The sense of presence and sense of immersion in VR

Virtual reality technology is not anything new. However, questions about its efficacy lie in the misunderstanding (or lack of understanding) of two important concepts: the sense of presence and the sense of immersion. This post delves into detail about both and provides concrete advice on how to enhance them during therapy sessions. When we speak about the efficacy of virtual reality in patients with mental conditions, we must consider the role of two integral components: the sense of immersion and the sense of presence. Without either, virtual reality therapy does not capture and maximize the patient’s attention to address mental concerns. This also applies in cases when one of the two facets is underdeveloped. For this reason, today’s post aims to elucidate these two elements as they relate to virtual reality therapy, and provide some points of guidance to deepen both senses. 

What is the sense of immersion (SoI)?

Have you ever read an adventure book or a love story in which the storyline and its accompanying characters have you turning the page without stopping? You are not aware of your actions, and yet your current reality pales to the vivacity of the imagined or conceived environment. This description reflects the sense of immersion, which virtual reality seeks to foster. In more detail, virtual reality (VR) therapy aims to immerse patients within virtual settings, so these experiences–in terms of location, characters, and actions–are similar to the real/lived experience.  As can be imagined, the degree of immersion will depend on the computer’s ability to represent these experiences through developed elements like resolution, information about the content, and richness. By the same token, though, the computer must prevent or minimize the intrusion of other physical realities present in the surrounding. 

What is the sense of presence (SoP)?

There is a nuanced difference between the sense of presence and the sense of immersion. While the latter focuses on engaging the user through a delineated and imagined environment, the former aims to transport the user to the environment and nurture the perception that the imagined (or virtual) setting and all it comprises are real (although it is not). The sense of presence is not an unfamiliar concept, though. It can be found within the area of mindfulness practice. However, the degree to which the sense of presence resonates with users, especially in a virtual reality therapy session, will differ. Such variations in the sense of presence can be attributed to certain factors. For example, display factors like physical obstacles or awareness of apparatus can diminish this subjective illusion. Other factors like internal (personality traits or immersion propensity) and social (interactions with VR characters) can affect the sense of presence felt by a patient using VR.  Finally, strong emotions like stress have been associated with a high sense of presence. 

What is necessary to heighten SoP and SoI?

For SoP and SoI to bear full effect within a virtual reality setting, patients using the breakthrough technology must find themselves truly immersed. That statement may seem blatantly obvious, but what it implies is that patients are not consciously aware that they have been placed in this simulated environment.  Cybersickness, which is a type of motion sickness that can trigger symptoms like malaise, is a clear example of a display factor capable of pulling the patient’s attention from the virtual setting to the reality of physical discomfort. Indeed,  mismatches between sensations felt and perceived, and visual display characteristics can result in this condition. Finally, the patient’s ability to conceive and accept a comprehensive, mental narrative while using VR technology is key to SoP. 

What role does the therapist play in SoP and SoI during VR therapy sessions?

Technology designed and provided by Amelia Virtual Care optimizes both SoP and SoI. While some programs or modules may only include SoI (for example, Amelia Virtual Care available on the smartphone), all programs aim to depict elements as realistically as possible, including accompanying sounds or graphic visual cues. Yet, these tools’ potential efficacy grows when mental health professionals integrate specific interventions during VR therapy sessions. Here is a list that describes just a few of those main actions:

• Establish clear intervention objectives that will guide patients during the session. For example, this may include asking patients to practice abdominal breathing, increasing the duration of the breath gradually. An intervention of this kind can help patients focus on the critical elements of their virtual surroundings.  
• Do not interact with the patient during the session. Maintaining a dialogue or asking questions during the use of VR technology may remind patients of their real-life settings. To foster SoP, patients should not ask their questions until reaching the completion of the module. 
• Promote in vivo exposure and imagination between sessions.  In some cases, namely anxiety and avoidance, the patient spends much time confronting a fear. Recent memories of having done that are faint. Therefore, in vivo exposure helps the patient apply what was learned in the consultation and acquire the “recent memories” needed for subsequent VR simulations and valuable take-aways.  

If you are interested in exploring how Amelia’s virtual reality technology can provide care to your patients, please contact us for a free demo session. Our therapeutic areas and virtual environments engage different visual and auditory elements to optimize the sense of presence and sense of immersion for full, notable benefits.

References:

• Virtual Reality Experience: Immersion, Sense of Presence, and Cybersickness. DOI: https://doi.org/10.1016/j.ecns.2019.09.006