From Virtual to Reality. How Virtual Reality can enhance People's Health and Social Lives

Abstract

The application of Virtual Reality (VR) has an increasing capacity to simulate everyday environments. It provides multimodal sensory stimulations that have the ability to influence the human brain to correct neurological and cognitive rehabilitation/behavioral disorders. The purpose of this research is to determine how Virtual Reality (VR) could aid the quest to eliminate or reduce mental disorders/the effects of brain injuries. The outcome suggests that appropriate applications of VR can lead the human brain to improve/reverse neurological activities that lead to mental disorders such as dementia, Alzheimer’s and brain injuries caused by accident or strokes. Cognitive rehabilitation and behavioral therapists would benefit from the application of VR to improve the therapeutic experiences of brain injury or anxiety disorder patients. The coming together of involved parties such as individuals, society, manufacturers of VR technology, neurosurgeons, neurologists and social psychology are paramount to the success of this considered approach to eliminate/reduce various types of mental disorders.

Key Words: Virtual-, Augmented and Mixed Realities, Social Psychology, Cognitive Rehabilitation/Behavioral Therapy, Neurology, Mental Disorders

1. Introduction

1.1 Introduction

There is an improved understanding of how the human brain works. It appears that scientists have learned more about the human brain over the last decade than they have done over centuries. This is due to fast-paced increases in neurological and behavioral research, combined with improved research methodologies. With increases in technological capabilities in areas such as virtual (VR), augmented (AR) and mixed realities (MR), it appears possible to combine these for the benefit of mankind, in many areas of human life such as surgical, medical, behavioral, automotive and educational. For example, recent experiments with infra-red laser stimulation of parts of the human brain such as the pre-frontal cortex have shown that both short-term and long-term memory can be influenced positively. New VR technology allows people to take this further by focusing on making the human brain believe that dormant or unused neurological connections can be vitalized/revitalized. The researchers’ focus was on an approach that was based on a combination of what was already known about the subject matter under investigation (a priori) and the practical experiences of research participants (a posteriori). It focused on applying VR in its various forms such as augmented and mixed to improve people’s social lives in a number of areas (A-C) considered to be of initial priority, using a cognitive rehabilitation/behavior approach together with a transfer of learning results:

A: Mental Disorders- Dementia, Alzheimer’s, Creutzfeldt-Jacob, Autism
B: Behavioral-Drug and Alcohol Abuse, Artificial Limbs, Automotive Responses, Attitude and Behavior and Personal Issues, Anxiety Disorders
C: Social and Work-Images of loved ones during periods of absence, Self-confidence and Personal Psychology People Skills

Virtual environments present new opportunities to conduct social research (Martens et al., 2018). Researchers are able to influence and alter the experiences of research participants. It is possible to immerse people into new worlds, engage people in actions previously obstructed by physical or ethical limitations. For example, it is possible to study, examine and evaluate the behavior of research participants when assigned with opposite-sex avatars (female=empathizing, male=systemizing behaviors/approaches), consistent with the social representation of their own gender. With an improved understanding of how the human brain works, and with increases in technological capabilities in areas such as virtual, augmented and mixed realities (VR), it appears possible to combine the two for the benefits of mankind. In the context of this research, social psychology is defined as being part of psychology that focuses on how social phenomena influence people and how people generally interact with each other. How people see themselves in relation to the rest of the world is paramount to how human beings make choices, their behavior and beliefs. Another interpretation of VR, considered for this research, is that of the Foundry Vision-mongers Organization (2018), a visual effects software company: ‘Virtual Reality is the umbrella term for all immersive experiences, which could be created using purely real-world content, purely synthetic content or a hybrid of both’ In this context, it is suggested that two more kinds of ‘reality’ should be considered: Augmented Reality (AR) and Mixed Reality (MR). Table 1 shows the details of the relationship between all three considered non-real realities.

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Fig. 1 The Relationships between Virtual, Augmented and Mixed Realities

This research investigates potential problem areas associated with regular exposure to VR applications, what the affects these have on people and what can be done to overcome these. The researchers suggest that people of all ages and both sexes will benefit from appropriate applications of the VR technology to boost the quality of their personal lives. The researchers have adopted the concept of additive manufacturing (aerospace industry) for the context of this research and suggest that only appropriate levels of VR are applied to influence the human brain to either rejuvenate existing neurons or create new ones. Section 1.2 presents the literature review, Section 1.3 discusses the knowledge gap and Section 1.4 lists the main research questions/hypotheses. This is followed by Methodology and Results (outcomes of face to face interviews and ranking of the considered application/solutions). Discussion and Conclusions form the final two Sections.

1.2 Literature Review

1.2.1 Films

Film: Glass (Universal Pictures), released in the US on 18 January 2019: the main character of the film, Kevin Wendell Crumb, suffers from dissociative identity disorder and has 24 different personalities within him known as The Horde. Over the course of the film Kevin is able to inhabit each different identity with a high level of authenticity and a deeply unsettling edge. ‘His mind is host to 24 warring personalities, some of whom are lethal. Three of those split personalities, "Dennis", "Patricia" and "Hedwig", eventually stage a coup to release "The Beast", a further persona that gives Kevin superhuman abilities and murderous rage. The Beast's agenda is to rid the world of the "Untouched": people who have never known suffering. Those who have had a harder time, according to his philosophy, are the "Pure" who will inherit the Earth’ (www.empireonline.com), 2019). Kevin’s psychiatrist, Dr Ellie Staple, specializes in delusions of grandeur, with particular emphasis on patients who think they are superhuman. At one point during the film she states that a collection of personalities is the ‘total utilization of the human brain power capacity’. This is an interesting notion and the researchers will discuss in Section 4-Discussion if VR should play a role to improve cognitive rehabilitation therapy covered in this paper, through the creation of virtual personalities.

Film: The Titan (Voltage Pictures/Automatik Entertainment, The Post Republic, Nostromo Pictures), released 30 April 2018, UK: This film presents a provocative approach to engage in radical genetic transformation to alter the human DNA in order to save humanity. In the year 2048, Earth is overpopulated and it appears that there is a necessity to consider a new home for humanity. Titan is considered suitable but due to its environmental conditions would require some serious human adaptations in order to survive in areas such as vision (low level light) and staying under water for extended periods of time. Climate on Titan includes wind and rain and thus creates surface features close to planet Earth. In order to achieve essential mutations to get the human being (Homo Titanians) ready for Titan, human DNA is infused with animal DNA to create the necessary adaptations such as night vision, running faster over prolonged periods of time and being able to remain under water much longer. No appropriate concern is given to these evolutionary experiments with regard to side effects: hair and skin loss/mutations and sensory changes such as low-level light vision and low frequency communications, resulting in unexpected changes to the normal human rational behavior patterns.

Film: Ready Player One (Warner Bros. Pictures, released March 2018, UK): This film is set in the year 2015. Much of mankind uses a virtual reality software known as OASIS to escape the desolation of reality/life in the real world. A hidden game within the OASIS software promises the winner total control over the OASIS. It appears that the lack of human interactions leads to people becoming obsessed with the virtual world. Avatars (image of person in the virtual world) replace actual people. The OASIS has become a replacement for real life living. It appears that most human interactions have been suspended. Emotions, feelings and perceptions have been replaced by VR interactions. The very essence of what makes human beings ‘human’ has been replaced by a convenient alternative to experience the real ups and downs of life. Knowledge, skills, and experiences of real-life events appear to have disappeared, taken over by all matters VR. People appear to be distracted from solving their real-life issues by a VR domination that cancels all things human. There are no real feelings for real people. The real world is much slower than VR. People who are primarily in that environment ultimately lose their sense of reality, for example, in terms of speed and realistic limitations. The human brain drives human behavior and it is not clear in how far VR influences the brain and what potential consequences are.

1.2.2 Literature

According to Rubin (2018), VR has grown over recent years to become the biggest technological innovation. VR is already deployed in everyday life in areas such as entertainment, travel, education and real estate but also in the medical profession. Rubin suggests that the human brain can be fooled by virtual experiences ‘that it triggers the body to respond as though the experience were real’ (page 4). Associated reactions such as emotional, cognitive and psychological, in the virtual world, appear to change human beings and their brains in fundamental ways. For example, if people’s senses can be manipulated to perceive and behave in the virtual world just like the real world, then it is possible to trick or overrule the rational human brain, too. This is the cognitive con referred to as ‘presence’. Presence can affect emotional and physical responses and as such people’s memory, in particular the explicit memory called episodic (experience-based). Clinical research in Germany (2017) considers that VR has the ‘ability to deliver perfectly tuned simulations of real-life experiences’ (page 140), thus ‘VR could induce reactions and memories indistinguishable from real-life memories’ (page 140). This appears to validate, subject to clarification, that VR could be used in an area such as mnemonics (study and development of systems in order to improve and assist the memory). Rubin argues that the more people work with VR, the stronger their memory becomes. Quoting the work of four researchers from the US (2010), Rubin reports that their application of an experiential research design to elicit evidence of what creates presence in VR users, concludes that five categories create this user experience: sensory (visual and haptic/sense of touch), cognitive (mental engagement), affective (emotional response), active (empathy) and relational (social aspects). Lanier (2017) suggests that VR is a means of creating complete illusions giving the impressions that people actually are in different places. This can take the form of, for example, appearing to be in a non-human body or being in a totally different environment. The application of VR environments helps researchers, too, to understand better what a human being actually is in terms of cognition and perception. According to Lanier, based on many years of pushing the transformative power of modern technology to its limits, VR is ‘The substitution of the interface between a person and the physical environment with an interface to a simulated environment’ (page 47). It appears that some VR fanatics suggest that VR will eventually overtake the human nervous system and that there should then be no further necessity to improve VR any further. Lanier refutes such notion. The human nervous system is far superior than any VR system can ever be. It benefits from hundreds of millions of years of evolution and is designed to ‘tune itself to the quantum limit of reality in special cases already’ (page 49). The knowledge human beings already have about their bodies and physical reality surpasses what VR can ever have. It appears and is suggested that VR cannot fool the human brain indefinitely. Human cognition is in motion and is likely to overtake any progress in VR over time. Lanier argues that the human nervous system is holistic whereas VR makes the brain believe, for a while, that the virtual world is real. VR is the technology that exposes people to themselves. It is a kind of proof that people are real. Olson (2017) considers that with the help of VR, people can get much closer to their own mind as they have ever done before. To achieve equilibrium and to endure success, Nash & Stevenson (2004) suggest that people should aim for sustainable, enduring success throughout their lives, across the following four main spheres of self, family, work and community: Happiness-Achievement-Legacy-Significance. People who regularly review their goals and adjust their habits, appear to be making better progress. It is all about doing rather than talking:

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Positive mental attitudes and habits lead to a more fulfilling life. The human brain can be trained and therefore re-shaped irrespective of age. Efforts to change the way people think is similar to physical exercise to improve the body. VR has the true potential to help people create new positive habits and improve ways of thinking and being (based on the research conducted by Seligman et al. (2005). Eschen et al. (2018) report that recent technological advances in areas such as VR and Augmented Reality (AR) have led to potential increases in areas such as employee training, remote aviation maintenance or inspection and assembly processes (Bacim et al, 2013; Bischoff & Kazi, 2004; Chong et al., 2009). AV and VR form part of Mixed Reality (MR). MR combines the physical with the digital world and sits between the extremes of real world and virtual world (Fig. 2).

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Fig.2 Mixed Reality Continuum (Eschen et al., 2018)

Kaku (2014) suggests that the human brain/mind is still one of the greatest and most mysterious forces in the world. It appears that the introduction of a variety of advanced brain scanning machines such as magnetic resonance imaging (MRI), electroencephalogram (EEG) and deep brain stimulation (DBS), has transformed neuroscience significantly. More is known today about the human brain than in all previous times in the history of mankind. The human mind is at the forefront and no longer considered out of reach. Applying, for example, MRI scans, it is possible to read thoughts circulating in the brain. Less-able people such as paralyzed patients, with the help of an inserted chip in their brains, can surf the web, read and write messages, control their wheelchair, operate household appliances and manipulate mechanical arms. Such patients can almost function in the same way as a more-able person can. Kaku quotes the work of neurosurgeon Dr Wilder G. Penfield (1891-1976) who discovered in the 1930s that electrical pathways connected the brain to the body and that by stimulating parts of the temporal lobe, patients experienced the revival of long-forgotten memories as if they had just happened. MRI scans have also provided new evidence of cognitive impairment of mental diseases such as Alzheimer’s, Parkinson’s and schizophrenia. Another tool, originally used by Dr Penfield in a crude form, is known as deep brain stimulation (DBS). It can be used to treat mental disorders mentioned earlier. Kaku concludes that, based on the contemporary views of neurologists, ‘What is missing, they pointed out, is the middle ground, where most of the interesting brain activity takes place. It is in this middle ground, involving the pathways of thousands to millions of neurons, that there are huge gaps in our understanding of mental disease and behavior’ (page 251). Kaku suggests to find the origins of certain mental disorders as it appears that many of these are caused by misconnection at molecular/cellular level. ‘The world of the future will be the world of the mind’ (page 320).

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Table 1 Brain Feedback Loop Theory Summary (adopted from Kaku, 2014)

According to some research conducted by Blissing et al. (2017), the performance and behavior of MR and VR systems are almost exclusively determined by the display techniques used to present the computer-generated graphics. There are a number of display techniques that can be applied to create images for AR, MR and VR. One option appears to be the use of a head-mounted display (HMD) to present visual cues to users, deploying either an optical see-through HMD (Bock et al., 2007), a video see-through HMD (Berg et al., 2013) or an opaque HMD for pure virtual worlds (Karl et al., 2013). Blissing et al suggest that the main challenge for future VR, AR and MR systems are in the areas of latency and improved tracking. A major priority must be to reduce the visual latency to remedy the misalignment between real and virtual objects. Pulijala et al. (2018) report that the purpose of their trial was to establish what effect the use of VR surgery would have on the self-confidence and knowledge of surgical residents. The study group participants showed substantial perceived self-confidence levels compared to a non-VR group. The conclusion from this trial purports that Immersed VR (iVR) experiences enhance knowledge and self-confidence of the surgical residents. Ip et al. (2018) argue that, for example, shortfalls in social-emotional reciprocity (one of the diagnostic criteria of Autism Spectrum Disorder (ASD), prevents children from responding appropriately so they can adjust themselves in different social situations. The outcome of their study demonstrates that it is possible to use VR for the training of children with ASD. It appears that it is feasible to improve social skills, emotional expressions and regulation of autistic children through appropriate VR training. Turner & Casey (2014) report that the application of VR in psychological interventions has only been on the increase recently (Gorini & Riva, 2008; Repetto & Riva, 2011). It appears that significant advantages have been achieved in areas such as computer graphics, speed and processing power and head-mounted displays (HMD). It is possible to engage in psychological and behavioral change in new and creative ways. Applying actions similar to face to face interviewing, VR can be used (and tailor-made) to identify a number of different psychological disorders and behavioral issues (Fox et al., 2009). Although research results have been promising, more research is suggested necessary to generalize whether findings can be generalized to VR interventions. Hesse et al. (2017) consider that the application of psychological therapies such as cognitive behavioral therapy (CBT) in VR environments can help people with abnormal thinking and perceptions (psychotic disorders). VR, in this context, provides a computer-controlled environment and immerses participants’ senses by a head-mounted display (HMD) and headphones. A so-called head-tracker simulates head movements within an HMD egocentric view. Complex, for example, social scenarios, can be presented in a controlled way. VR allows for avatars to be used to whose behavior can be controlled down to minute details. It is thus possible to induce social interactions with maximum therapeutic benefits. Foreman & Pollard (2016) report that the main focus of cognitive therapy is how information is processed by the human brain, how this information is then processed and stored, and how the human brain integrates new information with existing. Cognitive therapy is concerned with gaining a much better understanding how the human brain thinks. People’s behavior and emotions are driven by their perceptions of what is happening around them. It is possible to apply this knowledge for the benefit of people with psychological disorders who require treatment. The interaction of thoughts, emotions, behaviors and physical states appear to be the cause and reason why cognitive difficulties are maintained by the human brain. Cognitive behavioral therapy is considered to be particularly effective for mental health issues such as anxiety, depression, phobias and post-traumatic stress. Foreman and Pollard argue that an antecedent or trigger event generates an emotional reaction. This is based on people’s beliefs and leads to an evaluation of the event and any potential causes or meaning. The final stage is the consequence of how people view the event and this leads to their emotional or behavioral reaction to it (Table 2).

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Table 2 The ABC of CBT (adopted from Foreman & Pollard, 2016)

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