Social interaction is fundamental in daily life. While research shows that top-down influences affect social interactions, the level at which this takes place remains unclear. For example, studies investigating the influence of group membership on sensorimotor simulation, a core low-level mechanism of social interaction, have resulted in mixed evidence. We aimed to reconcile and extend these findings to offer a unified account of the effects of group membership on sensorimotor simulation processes. We hypothesized that group membership affects sensorimotor simulation of others’ actions only when embodied prediction is necessary. In two experiments, where participants observed hand movements congruent or incongruent with their own, we showed that racial group membership only modulated the congruency effect during response preparation when embodied prediction of the other’s movements was present. These results provide insights into how racial group membership, a salient visual inter-individual difference, shapes low-level mechanisms that are fundamental to our social life.

Anterior cruciate ligament (ACL) ruptures are prevalent, particularly among young athletes. Although ligament reconstruction is the gold standard treatment, the rehabilitation process is extensive and has high reinjury rates. Recovery is often hindered by muscle inhibition and psychological factors like kinesiophobia and associated fear of reinjury. Emerging evidence suggests that motor imagery and action observation could enhance rehabilitation outcomes. Immersive virtual reality (VR) offers a novel way to integrate these techniques, potentially accelerating recovery. In this parallel randomized controlled trial, patients undergoing ACL reconstruction were randomly assigned to receive either conventional rehabilitation alone or conventional rehabilitation plus VR training. Our VR content incorporated several novel elements, including embodiment in a virtual body, first-person perspective, and the performance of virtual exercises guided by a virtual physiotherapist. Another innovative feature was that patients conducted the daily VR training independently at home using a standalone head-mounted display. The VR group performed a 20-min daily VR rehabilitation program for 4 weeks post-surgery, visualizing, planning, and executing movements using an embodied virtual avatar. Self-reported disability (International Knee Documentation Committee score, IKDC), quadriceps strength limb symmetry, active knee extension range of motion (ROM) limb symmetry, and kinesiophobia (Tampa Scale of Kinesiophobia-short form, TSK-11) were measured at baseline, 4, 12, and 36 weeks. Forty-seven participants were randomized, with 44 completing treatment. IKDC scores were not statistically significantly different between groups, despite moderate effect sizes at 4 and 36 weeks (Cohen’s d = 0.559, and d = 0.722, respectively). The VR intervention group showed significantly lower kinesiophobia at 4 weeks post-surgery compared to controls (27.00 ± 6.58 vs. 33.35 ± 5.07, Cohen’s d = − 0.971, p = 0.045). Both groups demonstrated significant improvements in all outcomes over time (p < 0.001). No significant differences were found for range of motion or quadriceps strength limb symmetry. No adverse events were reported related to the intervention. Reducing kinesiophobia is crucial for timely and effective rehabilitation and return to sport, and for reducing reinjury risk. To our knowledge, this is the first clinical study to investigate the independent use of therapeutic VR at home during post-orthopedic surgery rehabilitation. Future research should explore different VR interventions, including more active exercises and personalized programs, to enhance adherence and optimize recovery. The study was pre-registered with the National Library of Medicine (NCT05080894; first registered 09/20/2021).

There is a world-wide deficit in physical exercise with many deleterious effects on health. Methods to enhance the uptake of physical exercise include digital applications and celebrity endorsements. Here we introduce a Virtual Reality (VR) self-conversation method combined with celebrity endorsement. Participants had a conversation with a virtual representation of a sporting celebrity to discuss ways of enhancing their exercise routine. However, they took both sides of the discussion—embodied as themselves and as the celebrity, swapping between the two bodies. A between groups experiment was carried out with three conditions: Video (n = 25), General (n = 20) and Self (n = 20). All participants watched a video of the celebrity athlete working out. Participants in the General condition additionally experienced the VR scenario with their own self representation as a general sex-matched virtual body. In the Self condition their virtual body was a likeness of themselves. The results showed that participants had improved in their exercise routines one week after the VR exposure. However, for women the improvement was superior with the General body, and for men with the Self body. The difference between the outcomes for males and females is probably due to the greater likelihood of body dissatisfaction amongst women. This is an exploratory study of a new technique with promising results.

BackgroundAccess to mental health services continues to pose a global challenge, with current services often unable to meet the growing demand. This has sparked interest in conversational artificial intelligence (AI) agents as potential solutions. Despite this, the development of a reliable virtual therapist remains challenging, and the feasibility of AI fulfilling this sensitive role is still uncertain. One promising approach involves using AI agents for psychological self-talk, particularly within virtual reality (VR) environments. Self-talk in VR allows externalizing self-conversation by enabling individuals to embody avatars representing themselves as both patient and counselor, thus enhancing cognitive flexibility and problem-solving abilities. However, participants sometimes experience difficulties progressing in sessions, which is where AI could offer guidance and support. ObjectiveThis formative study aims to assess the challenges and advantages of integrating an AI agent into self-talk in VR for psychological counseling, focusing on user experience and the potential role of AI in supporting self-reflection, problem-solving, and positive behavioral change. MethodsWe carried out an iterative design and development of a system and protocol integrating large language models (LLMs) within VR self-talk during the first two and a half years. The design process addressed user interface, speech-to-text functionalities, fine-tuning the LLMs, and prompt engineering. Upon completion of the design process, we conducted a 3-month long exploratory qualitative study in which 11 healthy participants completed a session that included identifying a problem they wanted to address, attempting to address this problem using self-talk in VR, and then continuing self-talk in VR but this time with the assistance of an LLM-based virtual human. The sessions were carried out with a trained clinical psychologist and followed by semistructured interviews. We used applied thematic analysis after the interviews to code and develop key themes for the participants that addressed our research objective. ResultsIn total, 4 themes were identified regarding the quality of advice, the potential advantages of human-AI collaboration in self-help, the believability of the virtual human, and user preferences for avatars in the scenario. The participants rated their desire to engage in additional such sessions at 8.3 out of 10, and more than half of the respondents indicated that they preferred using VR self-talk with AI rather than without it. On average, the usefulness of the session was rated 6.9 (SD 0.54), and the degree to which it helped solve their problem was rated 6.1 (SD 1.58). Participants specifically noted that human-AI collaboration led to improved outcomes and facilitated more positive thought processes, thereby enhancing self-reflection and problem-solving abilities. ConclusionsThis exploratory study suggests that the VR self-talk paradigm can be enhanced by LLM-based agents and presents the ways to achieve this, potential pitfalls, and additional insights.

This paper explores a method for enhancing intrapersonal emotion regulation skills through self-talk in virtual reality. Difficulty regulating emotions is a pervasive aspect of psychopathology and can be improved through clinical therapeutic work. Here, we employed virtual reality and the technique of body ownership illusions to create a conversation between two virtual representations of the self, using an application known as ConVRSelf (Conversations with yourself in Virtual Reality). Forty-seven healthy participants (85

BackgroundVirtual reality (VR) interventions, based on cognitive behavioral therapy principles, have been proven effective as complementary tools in managing obesity and have been associated with promoting healthy behaviors and addressing body image concerns. However, they have not fully addressed certain underlying causes of obesity, such as a lack of motivation to change, low self-efficacy, and the impact of weight stigma interiorization, which often impede treatment adherence and long-term lifestyle habit changes. To tackle these concerns, this study introduces the VR self-counseling paradigm, which incorporates embodiment and body-swapping techniques, along with motivational strategies, to help people living with obesity effectively address some of the root causes of their condition. ObjectiveThis study aims to assess the clinical efficacy of ConVRself (Virtual Reality self-talk), a VR platform that allows participants to engage in motivational self-conversations. MethodsA randomized controlled trial was conducted with 68 participants from the bariatric surgery waiting list from the obesity unit of the Vall d’Hebron University Hospital in Barcelona, Spain. Participants were assigned to 1 of 3 groups: a control group (CG), which only received treatment as usual from the obesity unit; experimental group 1 (EG1), which, after intensive motivational interviewing training, engaged in 4 sessions of VR-based self-conversations with ConVRself, and underwent embodiment and body-swapping techniques; and experimental group 2 (EG2), which engaged in 4 VR-based sessions led by a virtual counselor with a prerecorded discourse, and only underwent the embodiment technique. In the case of both EG1 and EG2, the VR interventions were assisted by a clinical researcher. Readiness to change habits, eating habits, and psychological variables, as well as adherence and satisfaction with ConVRself were measured at baseline, after the intervention, 1 week after the intervention, and 4 weeks after the intervention. ResultsRegarding the primary outcomes, EG1 (24/68, 35%) and EG2 (22/68, 32%) showed significant improvements in confidence to lose weight compared to the CG (22/68, 32%) at all assessment points (β=−.16; P=.02). Similarly, EG1 demonstrated a significant increase after the intervention in readiness to exercise more compared to the CG (β=−.17; P=.03). Regarding the secondary outcomes, EG1 participants showed a significant reduction in uncontrolled eating (β=.71; P=.01) and emotional eating (β=.29; P=.03) compared to the CG participants, as well as in their anxiety levels compared to EG2 and CG participants (β=.65; P=.01). In addition, participants from the experimental groups reported high adherence and satisfaction with the VR platform (EG1: mean 59.82, SD 4.00; EG2: mean 58.43, SD 5.22; d=0.30, 95% CI −0.30 to 0.89). ConclusionsThis study revealed that using VR self-conversations, based on motivational interviewing principles, may have benefits in helping people with obesity to enhance their readiness to change habits and self-efficacy, as well as reduce dysfunctional eating behaviors and anxiety. Trial RegistrationClinicalTrials.gov NCT05094557; https://www.clinicaltrials.gov/study/NCT05094557

IntroductionWe aim to examine the usability of a Virtual Reality (VR) platform, called ConVRSelf, which has been designed to address the needs of People Living With Obesity (PLWO).MethodsFourteen participants with a desire to eat healthier and exercise more (6 normal weight and 8 PLWO; Mean age = 41.86, SD = 13.89) were assigned to the experimental group (EG) or the control group (CG). EG participants, after being trained on motivational interviewing skills, engaged in a virtual self-conversation using embodiment and body swapping techniques, which aimed to normalize and resolve their ambivalence to change lifestyle habits. CG participants, embodied in their virtual bodies, participated in a pre-established discourse with a virtual counselor giving them psychoeducational advice about how to change lifestyle habits. A mixed-methods design was used, involving a semi-structured interview and self-report questionnaires, including readiness to change habits (Readiness Rulers), body ownership (Body Ownership Questionnaire, BOQ), and system usability (System Evaluation Questionnaire, SEQ). Thematic content analysis was carried out for qualitative data while statistical data analysis was carried out using SPSS 20.0.ResultsParticipants from both groups showed high readiness to change lifestyle (Readiness Rulers) before engaging with the virtual experiences, which was maintained at the same level after the interventions and their scores on the SEQ and BOQ were satisfactory. Regarding qualitative information obtained from the interviews, almost all participants found the VR experience to be novel, interesting, and enjoyable. A higher acceptability was observed among PLWO from the EG than normal weight participants from the same group, a promising finding for the ConVRSelf platform, which had been specifically designed to address the needs of PLWO.ConclusionThe ConVRSelf system is well-accepted by participants and is ready to be tested with PLWO in a clinical setting.

Introduction People living with obesity (PLWO) often experience ambivalence when starting their change process towards a healthier lifestyle. Psychological treatments for obesity should resolve this ambivalence and help PLWO to explore their own reasons for change in line with their needs and values, as well as promote self-efficacy. Following the Motivational Interviewing (MI) principles, the SOCRATES project proposes a “virtual self-conversation” to help PLWO to address some of the psychological aspects associated with obesity, such as the lack of awareness about their condition, the impact of the internalization of weight stigma, and the lack of self-efficacy. Objectives With the current longitudinal study, we aim to explore how the participants’ process of lifestyle change, and how their eating habits and dysfunctional eating patterns change before and after the virtual intervention. Methods Forty-eight patients with obesity from the Vall d’Hebron University Hospital (Mean age = 19.7 years) were assigned to 3 groups. The Experimental Group 1 (EG1) (N = 21), after completing an intensive training on MI, received a virtual intervention using the “motivational self-conversation” technique. The Experimental Group 2 (EG2) (N = 17) underwent a virtual intervention with a pre-registered psychoeducational dialogue, and the Control Group (CG) (N = 10) followed treatment-as-usual. All participants completed self-reported questionnaires on their motivation to change lifestyle [( Readiness Rulers (RR), Processes of Change questionnaire in weight management (P-W) ], eating habits ( Habits questionnaire ) and dysfunctional eating patterns ( Three Factor Eating Questionnaire-18 ) at baseline (T0), post-intervention (T1), and 4 weeks follow-up (T2). Repeated measures ANOVA was performed for all the questionnaires. Results Statistically significant results were shown regarding motivation to change through the RR and the “evaluation of the consequences of their weight” subscale of P-W across time for the EG1 (p < .05). These results suggest that participants’ motivation to eat healthier and do more exercise, as well as self-awareness about the negative consequences of their condition increased after the virtual intervention. Conclusions The present study showed that this novel virtual intervention might be an effective tool in helping PLWO resolve their ambivalence to change lifestyle and acquire self-awareness about their condition. However, the intervention did not lead to significant changes in other psychological variables, such as lifestyle habits or dysfunctional eating patterns; domains that may be less sensitive to changes over the time, and which may take place once motivation is well-established. Disclosure of Interest None Declared

IntroductionThe integration of Motivational Interviewing (MI) with behavioural and psychological interventions for the treatment of obesity has the potential to improve health-related outcomes of patients in the long-term.ObjectivesOur objective is to examine the usability of a VR embodiment tool for treating obesity.MethodsFourteen participants (6 healthy and 8 with morbid obesity) with a desire to make lifestyle changes were randomly assigned to the experimental group (EG) and the control group (CG). Participants from the EG engaged in a virtual self-conversation aiming at understanding their own motivation to make lifestyle changes. Using the body swapping technique, participants were embodied alternately in their own virtual representation and in their counsellor’s body. To better guide this virtual self-conversation, participants were previously trained on MI skills. Participants from the CG were embodied in their own virtual bodies and participated in a “scripted dialogue” with a virtual counsellor who gave them practical recommendations about how to achieve lifestyle changes. A mixed-methods design was used, involving a semi-structured interview examining users´ satisfaction with the virtual experience, as well as self-report questionnaires, including readiness to change habits, body ownership, and system usability.ResultsParticipants showed high usability of the platform with higher scores among participants from the EG compared to the CG. Levels of body ownership were satisfactory, with no differences between groups.ConclusionsThrough the integration of MI in the VR context with the patient being properly trained to carry out his/her own motivational self-conversation, we will provide an important advance in the psychological treatments of obesity.DisclosureThis project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 951930

An altered sense of self-awareness and agency has been proposed to underlie symptoms of schizophrenia. In this study, we used the enfacement illusion paradigm - in which perception of another person's face leads to changes in perception of one's own peri-personal space - to examine the brain correlates of the sense of agency and its potential disruption in schizophrenia. Thirty-three schizophrenic patients and 27 healthy controls underwent fMRI scanning during performance of a task designed to elicit the enfacement illusion. Activations were examined using whole-brain analysis and also in an a priori identified region of interest (ROI) in the temporoparietal junction (TPJ), a region that has been described as involved in self/other differentiation and sense of agency. Both groups showed a pattern of cortical activation involving the pre and postcentral cortex, Rolandic operculum, insula, parietal, temporal and occipital cortex bilaterally as well as TPJ (but only right-side in patients). Examination of the TPJ ROI revealed significantly reduced activation on the left in the patients that was associated with poorer insight. The findings suggest brain functional abnormality in schizophrenia related to the formation or maintenance of processes related to self and/or agency. Decreased function in the TPJ may have a role in the impaired insight seen in patients with the disorder.

Introduction Previous research has shown that it is feasible to integrate motivational interviewing techniques with behavioural and psychological interventions for the treatment of obesity. Moreover, these combined interventions have the potential to improve health-related outcomes of people living with obesity (PLWO) and to afford maintenance of behavioural changes over time. In addition, the use of virtual reality (VR) embodiment techniques in the treatment of eating disorders and obesity has promising preliminary effectiveness. The objective of this study is to assess the clinical efficacy of a VR intervention that uses embodiment and body-swapping techniques and has been specifically developed to cover the needs of PLWO. Methods and analysis A randomised control trial will be carried out with an estimated sample of 96 participants with body mass index (BMI)>30. The whole duration of the trial will be 12 months. Participants will be recruited from the external consultations of the Vall d'Hebron University Hospital and be randomly assigned to three groups. The experimental group 1 will engage in a virtual self-conversation using the ConVRself platform, the experimental group 2 will participate in a ‘pre-established discourse’ provided by the virtual counsellor, who will give psychoeducation advice, and the control group will continue with treatment as usual. Readiness to change, BMI, eating habits and physical activity, psychological well-being, body image satisfaction, quality of life in relation to body image, and weight bias internalisation will be assessed at baseline, post intervention, 1-week and 4-week follow-up. Finally, variables related to adherence and satisfaction with the VR tool will be evaluated for the experimental groups. Ethics and dissemination This study was approved by the Research Projects Committee of the Vall d’Hebron University Hospital. Findings will be disseminated through peer-reviewed journals, reports to the funding body, conferences and other events for the scientific and clinical community, and the general public. Trial registration number NCT05094557.

Immersive Virtual Reality (IVR) studies indicate that there is some level of the brain that does not distinguish between reality and virtual reality.In this context, a self avatar embodied from first person perspective brings a significant and lasting change to the user.IVR is therefore widely used in research and for psychological and physiological health rehabilitation.We use IVR in a wide range of areas in pain and mobility, emotional health, diversity equity and inclusion, to rehabilitate domestic violence offenders and to promote healthier lifestyles among obese people (Fig. 1).A remaining challenge is to accurately and efficiently create avatars with body shapes and appearance that closely match those of the real user's bodies.This is owing to the huge differences in human body forms, the reduction of the complex human shape by body scanning technology and the complexity of acquiring accurate body measurements.The primary objective of this work was to construct a cost-effective and accurate model to infer the 3D shape from a front and side image of a person taken with a smartphone.To achieve this, we used a fully morphable human body model to change the body shape using a set of body shape modifying parameters.We create a dataset of thousands of computer generated front and side images varying the shape modifiers of the morphable model.We then train a convolutional neural network (CNN) using that dataset (Fig. 3).Our approach efficiently infers 3D human body shapes from a person's front and side image generating an accurate representation of a person.We made preliminary tests using a set of 10 body scans with known measurements, creating computer generated front and side images of the scans and using these images as input to the CNN and to compare the resulting body shape with the original 3D body scan.Our results demonstrate the effectiveness of the designed approach (Fig. 5, Fig. 6).Our proposed model enables us to create a fully movable avatar that can be embodied in IVR from a front and side smartphone photo in a fully automated way.The same inferred shape modifiers can also be used on the clothing of the avatar to enable us to dress the avatar.Although a larger comparative study needs to be performed before the use of this approach can be routinely recommended, we believe that the convenience and ease-of-use of this model will contribute to increase the reach of VR tools with look-alike avatars also in clinical settings.

The objective of the present study, which is framed within the European Union's H2020 project titled SOCRATES, is to examine the usability of a Virtual Reality (VR) embodiment tool for treating obesity. Six healthy adult participants with a desire to make lifestyle changes in terms of eating healthier and doing more physical activity were recruited and were randomly assigned to the experimental group (EG) or the control group (CG). Participants from the EG engaged in a self-conversation aiming at enhancing their self-awareness and, through embodied perspective taking (body swapping), they were embodied alternately in their own virtual representation and in a counsellor's virtual body. Participants from the CG, embodied in their own virtual bodies, participated in a "scripted dialogue" with a counsellor of their choice who asked them about their perceived barriers for engagement with a healthier lifestyle and gave them practical recommendations about how to make lifestyle changes. A mixed-methods design was used, involving a semi-structured interview examining the level of users' satisfaction with the 2 virtual experiences and their uncovered needs, as well as self-report questionnaires including those addressing readiness to change habits, body ownership during the VR experiences, and system usability. The pilot usability study was conducted in July 2021. Then from September 2021 onwards, once modifications to the prototype are carried out based on the usability testing and the final VR tool is ready for use in a clinical setting, a Randomised Controlled Trial will be conducted with 96 participants with obesity to assess its efficacy compared to usual care.

As part of the open sourcing of the Microsoft Rocketbox avatar library for research and academic purposes, here we discuss the importance of rigged avatars for the Virtual and Augmented Reality (VR, AR) research community. Avatars, virtual representations of humans, are widely used in VR applications. Furthermore many research areas ranging from crowd simulation to neuroscience, psychology, or sociology have used avatars to investigate new theories or to demonstrate how they influence human performance and interactions. We divide this paper in two main parts: the first one gives an overview of the different methods available to create and animate avatars. We cover the current main alternatives for face and body animation as well introduce upcoming capture methods. The second part presents the scientific evidence of the utility of using rigged avatars for embodiment but also for applications such as crowd simulation and entertainment. All in all this paper attempts to convey why rigged avatars will be key to the future of VR and its wide adoption.

Agency is the attribution of an action to the self and is a prerequisite for experiencing responsibility over its consequences. Here we investigated agency and responsibility by studying the control of movements of an embodied avatar, via brain computer interface (BCI) technology, in immersive virtual reality. After induction of virtual body ownership by visuomotor correlations, healthy participants performed a motor task with their virtual body. We compared the passive observation of the subject’s ‘own’ virtual arm performing the task with (1) the control of the movement through activation of sensorimotor areas (motor imagery) and (2) the control of the movement through activation of visual areas (steady-state visually evoked potentials). The latter two conditions were carried out using a brain–computer interface (BCI) and both shared the intention and the resulting action. We found that BCI-control of movements engenders the sense of agency, which is strongest for sensorimotor areas activation. Furthermore, increased activity of sensorimotor areas, as measured using EEG, correlates with levels of agency and responsibility. We discuss the implications of these results for the neural bases of agency, but also in the context of novel therapies involving BCI and the ethics of neurotechnology. Key points summary We induced embodiment of a virtual body and its movements were controlled by two different BCI paradigms – one based on signals from sensorimotor versus one from visual cortical areas. BCI-control of movements engenders agency, but not equally for all paradigms. Cortical sensorimotor activation correlates with agency and responsibility. This has significant implications for neurological rehabilitation and neuroethics.

When faced with a personal problem people typically give better advice to others than to themselves. A previous study showed how it is possible to enact internal dialogue in virtual reality (VR) through participants alternately occupying two different virtual bodies - one representing themselves and the other Sigmund Freud. They could maintain a self-conversation by explaining their problem to the virtual Freud and then from the embodied perspective of Freud see and hear the explanation by their virtual doppelganger, and then give some advice. Alternating between the two bodies they could maintain a self-dialogue, as if between two different people. Here we show that the process of alternating between their own and the Freud body is important for successful psychological outcomes. An experiment was carried out with 58 people, 29 in the body swapping Self-Conversation condition and 29 in a condition where they only spoke to a Scripted Freud character. The results showed that the Self-Conversation method results in a greater perception of change and help compared to the Scripted. We compare this method with the distancing paradigm where participants imagine resolving a problem from a first or third person perspective. We consider the method as a possible strategy for self-counselling.

The most robust and clear biological index differentiating persons with schizophrenia from healthy controls is the drastic reduction of the amplitude of their P300b event-related brain potential (ERP). However, the cause of that reduction remains obscure. Nevertheless, the P300b belongs to the family of the late posterior positivities (LPPs) which are closely related to the consciousness of the meaning of the stimulus in the task for the participants themselves (e.g., the: I am seeing the target stimulus for which I have to respond). The fragmentation of the self present in schizophrenia, could thus be the cause. If this were true, then P300bs should be somewhat reduced in healthy participants when their self representations are temporarily and minimally fragmented. We tested this hypothesis by using the innocuous fragmentation of the self that occurs in virtual reality (VR). There, participants can have a fragment of their self in an avatar they feel embodied in, within a VR room, while having another fragment of their self in their real body in the real room where they know they are. Our participants were thus equipped with a head mounted display in which they viewed a virtual room where a female humanoid avatar was facing them. She was lifting her right hand in synchrony with the participants, in order to induce in them a feeling of embodiment. Stimuli were a frequent green- and a rare red-disk, the oddball stimulus, occurring over the right hand of the avatar. Participants had to perform a Go/NoGo task, lifting their right hand to the frequent green disk and repressing this action for the oddball red disk. In the syncMove block of trials the avatar was lifting her right hand synchronously with the participant, disturbing her self representation as confirmed by the debriefing session. In the noMove block, the avatar remained immobile. In the classic block, only the red and the green disk were displayed on a monochrome background, neither the room nor the avatar were shown. As predicted, P300bs were found to be smaller in the syncMove block than in the noMove- and the classic-block in participants who had the classically large P300b oddball effect between ERPs to the frequent and those to the rare stimuli. Reduced P300bs of schizophrenia could thus be partly due to self fragmentation. Results may also open an avenue of research to the functional significance of LPPs and the content of the consciousness indexed by these potentials.

There is an alarming level of violence by police in the US toward African Americans. Although this may be rooted in explicit racial bias, the more intractable problem is overcoming implicit bias, bias that is non-conscious but demonstrated in actual behavior. If bias is implicit, it is difficult to change through explicit methods that attempt to change attitudes. We carried out a study using virtual reality (VR) with 38 officers in a US police department, who took part in an interrogation of an African American suspect alongside an officer who was racially abusive toward the suspect. Seventeen of the participants witnessed the interview again from a third person perspective (Observer) and 21 from the embodied perspective of the suspect, now a victim of the interrogation (Victim condition), having been assigned randomly to these two groups. Some weeks later, all witnessed aggression by an officer toward an African American man in a virtual cafe scenario. The results show that the actions of those who had been in the Victim condition were coded as being more helpful toward the victim than those in the Observer condition. We argue that such VR exposures operate at the experiential and implicit level rather than the explicit, and hence are more likely to be effective in combating aggression rooted in implicit bias.

The concept of personal space is a key element of social interactions. As such, it is a recurring subject of investigations in the context of research on proxemics. Using virtual-reality-based experiments, we contribute to this area by evaluating the direct effects of emotional expressions of an approaching virtual agent on an individual’s behavioral and physiological responses. As a pilot study focusing on the emotion expressed solely by facial expressions gave promising results, we now present a study design to gain more insight.

BACKGROUND:Engaging, interactive, and automated virtual reality (VR) treatments might help solve the unmet needs of individuals with mental health disorders. We tested the efficacy of an automated cognitive intervention for fear of heights guided by an avatar virtual coach (animated using motion and voice capture of an actor) in VR and delivered with the latest consumer equipment. METHODS:We did a randomised trial of automated VR versus usual care. We recruited adults aged older than 18 years with a fear of heights by radio advertisements in Oxfordshire, UK. We diagnosed fear of heights if participants scored more than 29 on the Heights Interpretation Questionnaire (HIQ). We randomly allocated participants by computer in a 1:1 ratio to either automated VR delivered in roughly six 30-min sessions administered about two to three times a week over a 2-week period (intervention group) or to usual care (control group). Randomisation was stratified by severity of fear of heights. The research team, who were unaware of the random allocation, administered three fear-of-height assessments, at baseline (0 weeks), at the end of treatment (2 weeks), and at follow-up (4 weeks). The primary outcome measure was HIQ score (range 16-80, with higher scores indicating greater severity). This trial is registered with the ISRCTN registry, number ISRCTN11898283. FINDINGS:Between Nov 25, 2017, and Feb 27, 2018, 100 individuals were enrolled and underwent randomisation, of whom 49 were assigned to the VR treatment group and 51 to the control group. All participants completed the 4-week follow-up. The mean total treatment time in VR was 124·43 min (SD 34·23). Compared with participants in the control group, the VR treatment reduced fear of heights at the end of treatment (mean change score -24·5 [SD 13·1] in the VR group vs -1·2 [7·3] in the control group; adjusted difference -24·0, 95% CI -27·7 to -20·3; Cohen's d=2·0; p<0·0001). The benefit was maintained at follow-up (mean change score -25·1 [SD 13·9] in the VR group vs -1·5 [7·8] in the control group; adjusted difference -24·3, 95% CI -27·9 to -20·6; Cohen's d=2·0; p<0·0001). The number needed to treat to at least halve the fear of heights was 1·3. No adverse events were reported. INTERPRETATION:Psychological therapy delivered automatically by a VR coach can produce large clinical benefits. Evidence-based VR treatments have the potential to greatly increase treatment provision for mental health disorders. FUNDING:Oxford VR, and the National Institute of Health Research Oxford Health Biomedical Research Centre.