BackgroundStanley Milgram's 1960s experimental findings that people would administer apparently lethal electric shocks to a stranger at the behest of an authority figure remain critical for understanding obedience. Yet, due to the ethical controversy that his experiments ignited, it is nowadays impossible to carry out direct experimental studies in this area. In the study reported in this paper, we have used a similar paradigm to the one used by Milgram within an immersive virtual environment. Our objective has not been the study of obedience in itself, but of the extent to which participants would respond to such an extreme social situation as if it were real in spite of their knowledge that no real events were taking place.MethodologyFollowing the style of the original experiments, the participants were invited to administer a series of word association memory tests to the (female) virtual human representing the stranger. When she gave an incorrect answer, the participants were instructed to administer an ‘electric shock’ to her, increasing the voltage each time. She responded with increasing discomfort and protests, eventually demanding termination of the experiment. Of the 34 participants, 23 saw and heard the virtual human, and 11 communicated with her only through a text interface.ConclusionsOur results show that in spite of the fact that all participants knew for sure that neither the stranger nor the shocks were real, the participants who saw and heard her tended to respond to the situation at the subjective, behavioural and physiological levels as if it were real. This result reopens the door to direct empirical studies of obedience and related extreme social situations, an area of research that is otherwise not open to experimental study for ethical reasons, through the employment of virtual environments.

This is the most unambiguous demonstration of paranoid ideation in the general public so far. Paranoia can be understood in terms of cognitive factors. The use of virtual reality should lead to rapid advances in the understanding of paranoia.

BackgroundSelf-criticism is a ubiquitous feature of psychopathology and can be combatted by increasing levels of self-compassion. However, some patients are resistant to self-compassion.AimsTo investigate whether the effects of self-identification with virtual bodies within immersive virtual reality could be exploited to increase self-compassion in patients with depression.MethodWe developed an 8-minute scenario in which 15 patients practised delivering compassion in one virtual body and then experienced receiving it from themselves in another virtual body.ResultsIn an open trial, three repetitions of this scenario led to significant reductions in depression severity and self-criticism, as well as to a significant increase in self-compassion, from baseline to 4-week follow-up. Four patients showed clinically significant improvement.ConclusionsThe results indicate that interventions using immersive virtual reality may have considerable clinical potential and that further development of these methods preparatory to a controlled trial is now warranted.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.

BackgroundPersecutory delusions may be unfounded threat beliefs maintained by safety-seeking behaviours that prevent disconfirmatory evidence being successfully processed. Use of virtual reality could facilitate new learning.AimsTo test the hypothesis that enabling patients to test the threat predictions of persecutory delusions in virtual reality social environments with the dropping of safety-seeking behaviours (virtual reality cognitive therapy) would lead to greater delusion reduction than exposure alone (virtual reality exposure).MethodConviction in delusions and distress in a real-world situation were assessed in 30 patients with persecutory delusions. Patients were then randomised to virtual reality cognitive therapy or virtual reality exposure, both with 30 min in graded virtual reality social environments. Delusion conviction and real-world distress were then reassessed.ResultsIn comparison with exposure, virtual reality cognitive therapy led to large reductions in delusional conviction (reduction 22.0%, P = 0.024, Cohen's d = 1.3) and real-world distress (reduction 19.6%, P = 0.020, Cohen's d = 0.8).ConclusionCognitive therapy using virtual reality could prove highly effective in treating delusions.

A key problem in studying a hypothesized spectrum of severity of delusional ideation is determining that ideas are unfounded. The first objective was to use virtual reality to validate groups of individuals with low, moderate, and high levels of unfounded persecutory ideation. The second objective was to investigate, drawing upon a cognitive model of persecutory delusions, whether clinical and nonclinical paranoia are associated with similar causal factors. Three groups (low paranoia, high nonclinical paranoia, persecutory delusions) of 30 participants were recruited. Levels of paranoia were tested using virtual reality. The groups were compared on assessments of anxiety, worry, interpersonal sensitivity, depression, anomalous perceptual experiences, reasoning, and history of traumatic events. Virtual reality was found to cause no side effects. Persecutory ideation in virtual reality significantly differed across the groups. For the clear majority of the theoretical factors there were dose–response relationships with levels of paranoia. This is consistent with the idea of a spectrum of paranoia in the general population. Persecutory ideation is clearly present outside of clinical groups and there is consistency across the paranoia spectrum in associations with important theoretical variables.

An experiment was conducted in a Cave-like environment to explore the relationship between physiological responses and each of breaks in presence, and utterances by virtual characters towards the participants. Twenty people explored a virtual environment (VE) that depicted a virtual bar scenario. The experiment was divided into a training and an experimental phase.During the experimental phase breaks in presence (BIPs) in form of whiteouts of the VE scenario were induced for 2 seconds at four equally spaced times during the approximate 5 minutes in the bar scenario. Additionally 5 virtual characters addressed remarks at the subjects. Physiological measures including ECG and GSR were recorded throughout the whole experiment. The heart rate, the heart rate variability and the event-related heart rate changes were calculated from the acquired ECG data. The frequency response of the GSR signal was calculated with a wavelet analysis. The study shows that the heart rate and heart rate variability parameters vary significantly between the training and experimental phase.GSR parameters and event-related heart rate changes show the occurrence of breaks in presence. Event-related heart rate changes also signified the virtual character utterances.There were also differences in response observed between more and less social phobic participants.

BackgroundIn recent years a close association between anxiety and persecutory ideation has been established, contrary to the traditional division of neurosis and psychosis. Nonetheless, the two experiences are distinct. The aim of this study was to identify factors that distinguish the occurrence of social anxiety and paranoid thoughts in an experimental situation.MethodTwo hundred non-clinical individuals broadly representative of the UK general population were assessed on a range of psychological factors, experienced a neutral virtual reality social environment, and then completed state measures of paranoia and social anxiety. Clustered bivariate logistic regressions were carried out, testing interactions between potential predictors and the type of reaction in virtual reality.ResultsThe strongest finding was that the presence of perceptual anomalies increased the risk of paranoid reactions but decreased the risk of social anxiety. Anxiety, depression, worry and interpersonal sensitivity all had similar associations with paranoia and social anxiety.ConclusionsThe study shows that social anxiety and persecutory ideation share many of the same predictive factors. Non-clinical paranoia may be a type of anxious fear. However, perceptual anomalies are a distinct predictor of paranoia. In the context of an individual feeling anxious, the occurrence of odd internal feelings in social situations may lead to delusional ideas through a sense of ‘things not seeming right’. The study illustrates the approach of focusing on experiences such as paranoid thinking rather than diagnoses such as schizophrenia.

Virtual reality has been successfully used to study and treat psychological disorders such as phobias and posttraumatic stress disorder but has rarely been applied to clinically-relevant emotions other than fear and anxiety. Self-criticism is a ubiquitous feature of psychopathology and can be treated by increasing levels of self-compassion. We exploited the known effects of identification with a virtual body to arrange for healthy female volunteers high in self-criticism to experience self-compassion from an embodied first-person perspective within immersive virtual reality. Whereas observation and practice of compassionate responses reduced self-criticism, the additional experience of embodiment also increased self-compassion and feelings of being safe. The results suggest potential new uses for immersive virtual reality in a range of clinical conditions.