Seeing is Believing: Using Virtual Reality to Adapt to Change

Allie Lerman

Ms.Dungey

GT Independent Research II

May 5, 2017
USING VIRTUAL REALITY TO ADAPT TO CHANGE 1

Abstract

By 2018, virtual reality (VR) will be a multi-billion dollar industry and a technology that
impacts the masses (VR Bound Staff, 2016). VR is a concept that many people associate with
gaming and entertainment. While it does enhance these experiences, VRs uses reach far beyond
this. Literature shows that VR can be used to help people change the way they view the world or
a part of it. Specifically, the researcher investigated how VR could help veterans adapt back to
the civilian world, help reduce social biases, and help people with Autism Spectrum Disorder
learn and apply social skills. Many studies have analyzed VR exposure and cognitive therapies
and have found them to be equally as effective or more effective than current, traditional therapy
environments. Focusing on the idea of bias, the researcher decided to determine if VR could be
used to change how a person views a certain group of people. To assess this question, an online
and anonymous quasi-experiment was conducted. Participants, with ages ranging from 20-60
years old, took two Harvard Implicit Association Tests (IAT) and were shown a video in
between tests that may have changed their perspective of the race the initial IAT determined they
held bias against. Out of the eleven people surveyed from April 7-21, only two peoples bias was
moderately improved after watching the video. Because a 3-5 minute video cannot accomplish
virtual body swapping the same way that a VR can, more research must be done to determine if
VR can reduce racial bias. To encourage the use of this technology, therapists and VR game
designers need to work together to create VR environments that are more conducive to
cultivating change in bias.
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Introduction

What will cause virtual reality (VR) to grow to a $5.2 billion dollar industry by 2018 (VR

Bound Staff, 2016)? Often times, VR is advertised as a medium meant for gaming and

entertainment, but this alone is not what makes VR a multi-billion dollar industry. VR has the

capability to impact a multitude of fields, including psychology and medicine, making it a

promising tool for the future. By using realistic simulations, VR allows a user to practice a

challenging situation and learn how to handle it. Through the use of virtual reality exposure and

social cognition therapies, VR can be used as a psychological tool to help people adapt to

change.

VR has recently become a popular technological experience, but it has been existent for

centuries. The earliest form of VR took place in panoramic paintings during the 1800s (Virtual

Reality Society, 2016). While these two mediums seem unrelated, they are both centered around

the same concept: creating an immersive experience that makes users or viewers feel a part of the

world they see around them. The first major development in actual VR technology came in 1838

with the creation of stereoscopic photos and viewers. According to the source referenced above,

this occurred because a man named Charles Wheatstone discovered that people's eyes see two

different two-dimensional images, and the brain processes these separate images by combining

them to create one three-dimensional image (2016). This meant that stereoscopic images could

give users a sense of presence in an alternate environment. From this revelation, VR became a

real possibility, paving the way for the creation of the first flight simulators and head mounted

displays (HMDs). In 1965, Ivan Sutherland, a major contributor to VR, described the ideal VR

system as one being so realistic that a person could not tell the difference between the virtual
USING VIRTUAL REALITY TO ADAPT TO CHANGE 3

world and the real world (Mazuryk & Gervautz, 1996). His ideas would create the roadmap to

the VR interfaces of today. Since the mid-fifties,VR has made its way into TV, movies, and

books, exposing more people to the medium. With the rapid technological advancements of the

21st Century, VR has become a mainstream concept.

For a VR system to be effective in helping people adapt to change, it must possess certain

qualities. In todays society, VR is widely accepted as an immersive experience where users can

interact with objects and other users in a controlled, virtual environment. To accomplish this, VR

technologies have four key elements: virtual worlds, immersion, sensory feedback, and

interactivity (Sherman & Craig, 2003). In order for a VR to exist, there must be a mentally and

physically immersive virtual world for the user to explore. Users must feel that they are involved

and present in the virtual world that they are experiencing, therefore, total immersion is a crucial

element of VR. Sensory feedback provided by the VR system greatly enhances total immersion.

Based on a participants physical position, the system will provide multi-sensory feedback,

allowing users to feel like they are actually interacting with the environment they are seeing

(2003). Facilitating this interactivity is an important quality for VR systems because it makes the

systems feel authentic. When a system possesses these four elements an effective VR is created.

Literature Review

These systems can be applied effectively to aid veterans returning from war as many have

trouble adjusting back to civilian life, especially if they suffer from combat-related

Post-Traumatic Stress Disorder (PTSD). VR can be used as a tool to help veterans with PTSD

change how they view a part of the civilian world (ex: change what they associate with loud,

crowded places). By offering a high level of control and adaptability, VR allows veterans with
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PTSD to confront the specific triggers to the situations that caused them trauma. In one study

that implemented VR exposure therapy, clinicians altered the virtual environments into which

veterans were placed (Rizzo et al., 2008). Using this technique allows clinicians to gear their

therapy towards individual patients, making their patients therapy sessions more meaningful and

relatable. In this same study, clinicians also controlled the sensory elements of the VRs in order

to match those experienced by a veteran in a traumatic situation (2008). For example, if a

veterans PTSD stemmed from hearing gun shots, those sounds were replicated in the VR.

Repeated exposure to those sounds allowed for the veteran to adapt and become comfortable

with loud noises rather than to be afraid of them. By making use of these elements, clinicians

create VR environments that help individual veterans to overcome their specific combat-related

PTSD.

Currently, the most common treatment of combat-related PTSD is imaginal exposure

therapy; however, it lacks the immersiveness found in VR. Imaginal therapy requires patients to

imagine and repeatedly describe the traumatic situation that triggers their PTSD. These

descriptions continue until the patient comes to terms with the situation. However, for many

veterans, this treatment is ineffective because they do not want to think about the situation that

caused them trauma (Kramer, Savary, Pyne, & Jegley, 2013). If veterans avoid thinking about

the environments that trigger their PTSD, the therapy session becomes ineffective because the

root of the problem is not being addressed. Because of its adaptability and specificity, VR

exposure therapy can be as effective as or more effective than imaginal exposure therapy since it

does not allow users to avoid the particular environmental triggers for their PTSD (Smith, 2010).

Clinicians can gradually make the environment more specific to the veteran so that the veteran
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can directly confront the situation rather than just imagining themselves confronting the

situation. Because VR exposure therapy is highly customizable and immersive, it is an effective

treatment option for veterans with PTSD.

Equally as important as its effectiveness is acceptance by those who use it, and VR

exposure therapy has already been well-received by many veterans. In order for a virtual

environment to trigger a memory, it must be authentic. When rating the quality of VR combat

environments, 86% of veterans surveyed said the realism of the virtual environment in which

they were placed was adequate to excellent (Reger, Gahm, Rizzo, Swanson, & Duma, 2009).

Because these virtual environments are realistic, they effectively place veterans back into the

setting in which they fought, eliminating the need for veterans to imagine it. This causes the sole

focus of the veterans participating in the therapy to be overcoming their PTSD triggers. In a

different study of veterans perception of VR exposure therapy, 14 veterans were asked to rank

the acceptability of the use of VR exposure therapy as a therapeutic tool on a scale of 1 (worst) -

7 (best). On average, these veterans ranked VR exposure therapy as a 4.33 (Kramer, Savary,

Pyne, & Jegley, 2013). This relatively high rating shows promise for VR exposure therapy in the

future. In 2013, when this study was conducted, VR exposure therapy was still a fairly new

technological advance that was unfamiliar to many people. A rating of 4.33 shows that veterans

believe this technology has promise, yet they are still unsure about the long-lasting effects and

implications of its use. As veterans become more familiar with VR exposure therapy, their

acceptance of it will only continue to rise.

In addition to accepting the use of VR exposure therapy, veterans also believe that the

technology can be an effective therapeutic tool. A study published in 2007 asked veterans to rank
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the effectiveness of VR exposure therapy on a scale of 8 (worst) - 32 (best). All participants

surveyed in post-testing gave VR exposure therapy a rating of 30 or higher (Beck, Palyo, Winer,

Schwagler, & Ang). These ratings reveal the potential VR has in becoming a mainstream PTSD

treatment option. In fact, in a study of Iraq war veterans who underwent VR exposure therapy,

71% of veterans said they were equally or more willing to use VR exposure therapy over other

PTSD treatments (Botella, Serrano, Banos, & Garcia-Palacios, 2015). After using VR exposure

therapy, veterans with PTSD are experiencing the immediate results of their therapy, and they

are pleased with what they encounter. Because research indicates veterans are willing to use VR

therapy, trained clinicians can make the technology a valuable tool to help veterans adjust to

civilian life by teaching them how to cope with their triggers.

As established, VR can be used to aid veterans in adapting back to the civilian world, yet

it can also be used to change how one group of people views another, leading to an overall

reduction in social bias. VR systems that seek to accomplish this goal use a technique called

virtual body swapping. This is when a person sees him/herself as part of a different race, age,

sex, etc. and is able to experience virtual events from this new perspective. Often times, this

results in a change in perception towards members of the embodied group because participants

have a better understanding of what these people go through (Milk, 2015). When people have

more knowledge of people different from themselves, they are better able to relate to those

people. The new attitude people develop from virtual body swapping then transfers to the real

world, leading to a decrease in stereotyping.

One such example of this is the use of virtual body swapping to reduce racial bias. In an

experiment that employed the Rubber Hand Illusion- an illusion that makes people believe they
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have a hand of another race; pre and post Implicit Association Tests, which determines inherent

social bias, revealed Caucasians who participated showed reduced racial bias towards

African-Americans after the simulation (Tsakiris, 2015). People commonly associate their own

characteristics and traits as positive because they inherently see themselves in a positive light

(Yee & Bailenson, 2006). This is known as the ingroup/outgroup phenomenon. Members of an

ingroup tend to associate more negative traits with members of an outgroup. This pattern remains

true when a person appears to have a body part of a different race. It is as if the person becomes a

virtual member of the outgroup. The participant associates that other race with more positive

characteristics because he/she sees oneself as a member of that race, leading to a decrease in

ones bias (Maister, Slater, Sanchez-Vives, & Tsakiris, 2015). Once people see themselves in the

body of a different race, they realize that they are more similar to members of that race than they

thought. This causes people to compare how they treat members of the embodied race to people

of their own race. At the 2015 World Economic Forum, decision-makers of all races were shown

a video that made use of a 360 degree camera to capture the life of a girl in a refugee camp in

order to see the effect their decisions had on a real person. This video influenced the decisions

made by these world leaders as they were able to use virtual embodiment to experience the

consequences of their actions (Milk, 2015). Once these leaders saw themselves as similar to the

refugee, they began to question why they would treat the refugee a different way than they would

treat someone who was not a refugee. When people in VR see themselves and their actions from

a different perspective, they are able to recognize negative or biased behaviors and immediately

make a change.
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Many people who participate in virtual body swapping show a decrease in racial bias

directly following their VR exposures, yet these effects are also maintained after the simulation

ends. In a study of 60 females, reduced racial bias of Caucasians towards African-Americans was

sustained for at least a week following VR exposure (Banakou, Hanumanthu, & Slater, 2016).

The new mindset that a person obtains after a VR exposure is not a sudden sensation that only

lasts a few minutes. Virtual body swapping can truly alter a persons opinions and change their

behavior. Additionally, the more exposures a person has in a VR, the more radically their beliefs

change. In another experiment conducted as a part of the same study referenced above, results

from 30 females showed that the more VR exposures experienced by a female (1, 2, or 3), the

larger the reduction in bias towards the embodied race was (2016). When people spend a more

significant amount of time in a VR, they have more time to learn about who they are embodying

and how they relate to that group of people, causing their bias to decrease by a larger amount. If

this technology were applied on a massive scale, many people would gain a new perspective and

understanding.

In addition to combating racism, VR can also be used to reduce ageism. As a person

grows older, they develop more characteristics that frustrate younger people, such as walking

slowly or losing their train of thought. This causes the youth to hold at least a slight bias towards

the elderly. When virtual body swapping is used to place adolescents into the body of older

people, the participants are more likely to associate positive characteristics with the elderly than

people who do not undergo the simulation (Yee & Bailenson, 2006). In this case, virtual body

swapping allows a young person to relate to the elderly. As before, this increased similarity

causes a decrease in bias, making VR applicable to various social biases.

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Using VR to decrease social biases represents a change in a persons attitude, which also

leads to a change in a persons behavior in the real world. For example, when older people are

embodied as younger people, they demonstrate more childlike qualities to match their

appearance, proving that VR has the power to change both attitudes and behaviors (Maister,

Slater, Sanchez-Vives, & Tsakiris, 2015). New perspectives that are gained in VR translate to

real-world interactions, and when older people are embodied as younger people, they see a new

perspective, causing them to exhibit a new behavior. Because of its ability to alter perspectives

and affect changes in behavior, VR has the potential to change lives.

Similar to transforming the behaviors of people with social bias, VR can also change the

behaviors of people with Autism Spectrum Disorder (ASD). VR social cognition therapy gives

people with ASD the chance to practice social situations in order to develop the skills needed to

handle these scenarios in real life. During VR social cognition therapy, participants with ASD

are exposed to a situation, receive feedback from a clinician on their behaviors during that

scenario, and then are exposed to another similar situation in which they employ the suggestions

they were given, allowing a learned behavior to become natural (Kandalaft, Didehbani,

Krawczyk, Allen, & Chapman, 2013). Because this therapy provides immediate feedback to

people with ASD, it allows them to change their behaviors and alter their potentially

inappropriate habits immediately following exposure. People with ASD who have difficulty

recognizing other peoples emotions can practice their emotion identification in VR. Then, when

they see a person in real life who is displaying a certain emotion like sadness, they will know

how to handle the situation rather than misinterpreting the interaction. By learning and practicing

social skills before utilizing them in the real world, people with ASD begin to feel comfortable
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with the skill, allowing them to encounter more success with the skill when they actually need to

use it.

Like most VR therapies, VR social cognition therapy is customizable. By changing the

virtual environment or the social skill being taught in an environment, the therapy process can

become specific to an individual. This enables VR social cognition therapy to meet the needs of

ASD patients of all ages as they can be placed in virtual environments that range from

playgrounds to job interviews. In addition, because VR scenarios can be made relevant to the

individual user, people with autism can be placed in environments conducive to their success

(McComas, Pivik, & LaFlamme, 1998). If a person with ASD thrives in social settings with

children rather than adults, he/she can be placed in an environment with a lot of children (like a

playground). When interacting in social situations, many people with ASD feel anxious because

they are scared of doing or saying the wrong things. However, in VR, this fear is eliminated

because there are no social consequences (ie: embarrassment) for behaving the wrong way;

ASD patients are positioned to be successful.

Another benefit of the use of modifiable VR scenarios in social cognition therapy is that a

participant will never encounter the exact same situation. This allows the participant to learn how

to apply a strategy to various scenarios that are similar in nature (Didehbani, Allen, Kandalaft,

Krawczyk, & Chapman, 2016). If people with ASD are only taught how to handle one particular

situation, the skill they are learning will be less applicable to them in the real world because they

are not likely to encounter the exact same scenario that they experienced in VR. By training ASD

patients in a variety of environments that require the use of the same social skill, people with

ASD gain a more comprehensive understanding of when that skill should be used in the real
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world. Therefore, the flexibility of VR is a major component to the success of VR social

cognition therapy.

Furthermore, the adaptability of VR social cognition therapy leads to internal changes in

a person with ASDs brain which is what ultimately creates a behavioral change. VR social

cognition therapy stimulates and connects regions of the brain that are needed for effective and

meaningful social interactions (Virtual Reality Training, 2014). The reason people with ASD

struggle in social situations is because areas of the brain that need to be communicating are

disassociated from one another. A person with ASD may recognize someone smiling, yet their

brain may not connect that with happiness. VR social cognition therapy helps to bridge this gap

by facilitating new communication between brain regions.

Stimulating new brain activity also makes VR effective in gaining and sustaining the

attention of people with ASD. Data reveals that people with ASD are naturally intrigued by

technology, making technological interventions more effective with them than human

interventions would be (Miller & Bugnariu, 2016). Since technology peaks their interest and

eliminates the stress of human interactions, VR is a welcome treatment option for people with

ASD. When a therapy session is more enjoyable, ASD patients get more out of it. People with

ASD enjoy VR social cognition therapy because its repetitiveness allows them to feel

comfortable, which helps to engage them throughout the entire VR exposure session (Vasquez

III et al., 2015). Sustained engagement creates a more productive therapy environment as more is

being learned in the same time interval as was the original, human-run social cognition therapy

session. Maintaining the interest of people with ASD enhances the effects of traditional social

cognition therapy causing a long-term, positive change in behavior.

USING VIRTUAL REALITY TO ADAPT TO CHANGE 12

Because VR is customizable, immersive, and engaging, it can be a valuable tool in

helping people adapt to a major change. For veterans with combat-related PTSD, VR exposure

therapy provides a learning experience that teaches veterans how to confront the triggers to the

traumatic situations that plague them in the civilian world. In regards to social biases, VR can be

used to alter how a person views a different group of people, affecting the VR participants

treatment of this group in the real world. VR social cognition therapy can also aid in teaching

people with ASD how to interact in social situations. Therefore, because attitudes and behaviors

learned in VR transfer to the real world, increased popularity and use for the medium could

result in new, innovative, and effective psychological tools for people struggling to cope with

change.

Data Collection and Methods

In order to identify if changing a persons perspective could reduce their racial bias, a

quasi-experiment was conducted. Eleven Long Reach High School faculty members voluntarily

partook in this experiment from April 7-21, 2017. All participants were White with nine being

females and two being males. The ages of participants varied between 20-60 years old. Three

participants fell in the age range of 20-30 years old, three participants fell in the age range of

31-40 years old, one participant fell in the age range of 41-50 years old, and four participants fell

in the age range of 51-60 years old.

The experiment was divided into several sections that participants could navigate through

on their own. In the first section, participants answered demographic questions regarding their

gender, age, and race. Next, participants were directed to the Harvard Implicit Association Test

(IAT) and were given specific instructions on which test to take (Race IAT). After completing
USING VIRTUAL REALITY TO ADAPT TO CHANGE 13

this test, participants self-reported their determined bias. A video meant to alter participants

perspective was shown to participants based on their IAT results. Once participants had finished

the video, they were again directed to take a Race IAT. After participants had completed this

post-test, they self-reported their new IAT results. To conclude, participants were asked to

answer a few additional questions about the accuracy of the IAT and the effect of the video.

Overall, the experiment took about 20-30 minutes to complete. During this time, the researcher

was not present, so all results were anonymous. Before beginning the experiment, all participants

filled out a human-consent form.

The researcher elected to do a quasi-experiment because of the specificity of her topic.

Little research has been done in this domain, so more data was needed to prove the correlation

between altering perspective and reducing bias. In addition, since race is a sensitive topic, the

researcher felt something that could be completed anonymously would be best. The questions the

researcher selected to use in her experiment were chosen to support and further explain the IAT

results. Ultimately, the researcher was looking to see how post-IAT results differed from

pre-IAT results and analyze why this change did or did not occur.
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Results and Data Analysis

IAT Results

Figure 1

After participants took the first IAT, this question asked them to self-report their IAT results. It

was anticipated that a majority of respondents would hold inherent bias against

African-Americans. However, the data shows that only 27.3% of participants held some bias

against African-Americans. This may have occurred because Long Reach High School is

extremely diverse. Many teachers have worked with students of all different races and learned

how to overcome their personal prejudice. Over half of people surveyed (54.5%) reported Little

or no preference towards either White or African-American people. This was a surprising

statistic because the national IAT results (data from over 3 million people) show that only 18%

of people surveyed received this response. There is a 36.5% difference between the results

reported in this experiment and the national average. Again, this may have been because Long

Reach faculty have had ample experience working with students of all different races and
USING VIRTUAL REALITY TO ADAPT TO CHANGE 15

ethnicities. Since race is a sensitive subject, another possible explanation for this data is that

respondents did not accurately report their IAT results.

Figure 2

After watching the video and taking a second IAT, participants were again asked to self-report

their IAT scores. It is important to note that those who received Little to no preference towards

either White or African-American people did not watch a video or take a second IAT (because

their bias did not need to be changed) which is why there are only five responses to this question.

Out of these responses, only one is different from the initial IAT results, showing that the videos

did not alter participants bias. More responses are needed before this conclusion can be

definitively determined.
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IAT Analysis Questions

Figure 3

This question asked participants how accurately the IAT measured their implicit bias after they

took the test either once or twice (depending on their initial IAT results). 91% of respondents

found the IAT to be at least somewhat accurate in measuring their bias. This is interesting to note

because five participants were determined at least somewhat biased, so, at least some of them

agreed with that label because all eleven respondents answered this question. These results also

show that most people believe the IAT collects enough reliable data to draw conclusions

regarding inherent bias. If they thought otherwise, they would have said the IAT did not

accurately measure their bias.

USING VIRTUAL REALITY TO ADAPT TO CHANGE 17

Figure 4

This question asked participants if they found their IAT results surprising. None of the eleven

respondents were completely caught off guard by their IAT results. This means that the people

that participated in this quasi-experiment had a pretty solid grasp of their racial bias. In order to

determine if this is the case with a majority of people, more people would need to respond to this

question. It often seems like people are unaware of their own bias, yet these results suggest that

people know they are biased, but do not work to reduce their bias.
USING VIRTUAL REALITY TO ADAPT TO CHANGE 18

Figure 5

Participants were asked if they agreed with their IAT results so that the researcher could confirm

respondents had a sense of their own bias. A majority (72.8%) of people surveyed agreed (4) or

strongly agreed (5) with their IAT results. However, since six people were determined to be

unbiased, it is only natural that those participants would agree with their results. Since the

sample size of people with bias was so small, it is too difficult to conclude that people knew of

their bias before taking the IAT.

USING VIRTUAL REALITY TO ADAPT TO CHANGE 19

Figure 6

The researcher asked participants if the video they were shown changed their perspective of the

race they held bias against to determine if a technological medium similar to VR could reduce a

persons bias. 80% of people surveyed responded that the video did not change their perspective

of the race they held bias against. It is crucial to note that five of these respondents were not

shown a video because they were determined to be unbiased, therefore, their perspective did not

need changing. Out of the five people who were determined to possess bias, only two had a

change in opinion after viewing the video. Because only five people who answered this question

were actually shown a video, no conclusion can be drawn from this data.
USING VIRTUAL REALITY TO ADAPT TO CHANGE 20

Discussion/Conclusion

From the results of the quasi-experiment, the researcher was not able to determine

whether a technological medium similar to VR could or could not change a persons perspective

of another race. Only eleven people partook in this quasi-experiment, and six of them were

considered unbiased after taking the first IAT. Those participants were not shown a video

because their perspective did not need changing. Out of the five participants who were shown a

video, only one had a different IAT result after taking the IAT a second time. While this

demonstrates 20% of people surveyed had a perspective change after watching the video, it does

not lead to any new revelations because this 20% only represents a change in one person.

Therefore, there was not enough data to draw conclusions regarding the effectiveness of the

video in reducing racial bias.

This quasi-experiment had several limitations. Most evident is that there were not enough

participants, so there was not a large amount of data to analyze. In addition, the videos did not

create a feeling of embodiment in the viewers. Since VR is able to accomplish this, the videos

were not similar enough to VR. This means that the data gathered during this quasi-experiment

does not necessarily apply to VR. Another limitation encountered during this quasi-experiment

was a lack of diversity in the participants. All eleven participants were white teachers, and most

participants (9) were female. This may have impacted the results and limited the ability of the

researcher to apply the results to the general population.

Moving forward, this experiment needs to be redone with a larger, more diverse set of

participants. The videos in the experiment should be replaced with interactive VRs. Doing this

would cause any change in IAT score to be directly attributed to VR. More experiments like this
USING VIRTUAL REALITY TO ADAPT TO CHANGE 21

one should be completed in order to definitely determine that VR can or cannot reduce a persons

bias. If it is concluded that VR can positively change social biases, the public should be made

aware of this and exposed to VRs with this capability. By reducing racism and other social biases

in many individuals, these social biases can be decreased as a whole, creating a more peaceful

and content feeling among society members of all races.

USING VIRTUAL REALITY TO ADAPT TO CHANGE 22

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