Analgesic effects of posthypnotic suggestions and virtual reality distraction on thermal pain.

The individual and combined effects of posthypnotic suggestion (PHS) and virtual reality distraction (VRD) on experimentally induced thermal pain were examined using a 2 x 2, between-groups design. After receiving baseline thermal pain, each participant received hypnosis or no hypnosis, followed by VRD or no VRD during another pain stimulus. Consistent with the hypothesis that hypnosis and VRD work via different mechanisms, results show that posthypnotic analgesia was moderated by hypnotizability but VRD analgesia was not. The impact of PHSs for analgesia was specific to high hypnotizables, whereas VRD was effective independent of hypnotizability. Results also show a nonsignificant but predicted pattern for high hypnotizables: Audio hypnosis combined with VRD reduced worst pain 22% more and pain unpleasantness 25% more than did VRD alone. Theoretical and clinical implications are discussed.

Virtual reality monitoring: phenomenal characteristics of real, virtual, and false memories.

This study explored virtual-reality (VR) monitoring, the decision process by which people discriminate memories of real and virtual events. In a study phase, subjects touched 10 real objects with their real finger and touched 10 virtual objects (visual only, no tactile feedback) with their cyberfinger in VR. One week later they took a real versus virtual versus new source identification test. After the source identification test, subjects rated phenomenal qualities associated with each memory, using a Virtual-Real Memory Characteristics Questionnaire (VRMCQ). For old items, results from the VRMCQ are consistent with the idea that VR monitoring draws on differences in qualitative characteristics of memories for perceived and virtual events/objects (consistent with Johnson and Raye). However, subjects also reported similar qualities associated with their false memories for new items, suggesting that they sometimes infer/reconstruct the qualities a memory should have, based on their decision of its source of origin. Furthermore, VR monitoring might prove useful as a sort of Turing test of how convincing the virtual world is, and the VRMCQ can identify which qualities of the virtual experience (e.g., color) require improvement. Examples of applications are discussed.

The effectiveness of virtual reality for dental pain control: a case study.

The present study explored whether immersive virtual reality can serve as an effective non-pharmacologic analgesic for dental pain. Two patients (aged 51 and 56 years old) with adult periodontitis, a chronic, progressive inflammatory disease that affects gums, ligaments, and bones around the teeth, were studied in the treatment room of a periodontist. Each patient received periodontal scaling and root planing (scraping off/removing plaque deposits below the gum line, hereafter referred to as scaling) under three treatment conditions: (1) virtual reality distraction, (2) movie distraction, and (3) a no-distraction control condition. Condition order was randomized and counterbalanced. For each of the three treatment conditions, five visual analog pain scores for each treatment condition served as the dependent variables. On 0-10 labeled scales, both patients provided sensory and affective pain ratings, and subjective estimates of time spent thinking about his pain during the procedure. For patient 1, mean pain ratings were in the severe range while watching a movie (7.2), or no distraction (7.2) but in the mild pain range (1.2) during the VR condition. Patient 2 reported mild to moderate pain with no distraction (mean = 4.4), mild pain while watching the movie (3.3), and essentially no pain while in VR (0.6) during his periodontal scaling. Although the small sample size limits generalizability, we contend that virtual reality is a uniquely attention-grabbing medium capable of maximizing the amount of attention drawn away from the "real world," allowing patients to tolerate painful dental procedures. These preliminary results suggest that immersive VR merits more attention as a potentially viable adjunctive nonpharmacologic analgesia for procedural dental/periodontal pain. Virtual reality may also have analgesic potential for other painful procedures or pain populations. Practical implications are discussed.

Redefining therapeutic success with virtual reality exposure therapy.

The success rate for treating phobias with in vivo exposure is high. Unfortunately, few phobics (less than 15-20%) ever seek treatment. Virtual reality (VR) exposure therapy is also proving to be highly effective. The present surveys assessed 162 students high in fear of spiders. In Study 1, when asked to choose between multisession in vivo exposure vs. multisession VR exposure therapy, 81% chose VR. In Study 2, comparing one-session in vivo versus multisession VR exposure therapy, 89% chose VR. Results suggest that VR exposure therapy may prove valuable for increasing the number of phobics who seek treatment.

Effectiveness of virtual reality-based pain control with multiple treatments.

OBJECTIVE: The current study explored whether immersive virtual reality continues to reduce pain (via distraction) with repeated use. SETTING: The study was conducted in a burn care unit at a regional trauma center. PATIENTS: Seven patients aged 9-32 years (mean age of 21.9 years; average of 23.7% total body surface area burned [range, 3-60%]) performed range-of-motion exercises of their injured extremity under an occupational therapist's direction on at least 3 separate days each. INTERVENTION: For each physical therapy session, each patient spent equal amounts of time in virtual reality and in the control condition (no distraction). The mean duration of physical therapy in virtual reality was 3.5, 4.9, and 6.4 minutes for the first, second, and third session, respectively. Condition order was randomized and counter-balanced. OUTCOME MEASURES: For each of the three physical therapy sessions, five visual analog pain scores for each treatment condition served as the dependent variables. RESULTS: Pain ratings were statistically lower when patients were in virtual reality, and the magnitude of pain reduction did not diminish with repeated use of virtual reality. The results of this study may be examined in more detail at www.vrpain.com. CONCLUSIONS: Although the small sample size limits generalizability. results provide converging preliminary evidence that virtual reality can function as a strong nonpharmacological pain reduction technique for burn patients during physical therapy. Results suggest that virtual reality does not diminish in analgesic effectiveness with three (and possibly more) uses. Virtual reality may also have analgesic potential for other painful procedures or pain populations. Practical implications are discussed.

Perceptions of an old female eyewitness: is the older eyewitness believable?

Young adults rated an old female witness (82 years) to be less competent but more honest than a young female witness (28 years). The effect of age stereotyping on believability was assessed indirectly by using a variant of Loftus' misinformation paradigm. Regression analysis showed that the more competent a witness was perceived as being, the more influential was the misinformation she provided. This was true, however, only when the witness was young because the relatively lower competence of the old witness was associated with nonsignificant misinformation effects. These data suggest that negative beliefs associating incompetence with old age may compromise the believability of older eyewitnesses.

Social influences on reality-monitoring decisions.

A modified Asch (1951) conformity paradigm was used to study the impact of social influence on reality-monitoring decisions about new items. Subjects studied pictures of some objects and imagined others. In a later test phase, they judged whether items had been perceived in the study phase, had been imagined, or were new. Critically, for some items, the subjects were informed of a confederate's response before rendering a judgment. Although the confederate was always correct when they responded to old items, for new items, the confederate responded perceived, imagined, or new, or did not respond (baseline). In two experiments, we show that memory for new items was influenced by an erroneous response of the confederate. Social conformity was reduced by undermining the credibility of the confederate (Experiments 1A and 1B), and the confederate's influence was evident even after there was only a 20-min delay between study and test (Experiment 2), when the subjects were 87% accurate on new baseline items. These experiments reveal the power of social influence on reality-monitoring accuracy and confidence.

Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study.

OBJECTIVE: The pain experienced by burn patients during physical therapy range of motion exercises can be extreme and can discourage patients from complying with their physical therapy. We explored the novel use of immersive virtual reality (VR) to distract patients from pain during physical therapy. SETTING: This study was conducted at the burn care unit of a regional trauma center. PATIENTS: Twelve patients aged 19 to 47 years (average of 21% total body surface area burned) performed range of motion exercises of their injured extremity under an occupational therapist's direction. INTERVENTION: Each patient spent 3 minutes of physical therapy with no distraction and 3 minutes of physical therapy in VR (condition order randomized and counter-balanced). OUTCOME MEASURES: Five visual analogue scale pain scores for each treatment condition served as the dependent variables. RESULTS: All patients reported less pain when distracted with VR, and the magnitude of pain reduction by VR was statistically significant (e.g., time spent thinking about pain during physical therapy dropped from 60 to 14 mm on a 100-mm scale). The results of this study may be examined in more detail at www.hitL.washington.edu/projects/burn/. CONCLUSIONS: Results provided preliminary evidence that VR can function as a strong nonpharmacologic pain reduction technique for adult burn patients during physical therapy and potentially for other painful procedures or pain populations.

Virtual reality as an adjunctive pain control during burn wound care in adolescent patients.

For daily burn wound care procedures, opioid analgesics alone are often inadequate. Since most burn patients experience severe to excruciating pain during wound care, analgesics that can be used in addition to opioids are needed. This case report provides the first evidence that entering an immersive virtual environment can serve as a powerful adjunctive, nonpharmacologic analgesic. Two patients received virtual reality (VR) to distract them from high levels of pain during wound care. The first was a 16-year-old male with a deep flash burn on his right leg requiring surgery and staple placement. On two occasions, the patient spent some of his wound care in VR, and some playing a video game. On a 100 mm scale, he provided sensory and affective pain ratings, anxiety and subjective estimates of time spent thinking about his pain during the procedure. For the first session of wound care, these scores decreased 80 mm, 80 mm, 58 mm, and 93 mm, respectively, during VR treatment compared with the video game control condition. For the second session involving staple removal, scores also decreased. The second patient was a 17-year-old male with 33.5% total body surface area deep flash burns on his face, neck, back, arms, hands and legs. He had difficulty tolerating wound care pain with traditional opioids alone and showed dramatic drops in pain ratings during VR compared to the video game (e.g. a 47 mm drop in pain intensity during wound care). We contend that VR is a uniquely attention-capturing medium capable of maximizing the amount of attention drawn away from the 'real world', allowing patients to tolerate painful procedures. These preliminary results suggest that immersive VR merits more attention as a potentially viable form of treatment for acute pain.

Role of memory strength in reality monitoring decisions: evidence from source attribution biases.

Reality monitoring of verbal memories was compared with decisions about pictorial memories in this study. Experiment 1 showed an advantage in memory for imagined over perceived words and a bias to respond "perceived" on false alarms. Experiment 2 showed the opposite pattern: an advantage in memory for perceived pictures and a bias to respond "imagined" on false alarms. Participants attribute false alarms to whichever class of memories has the weakest trace strengths. The relative strength of memories of imagined and perceived objects was manipulated in Experiments 3 and 4, yielding changes in source attribution biases that were predicted by the strength heuristic. All 4 experiments generalize the mirror effect (an inverse relationship between patterns of hits and false alarms commonly found on recognition tests) to reality monitoring decisions. Results suggest that under some conditions differences between the strength of memories for perceived and imagined events, rather than differences in qualitative characteristics, are used to infer memory source.

Virtual reality and tactile augmentation in the treatment of spider phobia: a case report.

This is the first case report to demonstrate the efficacy of immersive computer-generated virtual reality (VR) and mixed reality (touching real objects which patients also saw in VR) for the treatment of spider phobia. The subject was a 37-yr-old female with severe and incapacitating fear of spiders. Twelve weekly 1-hr sessions were conducted over a 3-month period. Outcome was assessed on measures of anxiety, avoidance, and changes in behavior toward real spiders. VR graded exposure therapy was successful for reducing fear of spiders providing converging evidence for a growing literature showing the effectiveness of VR as a new medium for exposure therapy.

Creating new memories that are quickly accessed and confidently held.

In two experiments involving a total of 542 subjects, a series of slides depicting a burglary was shown. After the initial event, subjects were exposed to one or more narratives about the event that contained some misinformation or neutral information about four critical details. Finally, subjects were tested on their memories of what they saw, and their reaction times and confidence levels were measured. When subjects took a standard test in which the misinformation item was a possible response option, they responded very quickly and confidently when making this incorrect choice. Misled subjects responded as quickly and confidently to these "unreal" memories as they did to their genuine memories. It does not seem, then, that the misinformation effect arises from a large proportion of subjects who must resolve a conflict between two memories when they are tested, a conflict that would be expected to take time. When subjects took a modified test in which the misinformation item was not a possible response, misled subjects were as accurate as were controls, but they responded more slowly, regardless of whether they ultimately chose the right or wrong option. These findings indicate that misinformation does introduce some form of interference not detected by a simple test of accuracy.

Misinformation and memory: the creation of new memories.

Misleading information presented after an event can lead people to erroneous reports of that misinformation. Different process histories can be responsible for the same erroneous report in different people. We argue that the relative proportion of times that the different process histories are responsible for erroneous reporting will depend on the conditions of acquisition, retention, and retrieval of information. Given the conditions typical of most misinformation experiments, it appears that misinformation acceptance plays a major role, memory impairment plays some role, and pure guessing plays little or no role. Moreover, we argue that misinformation acceptance has not received the appreciation that it deserves as a phenomenon worthy of our sustained investigation. It may not tell us anything about impairment of memories, but it does tell us something about the creation of new memories.