Virtual reality (VR) technology is often characterized as “the ultimate empathy machine” as it enables users to experience how it is to be someone else or be somewhere other than where they are in the real physical world. Here, we conducted a narrative review of studies focused on using VR to elicit empathy. Considering the synthesized literature, we identified three contexts where VR systems have been used as a tool to study empathic behavior, namely: 1) to promote pro-environmental behavior; 2) to promote prosocial behavior toward specific social groups (e.g., refugees); and 3) to medical training to promote empathy and more in-depth knowledge of clinical conditions. Based on the data collected VR seems more efective in evoking empathy than traditional approaches such as films/videos, narratives, and curriculum content. Furthermore, it was possible to identify an increase in participants' empathic responses immediately after exposure to VR and up to some period after the intervention (e.g., two months). However, despite the popularity of VR in the study of empathy, the conclusions that can be drawn regarding VR eficacy to promote/elicit empathic behavior are still obscured by the lack of consensual theoretical constructs, the use of a wide variety of self-reported measures, and the incipient use of physiological measures.
Virtual reality (VR) can be defined as an immersive and interactive computer-generated environment that gives users the feeling of being somewhere else other than where they are in the physical world [1]. Through VR, individuals have the feeling of being in a real environment and, potentially, behave accordingly [2]. Thereby, a considerable number of scientific papers have presented claims that VR can be used to elicit empathic behavior, characterizing VR technology as “the ultimate empathy machine” [3]. Empathy is the ability or tendency to share 2. Methods and understand others’ thoughts, emotions, and internal states. Although there is no widely accepted definition We conducted a narrative review of articles that use VR of empathy, there is a consensus regarding its multidi- technology to study human empathic responses. Papers mensional nature. For instance, one of the most used were screened independently by two researchers (EK and theoretical models is the one that conceives empathy FFB), and data extraction was performed by one of the as encompassing a cognitive component (i.e., the capac- co-authors (EK) and checked/complemented by another ity for understanding another person’s experience and co-author (FFB). perspective) and an emotional component (i.e., the ability to share the emotional state of another person) [4]. 2.1. Electronic Databases and Search Furthermore, in the last few years, emotion regulation String strategies have shown that empathy with other emotional competencies such as mindfulness, self-compassion, and resilience are predictors of well-being [5]. Recent studies have concluded when empathy declines, distress is a key determinant of it [6]. Furthermore, empathy has been linked to increased well-being, reduced symptoms of burnout, and more meaningful work experiences as in the case of medical workers [7]. This narrative review is a first attempt to map the current state-of-the-art on VR to study empathic behavior since, to the best of our knowledge, there is no review on this topic without focusing on a specific context (e.g., medical training) or populations (e.g., schizophrenia).
databases (i.e., the ones that authors are more familiar with). PubMed/MEDLINE and EBSCO (Psychology and Behavioral Sciences Collection) electronic databases were searched on the 14th of September using the following search string:
((empathy OR (“cognitive empathy”) OR (“emotional empathy”)) AND ((“Virtual Reality”) OR (VR)))
However, we plan to increase the number of databases include in the next step of our work which will be con- 3.1. General Characteristics of the Studies ducting a systematic review of VR to study empathy. Included
2.2. Filters and Eligibility Criteria three diferent contexts: 1) as a means to promote proWhenever possible, electronic searches were restricted environmental behaviors, for instance, by increasing doto full-text papers published in peer-reviewed journals nations to protect coral reefs [9]; 2) to promote empathy between 2012 – 2022 in English. Furthermore, in the and more in-depth knowledge of the dificulties faced by EBSCO electronic database, papers were searched using patients with dementia in healthcare workers [10] and the broader search field, while in PubMed/ MEDLINE, caregivers [11]; and 3) to promote prosocial behavior by the search-string was searched using the title/abstract facilitating perspective taking on a peer [12], homeless search field. All papers retrieved were assessed against people [13], refugees [14], victims of sexual harassment the following inclusion criteria: 1) aimed to study partic- [15], or towards people/avatars experiencing pain [16] ipants’ empathic behavior [even if the authors did not and pleasure [17][18]. A total of 2061 participants were directly mention the term empathy]; 2) while or after recruited with sample sizes ranging between 24 [17][14] being exposed to VR. Book chapters, gray literature, and and 1006 [9] participants, with four studies having resystematic and narrative reviews were excluded. Further- cruited more than 100 participants (114 [10], 180 [12], more, papers were excluded if they recruited exclusively 556 [13], and 1006 [9] participants, respectively). On under-age participants (i.e., < 18 years) or did not present average, participants were 33.19 +/- 12.75 years [19.91 standardized measures of empathy (e.g., feasibility stud- - 55.1] (mean age), and 56.85% identified themselves as ies). female, with one study only recruiting men [15]. Regarding exposure to VR, sessions took on average 10.18 +/- 5.34 minutes [4.87 - 20] (mean min), with six studies 3. Results [9][13][18][17][11][14] immersed participants in one session and three immersed participants twice [12][15][16].
With no exceptions, all included papers reported using one [9][10] [18][17][11][14] or multi-self-reported questionnaires [12][13][15][16] to measure empathy. Examples of the questionnaires used are the Interpersonal Reactivity Index [13][17], or some of its sub-scales [10][18], the Empathy Scale [15], the Situational Empathy and Perspective Taking Scale [10], the Empathy for Pain Scale [18][17], or adapted items from other empathy scales [11][14]. In addition, three papers also assessed the impact of VR on the feeling of connectedness with others [15][13][12], body transfer [12], attitude towards genderbased violence [15], personal distress, attitudes towards the homeless [13] and social presence [13][16]. Regarding objective measures, four studies used biometric signals, such as galvanic skin response (GSR) [16], and skin conductance reactivity alone (SCR) [18][17] or combined with heart rate (HR) [17]. Also, participants’ head position was tracked by a wireless InterSense IS-900 VET system [16] or using an infrared camera (Oculus DK2 IR camera) [13]. Concerning the analysis of which VR/technical components were more efective to elicit empathy, studies compared the impact of 360º immersive virtual environments (IVE) with two-dimensional video/film [ 9][14], curriculum contents (i.e., workshops [10] or e-courses material [11]), narrative-based perspective taking exercises [13][15] text-based information [9][13]. Other technical features analyzed were the degree of immersion (i.e., 3D versus 2D) [13] and the perspective in which participants experienced the VE (i.e., first-person versus third-person perspective) [18][17]. The majority of the papers immersed participants using head-mounted displays (HMD) [15], some have specified it is Oculus Rift DK2 [13][18][17][11] or HTC Vive [12], but also headsets as Oculus Quest [10], Samsung VR headset [14] or Zeiss VR One Headset [9] were used, and in one study the immersion is achieved by 3D shutter glasses NuVision [16].
research concerning the use of VR to study/elicit empathy.
As the next step, we plan to upgrade it to a systematic review by surveying more papers and analyzing them more thoroughly. While we find the evidence on the efectiveness of VR in eliciting empathy promising, it is still clouded by the lack of gold-standard instruments to measure empathy. We believe that an important next research step in this domain should be finding how empathy influences physiological attributes and using the 3.3. Eficacy of VR to Elicit Empathy sensors as a more objective measure of empathy. Furthermore, VR’s impact on empathy seems to be moderated The impact of VR to elicit empathy seems to be moderated by demographic, methodological and context variables by several factors (e.g., contexts, order of exposure, con- that should be taken into consideration in future studies, trol condition to which VR is compared, and demographic too. variables). For instance, two studies reported that 360º IVEs are more efective than (unidirectional) videos/films Acknowledgments to promote pro-environmental behavior [9] and empathy toward refugees [14]. In another study, targeting per- The research and the preparation of the paper on the sonal distress and empathy toward the homeless [13], no part of E.K. was supported by the Slovenian Research statistical diferences were found between 360 º IVEs and Agency (ARRS) as part of the young researcher PhD pronarrative-based perspective exercises. However, it was gram, Grant (PR-12092). This work was also supported possible to identify a long-lasting positive attitude toward by FCT through LASIGE funding (ref. UIDB/00408/2020 the homeless (i.e., two months after the intervention) in and ref. UIDP/00408/2020), and the WideHealth project, the IVEs group but not in the control group [13]. In addi- European Union’s Horizon 2020 research and innovation tion, when analyzing empathy toward victims of sexual program under grant agreement No 952279. harassment, 360º IVEs was as efective as a narrative- (*Asterisk denotes studies included in the review) based perspective-taking exercise [15]. However, significantly higher scores on empathy were identified when participants were first exposed to the narrative-based References perspective-taking exercise after the 360° IVEs rather than before the 360° video [15]. When VR was used as a medical training tool, one study [11] showed that 360º IVEs’ are more efective in promoting empathy toward the challenges faced by people with dementia, while in another study, 360º IVEs’ impact on medical training and empathy towards patients with dementia were moderated by demographic characteristics, with significant improvements on empathy levels being identified only in older and non-english native speakers participants [10]. Furthermore, higher scores on empathy scales were identified when participants are asked to interact with avatars depicting familiar faces expressed pain compared to unfamiliar avatars [16] or when taking the perspective of an individual they expect later to interact [12].
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