiological VR intervention led to a
al. GAD meditation measurement physiological reduction
(articles) with EGG in anxiety.
Bornioli 2019 384 healthy Non- UWIST MACL Results show the
et al. adults immersive scale, PRS crucial features that
(articles) laptop scale make walking positive
for psychological
wellbeing
Rodriguez 2015 24 healthy adult VR and Visual- activation in several
et al. Emotiv Analogue relevant brains regions
(articles) EPOC-based Scale (VAS) that are associated
EEG and PANAS with sadness induction
and that are associated
with the application of
emotion regulation
strategies
Lorenzetti 2018 8 healthy adults Exposure to Emotion Participants were
et al. the natural Regulation instructed to control
(articles) environment Questionnaire the intensity of
and (ERQ) emotions
Neurofeedba
ck
4. Conclusion
The results of this systematic review show that VR should be a valid tool for improving the ability of
individuals to manage emotions by allowing the learning of more adaptive emotion regulation strategies
to the context.
The use of this innovative technology in this sense is promising because it allows to recreate realistic
digital environments within which VR interventions can, for example, inspire new actions, increase the
awareness of subjects regarding their emotions, allow the modification of the emotion response through
the re-evaluation of emotion stimuli and, subsequently, memorize the re-evaluated experience.
These results are relevant both for health promotion and prevention treatments for the onset of disorders,
both for the treatment of subjects who already have more or less serious pathologies, as in the case of
anxiety or borderline disorders.
It has also been shown that the effectiveness can be better than non-VR treatments and that adherence to
the treatment was, in some cases, greater.
It has also been shown that the effectiveness can be better than non-VR treatments and that adherence to
the treatment was also, in some cases, greater.
Considering, therefore, the different advantages of VR exposure and its high potential, its diffusion
should be emphasized and a deeper investigation of what are the relevant operating mechanisms is
necessary in order to develop improvements in technology and procedures that they could produce even
greater effects in the future.
Research should aim to investigate the mechanisms and underlying factors that may contribute to the
effectiveness of biofeedback systems when using VR interventions for ER in order to maximize their
positive therapeutic outcomes, and furthermore, it would be interesting again, to be able to understand
how way avatars and embodiment in virtual bodies can enhance the learning of emotion regulation
strategies in a more engaging way.
As the introduction of avatars into mental health applications is relatively new, a deeper understanding
of their influence on user behavior is of great importance.
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