Todd Maddox, PhD

Learning Scientist | Researcher

Hi, I'm Todd Maddox. I've spent over two decades researching and teaching the brain science behind how humans learn. For the last two years I've helped build IKONA's platform using what I've learned in my own lab and in uncovering the power of virtual and augmented reality. This page is meant to be a resource for you — to expand your knowledge of what's possible, what's working and why, and what we still hope to discover.

Is Clinical Virtual Reality Ready for Primetime?

Objective: Since the mid-1990s, a significant scientific literature has evolved regarding the outcomes from the use of what we now refer to as clinical virtual reality (VR). This use of VR simulation technology has produced encouraging results when applied to address cognitive, psychological, motor, and functional impairments across a wide range of clinical health conditions. This article addresses the question, "Is clinical VR ready for primetime?"

Conclusions: Although there is still much research needed to advance the science in this area, we strongly believe that clinical VR applications will become indispensable tools in the toolbox of psychological researchers and practitioners and will only grow in relevance and popularity in the future.

Find the full report here.


Rizzo AS. Keynote Speaker is Clinical Virtual Reality Ready for Primetime? 2018 IEEE Conference on Virtual Reality and 3D User Interfaces (VR). 2018. doi:10.1109/vr.2018.8446505

The Past, Present, and Future of Virtual and Augmented Reality Research: A Network and Cluster Analysis of the Literature

Abstract: The recent appearance of low cost virtual reality (VR) technologies – like the Oculus Rift, the HTC Vive and the Sony PlayStation VR – and Mixed Reality Interfaces (MRITF) – like the Hololens – is attracting the attention of users and researchers suggesting it may be the next largest stepping stone in technological innovation. However, the history of VR technology is longer than it may seem: the concept of VR was formulated in the 1960s and the first commercial VR tools appeared in the late 1980s. For this reason, during the last 20 years, 100s of researchers explored the processes, effects, and applications of this technology producing 1000s of scientific papers. What is the outcome of this significant research work? This paper wants to provide an answer to this question by exploring, using advanced scientometric techniques, the existing research corpus in the field.

Find the full report here.


Inzerillo L. Augmented reality: past, present, future. The Engineering Reality of Virtual Reality 2013. 2013. doi:10.1117/12.2001833

Virtual reality and the role of the prefrontal cortex in adults and children

In this review, the neural underpinnings of the experience of presence are outlined. Firstly, it is shown that presence is associated with activation of a distributed network, which includes the dorsal and ventral visual stream, the parietal cortex, the premotor cortex, mesial temporal areas, the brainstem and the thalamus. Secondly, the dorsolateral prefrontal cortex (DLPFC) is identified as a key node of the network as it modulates the activity of the network and the associated experience of presence. Thirdly, children lack the strong modulatory influence of the DLPFC on the network due to their unmatured frontal cortex. Fourthly, it is shown that presence-related measures are influenced by manipulating the activation in the DLPFC using transcranial direct current stimulation (tDCS) while participants are exposed to the virtual roller coaster ride. Finally, the findings are discussed in the context of current models explaining the experience of presence, the rubber hand illusion, and out-of-body experiences.

Find the full study here.


Jäncke L. Virtual reality and the role of the prefrontal cortex in adults and children. Frontiers in Neuroscience. 2009;3(1). doi:10.3389/neuro.01.006.2009

The Effects of Immersion and Real-World Distractions on Virtual Social Interactions

Abstract: This study explores the independent and joint effects of immersion and real-world distractions (a ringing cell phone) on cognitive (i.e., recognition and recall), affective valence, and interpersonal outcomes (i.e., interpersonal liking and communication satisfaction) as well as general feelings of presence (social presence and telepresence) during a virtual experience. Participants interacted with a virtual agent in an immersive virtual environment or nonimmersive virtual environment under three different levels of real-world distractions (i.e., no distraction, passively being exposed to the sound of a ringing cell phone, and actively responding to ringing cell phone). Increased immersion had a positive effect on telepresence, but a negative effect on recognition and recall; immersion did not have a significant effect on social presence. Real-world distractions had a negative effect on recognition, recall, and social presence, but did not affect telepresence or affective valence. Participants who were actively distracted performed more poorly on the recall measure and reported lower levels of social presence than their passively distracted counterparts. These findings suggest that (a) increased immersion will not uniformly improve social virtual reality experiences and (b) more research is needed on whether and how real-world events should be integrated into virtual environments.

Find the full report here.


Oh C, Herrera F, Bailenson J. The Effects of Immersion and Real-World Distractions on Virtual Social Interactions. Cyberpsychology, Behavior, and Social Networking. 2019;22(6):365-372. doi:10.1089/cyber.2018.0404

Report: Using Extended Reality in Healthcare

The healthcare industry is ripe for embracing immersive learning technologies in training professionals and informing patients.

After a 25-year career as a learning scientist and the last 3 years “immersed” in the private sector, Todd's opinion is that immersive technologies have the potential to improve the quality and quantity of training, to reduce training costs and to enhance patient satisfaction through better care from healthcare professionals and a deeper understanding for patients.


This report was originally published in Tech Trends.


Maddox T, Bonasio A, Barber T. Report: Using Extended Reality in Healthcare. Tech Trends. Published September 7, 2018. Accessed April 5, 2019.

Anxiety Reduction
Clinical VR tools to advance the prevention, assessment, and treatment of PTSD

The article presents the use of Virtual Reality (VR) as a clinical tool to address the assessment, prevention, and treatment of PTSD, based on the VR projects that were evolved at the University of Southern California Institute for Creative Technologies since 2004.

You can find the full article here.


Rizzo A‘S, Shilling R. Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD. European Journal of Psychotraumatology. 2017;8(sup5):1414560. doi:10.1080/20008198.2017.1414560

VR-based cognitive behavioral therapy for patients with generalized social anxiety disorder

Aims: To assess the feasibility and potential effect of virtual reality-based cognitive behavioral therapy (VR-CBT) for patients with severe generalized social anxiety disorder (SAD).

Conclusions: This uncontrolled pilot study demonstrated the feasibility and treatment potential of VR-CBT in a difficult-to-treat group of patients with generalized SAD. Results suggest that VR-CBT may be effective in reducing anxiety as well as depression, and can increase quality of life.

You can find the full pilot study here.


Geraets CN, Veling W, Witlox M, Staring AB, Matthijssen SJ, Cath D. Virtual reality-based cognitive behavioural therapy for patients with generalized social anxiety disorder: a pilot study. Behavioural and Cognitive Psychotherapy. 2019:1-6. doi:10.1017/s1352465819000225

Virtual Reality for Anxiety Reduction Demonstrated by Quantitative EEG: A Pilot Study


While previous research has established that virtual reality (VR) can be successfully used in the treatment of anxiety disorders, including phobias and PTSD, no research has examined changes in brain patterns associated with the use of VR for generalized anxiety management. In the current study, we compared a brief nature-based mindfulness VR experience to a resting control condition on anxious participants. Self-reported anxiety symptoms and resting-state EEG were recorded across intervals containing quiet rest or the VR intervention. EEG activity was analyzed as a function of global power shifts in Alpha and Beta activity, and with sLORETA current source density estimates of cingulate cortex regions of interest. Results demonstrated that both a quiet rest control condition and the VR meditation significantly reduced subjective reports of anxiety and increased Alpha power. However, the VR intervention uniquely resulted in shifting proportional power from higher Beta frequencies into lower Beta frequencies, and significantly reduced broadband Beta activity in the anterior cingulate cortex. These effects are consistent with a physiological reduction of anxiety. This pilot study provides preliminary evidence supporting the therapeutic potential of VR for anxiety management and stress reduction programs.

Find the full report here.


Tarrant J, Viczko J, Cope H. Virtual Reality for Anxiety Reduction Demonstrated by Quantitative EEG: A Pilot Study. Frontiers in Psychology. 2018;9. doi:10.3389/fpsyg.2018.01280

Inducing an Anxiety Response Using a Contaminated Virtual Environment: Validation of a Therapeutic Tool for Obsessive–Compulsive Disorder.

Obsessive–compulsive disorder (OCD) is characterized by the presence of unwanted and repetitive thoughts triggering significant anxiety, as well as the presence of ritual behaviors or mental acts carried out in response to obsessions to reduce the associated distress. In the contamination subtype, individuals are scared of germs and bacteria, are excessively concerned with cleaning, fear contamination and the spread of disease, and may have a very strong aversion to bodily secretions. A few studies on virtual reality (VR) have been conducted with people suffering from OCD, but they all focus on the subtype characterized by checking rituals. The goal of this study is to confirm the potential of a “contaminated” virtual environment in inducing anxiety in 12 adults suffering from contamination-subtype OCD compared to 20 adults without OCD (N = 32) using a within–between protocol. Subjective (questionnaire) and objective (heart rate) measurements were compiled.

Participants were immersed in a control virtual environment (empty and clean room) and a “contaminated” virtual environment (filthy public restroom) designed for the treatment of OCD. Immersions were conducted in a 6-wall CAVE-like system. As hypothesized, the results of repeated-measures ANCOVAs revealed the significant impact of immersion in a filthy public restroom for participants suffering from OCD on both measures. Presence was correlated with anxiety in OCD participants and no difference in presence was observed between groups. Unwanted negative side effects induced by immersions in VR were higher in the OCD group. The clinical implications of the results and directions for further studies are discussed.

Find the full report here.


Laforest M, Bouchard S, Crétu A-M, Mesly O. Inducing an Anxiety Response Using a Contaminated Virtual Environment: Validation of a Therapeutic Tool for Obsessive–Compulsive Disorder. Frontiers in ICT. 2016;3. doi:10.3389/fict.2016.00018

Controlling Social Stress in Virtual Reality Environments

Abstract: Virtual reality exposure therapy has been proposed as a viable alternative in the treatment of anxiety disorders, including social anxiety disorder. Therapists could benefit from extensive control of anxiety eliciting stimuli during virtual exposure. Two stimuli controls are studied in this study: the social dialogue situation, and the dialogue feedback responses (negative or positive) between a human and a virtual character. In the first study, 16 participants were exposed in three virtual reality scenarios: a neutral virtual world, blind date scenario, and job interview scenario. Results showed a significant difference between the three virtual scenarios in the level of self-reported anxiety and heart rate.

In the second study, 24 participants were exposed to a job interview scenario in a virtual environment where the ratio between negative and positive dialogue feedback responses of a virtual character was systematically varied on-the-fly. Results yielded that within a dialogue the more positive dialogue feedback resulted in less self-reported anxiety, lower heart rate, and longer answers, while more negative dialogue feedback of the virtual character resulted in the opposite. The correlations between on the one hand the dialogue stressor ratio and on the other hand the means of SUD score, heart rate and audio length in the eight dialogue conditions showed a strong relationship: r(6) = 0.91, p = 0.002; r(6) = 0.76, p = 0.028 and r(6) = −0.94, p = 0.001 respectively. Furthermore, more anticipatory anxiety reported before exposure was found to coincide with more self-reported anxiety, and shorter answers during the virtual exposure. These results demonstrate that social dialogues in a virtual environment can be effectively manipulated for therapeutic purposes.

Find the full study here.


Hartanto D, Kampmann IL, Morina N, Emmelkamp PGM, Neerincx MA, Brinkman W-P. Controlling Social Stress in Virtual Reality Environments. PLoS ONE. 2014;9(3). doi:10.1371/journal.pone.0092804

Can VR reduce fear of spiders?

Findings: Compared to a control group of standard psychoeducation, VR exposure therapy significantly reduced arachnophobia in a randomized trial.

You can find the full study here.


Minns S, Levihn-Coon A, Carl E, et al. Immersive 3D exposure-based treatment for spider fear: A randomized controlled trial. Journal of Anxiety Disorders. 2018;58:1-7. doi:10.1016/j.janxdis.2018.05.006

Patient Satisfaction
Effect of an Immersive Preoperative VR Experience on Patient Reported Outcomes

Objective: To investigate the effect of exposure to a virtual reality (VR) environment preoperatively on patient-reported outcomes for surgical operations.

Conclusions: In a randomized controlled trial, the research team demonstrated that patients exposed to preoperative VR had increased satisfaction during the surgical encounter. Harnessing the power of this technology, hospitals can create an immersive environment that minimizes stress, and enhances the perioperative experience.

You can find the full report here.


Bekelis K, Calnan D, Simmons N, Mackenzie TA, Kakoulides G. Effect of an Immersive Preoperative Virtual Reality Experience on Patient Reported Outcomes. Annals of Surgery. 2017;265(6):1068-1073.

Using mobile VR to enhance medical comprehension and satisfaction in patients and their families

 Abstract: Patients are typically debriefed by their healthcare provider after any medical procedure or surgery to discuss their findings and any next steps involving medication or treatment instructions. However, without any medical or scientific background knowledge, it can feel overwhelming and esoteric for a patient to listen to a physician describe a complex operation. Instead, providing patients with engaging visuals and a virtual reality (VR) simulation of their individual clinical findings could lead to more effective transfer of medical knowledge and comprehension of treatment information. A newly developed VR technology is described, called HealthVoyager, which is designed to help facilitate this knowledge transfer between physicians and patients. The platform represents a customizable, VR software system utilizing a smartphone or tablet computer to portray personalized surgical or procedural findings as well as representations of normal anatomy. The use of such technology for eliciting medical understanding and patient satisfaction can have many practical and clinical applications for a variety of disease states and patient populations.

Find the full report here.


Palanica A, Docktor MJ, Lee A, Fossat Y. Using mobile virtual reality to enhance medical comprehension and satisfaction in patients and their families. Perspectives on Medical Education. 2019. doi:10.1007/s40037-019-0504-7

Brain Science of Satisfaction and Why VR Provides an Ideal Solution

Familiarity and experience can reduce stress, anxiety, and discomfort while enhancing preparedness and satisfaction for patients and their loved ones. 

Virtual reality achieves these goals; the psychological and brain research are clear on that point.

Read the full article here.


This article was originally published by the Association for Talent Development.


Maddox T, Fitzpatrick T. The Brain Science of Patient Satisfaction and Why VR Provides an Ideal Solution. Main. Published December 19, 2018. Accessed April 5, 2019.

Patient Education
Virtual Reality Simulation in Peritoneal Dialysis Training

Background/Aim: Peritonitis rates in peritoneal dialysis (PD) vary considerably not only across countries but also between centers in the same country. Patient education has been shown to significantly reduce infection rates but up till now training lacks standardization with patients being trained using different methods and media (e.g., illustrations, videos). As a result, patients may be insufficiently experienced in performing PD, which might be one of the causes for high peritonitis rates. To address these issues, we developed a PD training program based on virtual reality (VR).

Conclusion: Previous studies on the effectiveness of learning showed that VR training applications are superior to traditional methods, such as text- or video-based training. However, no study has been undertaken in the context of dialysis. We believe that the implementation of VR training programs in clinical practice will be beneficial in improving the patient's proficiency, and thereby the quality and safety of PD.

Find the full report here.


Zgoura P, Hettich D, Natzel J, Özcan F, Kantzow B. Virtual Reality Simulation in Peritoneal Dialysis Training: The Beginning of a New Era. Blood Purification. 2018;47(1-3):265-269. doi:10.1159/000494595

The Role of Personalized Virtual Reality in Education for Patients Post Stroke

Background/Aim: Education is essential to promote prevention of recurrent stroke and maximize rehabilitation; however, current techniques are limited and many patients remain dissatisfied. Virtual reality (VR) may provide an alternative way of conveying complex information through a more universal language. To develop and conduct preliminary assessments on the use of a guided and personalized 3D visualization education session via VR, for stroke survivors and primary caregivers.

Conclusions: Preliminary results suggest this approach provides a safe and promising educational tool to promote understanding of individualized stroke experiences.

Find the full report here.


Thompson-Butel AG, Shiner CT, Mcghee J, et al. The Role of Personalized Virtual Reality in Education for Patients Post Stroke—A Qualitative Case Series. Journal of Stroke and Cerebrovascular Diseases. 2019;28(2):450-457. doi:10.1016/j.jstrokecerebrovasdis.2018.10.018

Radiation therapy patient education using VERT: combination of technology with human care

Abstract: The Virtual Environment for Radiotherapy Training (VERT) system is a recently available tool for radiation therapy education. The majority of research regarding VERT-based education is focused on students, with a growing area of research being VERT's role in patient education. Because large differences in educational requirements exist between students and patients, focused resources and subsequent evaluations are necessary to provide solid justification for the unique benefits and challenges posed by VERT in a patient education context. This commentary article examines VERT's role in patient education, with a focus on salient visual features, VERT's ability to address some of the spatial challenges associated with RT patient education and how to combine technology with human care.

Find the full report here.


Jimenez YA, Lewis SJ. Radiation therapy patient education using VERT: combination of technology with human care. Journal of Medical Radiation Sciences. 2018;65(2):158-162. doi:10.1002/jmrs.282

Patient education using VR increases knowledge and positive experience for breast cancer patients undergoing radiation therapy


Purpose: Improved access to technology in the radiation therapy (RT) workforce education has resulted in opportunities for innovative patient education methods. This study investigated the impact of a newly developed education tool using the Virtual Environment for Radiotherapy Training (VERT) system on patients' RT knowledge and anxiety.

Conclusions: This study reports the high value of VERT breast cancer-targeted education programs in improving RT knowledge and perhaps decreasing patient anxiety. Continued efforts are required to improve patients' accessibility to VERT in Australia, and to better understand the effect of VERT's unique educational features on patients' emotional and physical needs throughout their RT.

Find the full report here.


Jimenez YA, Cumming S, Wang W, Stuart K, Thwaites DI, Lewis SJ. Patient education using virtual reality increases knowledge and positive experience for breast cancer patients undergoing radiation therapy. Supportive Care in Cancer. 2018;26(8):2879-2888. doi:10.1007/s00520-018-4114-4

Professional Training
Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial

Objective: This study aimed to evaluate the effect of clinical virtual simulation with regard to knowledge retention, clinical reasoning, self-efficacy, and satisfaction with the learning experience among nursing students.

Conclusions: The introduction of clinical virtual simulation in nursing education has the potential to improve knowledge retention and clinical reasoning in an initial stage and over time, and it increases the satisfaction with the learning experience among nursing students.

You can find the full study here.


Padilha JM, Machado PP, Ribeiro A, Ramos J, Costa P. Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial (Preprint). 2018. doi:10.2196/preprints.11529

Digital Education for the Management of Chronic Wounds in Healthcare Professionals

Objective: Our main objective is to assess the effectiveness of digital education as a stand-alone approach or as part of a blended-learning approach in improving pre- and postregistration health care professionals' knowledge, attitudes, practical skills, and behavior in the management of chronic wounds, as well as their satisfaction with the intervention. Secondary objectives are to evaluate patient-related outcomes, cost-effectiveness of the interventions, and any unfavorable or undesirable outcomes that may arise.

Conclusions: This systematic review will provide an in-depth analysis of digital education strategies to train health care providers in the management of chronic wounds. We consider this topic particularly relevant given the current challenges facing health care systems worldwide, including shortages of skilled personnel and a steep increase in the population of older adults as a result of a prolonged life expectancy.

Find the full report here.


Martinengo L, Yeo NJY, Tang ZQ, Markandran KD, Kyaw BM, Car LT. Digital Education for the Management of Chronic Wounds in Health Care Professionals: Protocol for a Systematic Review by the Digital Health Education Collaboration. JMIR Research Protocols. 2019;8(3). doi:10.2196/12488

The (human) science of medical virtual learning environments

Abstract: The uptake of virtual simulation technologies in both military and civilian surgical contexts has been both slow and patchy. The failure of the virtual reality community in the 1990s and early 2000s to deliver affordable and accessible training systems stems not only from an obsessive quest to develop the ‘ultimate’ in so-called ‘immersive’ hardware solutions, from head-mounted displays to large-scale projection theatres, but also from a comprehensive lack of attention to the needs of the end users. While many still perceive the science of simulation to be defined by technological advances, such as computing power, specialized graphics hardware, advanced interactive controllers, displays and so on, the true science underpinning simulation—the science that helps to guarantee the transfer of skills from the simulated to the real—is that of human factors, a well-established discipline that focuses on the abilities and limitations of the end user when designing interactive systems, as opposed to the more commercially explicit components of technology. Based on three surgical simulation case studies, the importance of a human factors approach to the design of appropriate simulation content and interactive hardware for medical simulation is illustrated. The studies demonstrate that it is unnecessary to pursue real-world fidelity in all instances in order to achieve psychological fidelity—the degree to which the simulated tasks reproduce and foster knowledge, skills and behaviours that can be reliably transferred to real-world training applications.

Find the full report here.


Stone RJ. The (human) science of medical virtual learning environments. Philosophical Transactions of the Royal Society B: Biological Sciences. 2011;366(1562):276-285. doi:10.1098/rstb.2010.0209

Virtual Reality for Health Professions Education: Systematic Review

Objectives: The aim of this systematic review was to evaluate the effectiveness of VR for educating health professionals and improving their knowledge, cognitive skills, attitudes, and satisfaction.

Conclusions: We found evidence suggesting that VR improves post-intervention knowledge and skills outcomes of health professionals when compared with traditional education or other types of digital education such as online or offline digital education. The findings on other outcomes are limited. Future research should evaluate the effectiveness of immersive and interactive forms of VR and evaluate other outcomes such as attitude, satisfaction, cost-effectiveness, and clinical practice or behavior change.

Find the full report here.


Dunleavy G, Nikolaou CK, Nifakos S, Atun R, Law GCY, Car LT. Mobile Digital Education for Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. Journal of Medical Internet Research. 2019;21(2). doi:10.2196/12937

Report: Building Healthcare Expertise With Virtual Reality

Q. Can immersive technologies help professionals in the healthcare sector build crucial expertise and save lives?

A. Yes, it certainly can — and it already is!


This report was originally published in Tech Trends.


Maddox T, Bonasio A. Report: Building Healthcare Expertise With VR. Tech Trends. Published January 4, 2019. Accessed April 4, 2019.

How xR Technologies Will Accelerate Healthcare Training

Immersive learning technologies are growing, and one sector embracing them is healthcare training. Immersive learning tools uniquely engage learning systems in the brain that are highly effective for many forms of training, especially training related to healthcare. These technologies have the potential to improve the quality and quantity of training, reduce training costs, and enhance patient satisfaction through better care from healthcare professionals and a deeper understanding for patients.

Read the full article here.


This article was originally published by the Association for Talent Development.


Maddox T. How xR Technologies Will Accelerate Healthcare Training. Main. Published September 19, 2018. Accessed April 5, 2019.

A Discussion of Virtual Reality As a New Tool for Training Healthcare Professionals

Background: Virtual reality technology describes the use of headsets displaying a particular environment to simulate a user’s physical existence in a virtual or imaginary setting. Headsets are sometimes combined with other sensory inputs, such as haptic feedback, smells, and changing temperatures. Avatars (virtual characters with whom the user interacts) can be programmed to express emotions, for example, by blushing or crying. These high-fidelity avatars provide the user a greater sense of reality and facilitate meaningful interaction.

The field of virtual reality first came to light decades ago; however, recent advances in technology have made it the exciting and emerging field it is today. Its applications are vast, ranging from military training to gaming. In medicine, the technology has been trialed for uses such as cognitive rehabilitation post-stroke (), improving reaction times in children with cerebral palsy () and in aiding the diagnosis of psychiatric conditions ().

This paper sets out the viewpoint that virtual reality technology could be a new focus of direction in the development of training tools for medical education. We concentrate on its use in improving the communication skills of clinicians and medical students. 

Find the full report here.


Fertleman C, Aubugeau-Williams P, Sher C, et al. A Discussion of Virtual Reality As a New Tool for Training Healthcare Professionals. Frontiers in Public Health. 2018;6. doi:10.3389/fpubh.2018.00044

Emotion & Mood
The ENGAGE study: managing depression and obesity in a precision medicine model

Abstract: Precision medicine models for personalizing achieving sustained behavior changeare largely outside of current clinical practice. Yet, changing self-regulatory behaviors is fundamental to the self-management of complex lifestyle-related chronic conditions such as depression and obesity - two top contributors to the global burden of disease and disability. To optimize treatments and address these burdens, behavior change and self-regulation must be better understood in relation to their neurobiological underpinnings. Here, we present the conceptual framework and protocol for a novel study, “Engaging self-regulation targets to understand the mechanisms of behavior change and improve mood and weight outcomes (ENGAGE)”. The ENGAGE study integrates neuroscience with behavioral science to better understand the self-regulation related mechanisms of behavior change for improving mood and weight outcomes among adults with comorbid depression and obesity. We collect assays of three self-regulation targets (emotion, cognition, and self-reflection) in multiple settings: neuroimaging and behavioral lab-based measures, virtual reality, and passive smartphone sampling. By connecting human neuroscience and behavioral science in this manner within the ENGAGE study, we develop a prototype for elucidating the underlying self-regulation mechanisms of behavior change outcomes and their application in optimizing intervention strategies for multiple chronic diseases.

You can access the ENGAGE here.


Williams LM, Pines A, Goldstein-Piekarski AN, et al. The ENGAGE study: Integrating neuroimaging, virtual reality and smartphone sensing to understand self-regulation for managing depression and obesity in a precision medicine model. Behaviour Research and Therapy. 2018;101:58-70. doi:10.1016/j.brat.2017.09.012

Trauma and Self-Narrative in Virtual Reality: Toward Recreating a Healthier Mind

This study discusses the concept of virtual selves created in the virtual spaces [e.g. social network services or virtual reality (VR)]. It analyzes the activities in the different virtual spaces and claims that experience gained there can be transferred to real life. In respect to that, the effects of the VR treatment on the self as well as the concept of creating a life story are analyzed as interconnected. The research question which arises from these considerations is how to look at psychological trauma in order to explain the effectiveness of the usage of VR for treatment of traumatic disorders.

The proposal in the study is to see trauma as a shift in the normal storyline of the narrative people create. With this concept in mind, it might be possible to support the claim that reliving traumatic events, regaining control over one’s life narrative, and creating new stories in the VR aids the treatment process in the search for meaning and resolution in life events. Considering the findings of researchers who argue in the field of self-narrative and traumatic treatment, as well as researchers on virtual selves, virtual spaces and VR, this study discusses the virtual as a possible medium to experience narratives and utilize those narratives as better explanatory stories to facilitate the therapeutic process of recovery and self-recreation.

This study supports the idea that VR can be used to visualize patients’ narratives and help them perceive themselves as active authors of their life’s story by retelling traumatic episodes with additional explanation. This experience in the VR is utilized to form healthier narratives and coping techniques for robust therapeutic results that are transferred to real life.

Find the full study here.


Georgieva I. Trauma and Self-Narrative in Virtual Reality: Toward Recreating a Healthier Mind. Frontiers in ICT. 2017;4. doi:10.3389/fict.2017.00027

A Public Database of Immersive VR Videos with Corresponding Ratings of Arousal, Valence, and Correlations between Head Movements and Self Report Measures

Virtual reality (VR) has been proposed as a methodological tool to study the basic science of psychology and other fields. One key advantage of VR is that sharing of virtual content can lead to more robust replication and representative sampling. A database of standardized content will help fulfill this vision. There are two objectives to this study. First, we seek to establish and allow public access to a database of immersive VR video clips that can act as a potential resource for studies on emotion induction using virtual reality. Second, given the large sample size of participants needed to get reliable valence and arousal ratings for our video, we were able to explore the possible links between the head movements of the observer and the emotions he or she feels while viewing immersive VR. To accomplish our goals, we sourced for and tested 73 immersive VR clips which participants rated on valence and arousal dimensions using self-assessment manikins. We also tracked participants' rotational head movements as they watched the clips, allowing us to correlate head movements and affect. Based on past research, we predicted relationships between the standard deviation of head yaw and valence and arousal ratings. Results showed that the stimuli varied reasonably well along the dimensions of valence and arousal, with a slight underrepresentation of clips that are of negative valence and highly arousing. The standard deviation of yaw positively correlated with valence, while a significant positive relationship was found between head pitch and arousal. The immersive VR clips tested are available online as supplemental material.

You can find the full study here.


Li BJ, Bailenson JN, Pines A, Greenleaf WJ, Williams LM. A Public Database of Immersive VR Videos with Corresponding Ratings of Arousal, Valence, and Correlations between Head Movements and Self Report Measures. Frontiers in Psychology. 2017;8. doi:10.3389/fpsyg.2017.02116

Actionable Empathy
Building long-term empathy: a large-scale comparison of traditional and virtual reality perspective taking

Abstract: Virtual Reality (VR) has been increasingly referred to as the “ultimate empathy machine” since it allows users to experience any situation from any point of view. However, empirical evidence supporting the claim that VR is a more effective method of eliciting empathy than traditional perspective-taking is limited. Two experiments were conducted in order to compare the short and long-term effects of a traditional perspective-taking task and a VR perspective-taking task (Study 1), and to explore the role of technological immersion when it comes to different types of mediated perspective-taking tasks (Study 2).

You can read the full study here.


Herrera F, Bailenson J, Weisz E, Ogle E, Zaki J (2018) Building long-term empathy: A largescale comparison of traditional and virtual reality perspective-taking. PLoS ONE 13(10): e0204494.

VR perspective-taking increases cognitive empathy for specific others

Abstract: Previous research shows that virtual reality perspective-taking experiences (VRPT) can increase prosocial behavior toward others. We extend this research by exploring whether this effect of VRPT is driven by increased empathy and whether the effect extends to ostensibly real-stakes behavioral games. 

You can find the full study here.


van Loon A, Bailenson J, Zaki J, Bostick J, Willer R (2018) Virtual reality perspective-taking increases cognitive empathy for specific others. PLoS ONE 13(8): e0202442. 10.1371/journal.pone.0202442

Learning Empathy Through Virtual Reality: Multiple Strategies for Training Empathy-Related Abilities Using Body Ownership Illusions in Embodied Virtual Reality

Several disciplines have investigated the interconnected empathic abilities behind the proverb “to walk a mile in someone else’s shoes” to determine how the presence, and absence, of empathy-related phenomena affect prosocial behavior and intergroup relations. Empathy enables us to learn from others’ pain and to know when to offer support. Similarly, virtual reality (VR) appears to allow individuals to step into someone else’s shoes, through a perceptual illusion called embodiment, or the body ownership illusion. Considering these perspectives, we propose a theoretical analysis of different mechanisms of empathic practices in order to define a possible framework for the design of empathic training in VR. This is not intended to be an extensive review of all types of practices, but an exploration of empathy and empathy-related phenomena. Empathy-related training practices are analyzed and categorized. We also identify different variables used by pioneer studies in VR to promote empathy-related responses. Finally, we propose strategies for using embodied VR technology to train specific empathy-related abilities.


Find the full report here.


Bertrand P, Guegan J, Robieux L, Mccall CA, Zenasni F. Learning Empathy Through Virtual Reality: Multiple Strategies for Training Empathy-Related Abilities Using Body Ownership Illusions in Embodied Virtual Reality. Frontiers in Robotics and AI. 2018;5. doi:10.3389/frobt.2018.00026

Combining Virtual Reality and Biofeedback to Foster Empathic Abilities in Humans

Recent technological advances coupled with progress in brain and psychological sciences allow the controlled induction and regulation of human psychophysiological states. These progresses often aim toward the goal of developing human-machine interfaces to improve human factors such as mental health, human relations, well-being, and empathy. In this short article, we present some of such devices with a particular emphasis on technology aiming to foster empathic abilities in humans; that is, our ability to care, understand, and help our fellow human beings. In order to discuss any possible use for such devices in a clinical setting, we start by outlining definitions for the terms used in the article, and present three devices designed with the goal of modulating empathy in humans.

Find the full report here.


Schoeller F, Bertrand P, Gerry LJ, Jain A, Horowitz AH, Zenasni F. Combining Virtual Reality and Biofeedback to Foster Empathic Abilities in Humans. Frontiers in Psychology. 2019;9. doi:10.3389/fpsyg.2018.02741

VR vs Traditional Learning
Virtual Memory Palaces: Immersion Aids Recall

Abstract: Virtual reality displays, such as head-mounted displays (HMD), aford us a superior spatial awareness by leveraging our vestibular and proprioceptive senses, as compared to traditional desktop displays. Since classical times, people have used memory palaces as a spatial mnemonic to help remember information by organizing it spatially and associating it with salient features in that environment. In this paper, we explore whether using virtual memory palaces in a head-mounted display with head-tracking (HMD condition) would allow a user to better recall information than when using a traditional desktop display with a mouse-based interaction (desktop condition). We found that virtual memory palaces in HMD condition provide a superior memory recall ability compared to the desktop condition. We believe this is a first step in using virtual environments for creating more memorable experiences that enhance productivity through better recall of large amounts of information organized using the idea of virtual memory palaces.

Find the full report here.


Krokos E, Plaisant C, Varshney A. Correction to: Virtual memory palaces: immersion aids recall. Virtual Reality. 2018;23(1):17-17. doi:10.1007/s10055-018-0360-5

A Case Study - The Impact of VR on Academic Performance

Objectives: This experiment aims to show the difference between traditional teaching and VR-based teaching in students’ celestial physics learning. 

Results:In Retention Test, the average score of VR group is 90, while that of the traditional teaching group is 68. The gap between the two average scores is 32.4%, higher than that in the Immediate Test 27.4% (# 4.1.1-1), suggesting that knowledge taught in traditional mode is more inclined to be forgotten, while VR-based teaching could help students get a deeper impression and maintain long-term memory because it creates a quasi-real environment, interacts with students and make students more involved in the teaching.

VR-based teaching enjoys tremendously positive reception among students. Students like it very much and students fairly like it account for 100% of all the students. In the experiment, 65% students have heard about VR, 45% students have 15 experienced VR content, most of which is VR games. This is the first time for these students to experience VR in education. The introduction of the latest VR Technology into education is very fascinating to students, who are looking forward to seeing VR-based teaching integrated in their classes.

Find the full report here


A Case Study - The Impact of VR on Academic Performance. Accessed April 4, 2019.

Training Situational Awareness With Virtual Reality

VR provides the ideal training tool for gaining the emotional intelligence and cognitive behavioral understanding needed to develop situational awareness.

Situational awareness involves understanding how information, events and actions around us impact our current situation and how changes might impact the future. While it is important in all settings, it is especially critical in high stakes, rapidly-changing environments such as healthcare, law enforcement, leadership, air traffic control, ship navigation, and nuclear power plant operation (to name but a few) where a bad decision could have serious or dangerous consequences.

This article originally appeared in Tech Trends.


Maddox T, Atkinson T, Bonasio A. Training Situational Awareness With Virtual Reality. Tech Trends. Published July 23, 2018. Accessed April 5, 2019.

AFFECT: Altered-Fidelity Framework for Enhancing Cognition and Training

In this paper, we present a new framework for analyzing and designing virtual reality (VR) techniques. This framework is based on two concepts – system fidelity (i.e., the degree with which real-world experiences are reproduced by a system) and memory (i.e., the formation and activation of perceptual, cognitive, and motor networks of neurons). The premise of the framework is to manipulate an aspect of system fidelity in order to assist a stage of memory. We call it the Altered-Fidelity Framework for Enhancing Cognition and Training (AFFECT). AFFECT provides nine categories of approaches to altering system fidelity to positively affect learning or training. These categories are based on the intersections of three aspects of system fidelity (interaction fidelity, scenario fidelity, and display fidelity) and three stages of memory (encoding, implicit retrieval, and explicit retrieval). In addition to discussing the details of our new framework, we show how AFFECT can be used as a tool for analyzing and categorizing VR techniques designed to facilitate learning or training. We also demonstrate how AFFECT can be used as a design space for creating new VR techniques intended for educational and training systems.

Find the full report here.


Mcmahan RP, Herrera NS. AFFECT: Altered-Fidelity Framework for Enhancing Cognition and Training. Frontiers in ICT. 2016;3. doi:10.3389/fict.2016.00029

Healthcare Simulation
VR in Healthcare: Medical Simulation and Experiential Interface

Abstract: Annual Review of CyberTherapy and Telemedicine (ARCTT) ISSN: 1554-8716 is published annually by the Interactive Media Institute (IMI), a 501c3 non-profit organisation, dedicated to the collaboration of interdisciplinary researchers from around the world to create, test and develop clinical tools and protocols for the medical and psychological community. IMI realizes that the mind and body work in concert to affect quality of life in individuals and works to develop technology that can be effectively used to improve the standards and reduce the cost of healthcare delivery worldwide.

You can download the full PDF here.


Wiederhold, Brenda & Riva, Giuseppe & Wiederhold, Mark. (2015). Annual Review of CyberTherapy and Telemedicine: Virtual Reality in Healthcare: Medical Simulation and Experiential Interface. 

Training Together: How Another Human Trainee’s Presence Affects Behavior during Virtual Human-Based Team Training

Despite research showing that team training can lead to strong improvements in team performance, logistical difficulties can prevent team training programs from being adopted on a large scale. A proposed solution to these difficulties is the use of virtual humans to replace missing teammates. Existing research evaluating the use of virtual humans for team training has been conducted in settings involving a single human trainee. However, in the real world, multiple human trainees would most likely train together. In this paper, we explore how the presence of a second human trainee can alter behavior during a medical team training program. Ninety-two nurses and surgical technicians participated in a medical training exercise, where they worked with a virtual surgeon and virtual anesthesiologist to prepare a simulated patient for surgery. The agency of the nurse and the surgical technician were varied between three conditions: human nurses and surgical technicians working together; human nurses working with a virtual surgical technician; and human surgical technicians working with a virtual nurse. Variations in agency did not produce statistically significant differences in the training outcomes, but several notable differences were observed in other aspects of the team’s behavior. Specifically, when working with a virtual nurse, human surgical technicians were more likely to assist with speaking up about patient safety issues that were outside of their normal responsibilities; human trainees spent less time searching for a missing item when working with a virtual partner, likely because the virtual partner was physically unable to move throughout the room and assist with the searching process; and more breaks in presence were observed when two human teammates were present. These results show that some behaviors may be influenced by the presence of multiple human trainees, though these behaviors may not impinge on core training goals. When developing virtual human-based training programs, designers should consider that the presence of other humans may reduce involvement during training moments perceived to be the responsibility of other trainees and also should consider that a virtual teammate’s limitations may cause human teammates to limit their own behaviors in corresponding ways (e.g., searching less).

Find the full report here.


Robb A, Kleinsmith A, Cordar A, et al. Training Together: How Another Human Trainee’s Presence Affects Behavior during Virtual Human-Based Team Training. Frontiers in ICT. 2016;3. doi:10.3389/fict.2016.00017

A ‘mixed reality’ simulator concept for future Medical Emergency Response Team training

Abstract: The UK Defence Medical Service's Pre-Hospital Emergency Care (PHEC) capability includes rapid-deployment Medical Emergency Response Teams (MERTs) comprising tri-service trauma consultants, paramedics and specialised nurses, all of whom are qualified to administer emergency care under extreme conditions to improve the survival prospects of combat casualties. The pre-deployment training of MERT personnel is designed to foster individual knowledge, skills and abilities in PHEC and in small team performance and cohesion in ‘mission-specific’ contexts. Until now, the provision of airborne pre-deployment MERT training had been dependent on either the availability of an operational aircraft (eg, the CH-47 Chinook helicopter) or access to one of only two ground-based facsimiles of the Chinook's rear cargo/passenger cabin. Although MERT training has high priority, there will always be competition with other military taskings for access to helicopter assets (and for other platforms in other branches of the Armed Forces). This paper describes the development of an inexpensive, reconfigurable and transportable MERT training concept based on ‘mixed reality’ technologies—in effect the ‘blending’ of real-world objects of training relevance with virtual reality reconstructions of operational contexts.

Find the full study here.


Stone RJ, Guest R, Mahoney P, Lamb D, Gibson C. A ‘mixed reality’ simulator concept for future Medical Emergency Response Team training. Journal of the Royal Army Medical Corps. 2017;163(4):280-287. doi:10.1136/jramc-2016-000726

Pain Reduction
Virtual Reality Analgesia in Labor: The VRAIL Pilot Study

Findings: Compared to a standard control group, VR reduced sensory pain, affective pain, cognitive pain, and anxiety during childbirth.

You can find the full report here.


Frey DP, Bauer ME, Bell CL, et al. Virtual Reality Analgesia in Labor. Anesthesia & Analgesia. 2018:1. doi:10.1213/ane.0000000000003649

Virtual Reality Analgesia During Venipuncture in Pediatric Patients With Onco-Hematological Diseases

Background: Venipuncture is described by children as one of the most painful and frightening medical procedures.

Objective: To evaluate the effectiveness of Virtual Reality (VR) as a distraction technique to help control pain in children and adolescents undergoing venipuncture.

Methods: Using a within-subjects design, fifteen patients (mean age 10.92, SD = 2.64) suffering from oncological or hematological diseases received one venipuncture with “No VR” and one venipuncture with “Yes VR” on two separate days (treatment order randomized). “Time spent thinking about pain”, “Pain Unpleasantness”, “Worst pain” the quality of VR experience, fun during the venipuncture and nausea were measured.

Results: During VR, patients reported significant reductions in “Time spent thinking about pain,” “Pain unpleasantness,” and “Worst pain”. Patients also reported significantly more fun during VR, and reported a “Strong sense of going inside the computer-generated world” during VR. No side effects were reported.

Conclusion: VR can be considered an effective distraction technique for children and adolescents’ pain management during venipuncture. Moreover, VR may elicit positive emotions, more than traditional distraction techniques. This could help patients cope with venipuncture in a non-stressful manner. Additional research and development is needed.

Find the full study here.


Atzori B, Hoffman HG, Vagnoli L, et al. Virtual Reality Analgesia During Venipuncture in Pediatric Patients With Onco-Hematological Diseases. Frontiers in Psychology. 2018;9. doi:10.3389/fpsyg.2018.02508

Assessing the feasibility of implementing low-cost virtual reality therapy during routine burn care

Abstract: Burn care often involves procedures that result in significant pain experiences for patients which, in turn, can lead to poorer physical and psychological health outcomes. Distraction and virtual reality (VR) are an effective adjunct to pharmacological interventions in reducing pain. Much of the research that has demonstrated efficacy for VR in burn care has involved expensive and extensive technology. Thus, identifying cost-effective, feasible, acceptable, and effective approaches to apply distraction within routine burn care is important. The objective of this mixed-methods study was to evaluate key stakeholder (i.e., patients, providers) perceptions of feasibility, acceptability, and effectiveness for the use of low-cost VR technology during routine burn care with adult patients. Ten adult patients used VR during burn care dressing changes in an outpatient clinic setting, after which they completed a satisfaction survey and individual qualitative interview. Providers also completed a satisfaction/perception survey after each participant's care. Quantitative and qualitative results from both patient and provider perspectives consistently supported the feasibility and utility of applying low-cost VR technology in this outpatient burn clinic setting. Special considerations (e.g., aspects to consider when choosing an apparatus or application) stemming from stakeholder feedback are discussed.

Find the full report here.


Ford CG, Manegold EM, Randall CL, Aballay AM, Duncan CL. Assessing the feasibility of implementing low-cost virtual reality therapy during routine burn care. Burns. 2018;44(4):886-895. doi:10.1016/j.burns.2017.11.020

Adjunctive VR for procedural pain management of burn patients during dressing change or physical therapy

Abstract: Dressing change and physical therapy are extremely painful procedures for burn patients. Adjunctive virtual reality therapy reportedly reduces pain when added to analgesics, but a summary analysis of the data has yet to be performed. We conducted this systematic review and meta-analysis of randomized controlled trials to verify the pain-reducing efficacy of virtual reality among burn patients undergoing dressing change or physical therapy. We searched MEDLINE (via PubMed), EMBASE (via OVID), and the Cochrane Central Register of Controlled Trials (via OVID) for relevant trials based on predetermined eligibility criteria from database establishment to February 2018. Two reviewers screened citations and extracted data independently. The quality of the included studies was evaluated according to the Cochrane Handbook, whereas statistical heterogeneity was assessed using chi-square tests and I2 statistics. Review Manager 5.3 was used for statistical analysis. Thirteen randomized controlled trials with 362 patients who underwent 627 burn dressing change or physical therapy sessions were included. The additional use of virtual reality significantly reduced pain intensity, time spent thinking about pain, and unpleasantness, and was more fun compared with that of using analgesics alone. Virtual reality is an effective pain reduction measurement added to analgesics for burn patients undergoing dressing change or physical therapy. However, multicenter, parallel group design randomized controlled trials are still required.

Find the full report here.


Luo H, Cao C, Zhong J, Chen J, Cen Y. Adjunctive virtual reality for procedural pain management of burn patients during dressing change or physical therapy: A systematic review and meta-analysis of randomized controlled trials. Wound Repair and Regeneration. 2018;27(1):90-101. doi:10.1111/wrr.1

Virtual Reality for Management of Pain in Hospitalized Patients

Objective: The objective of the study was to measure the impact of a onetime 3D VR intervention versus a two-dimensional (2D) distraction video for pain in hospitalized patients.

Conclusions: Use of VR in hospitalized patients significantly reduces pain versus a control distraction condition. These results indicate that VR is an effective and safe adjunctive therapy for pain management in the acute inpatient setting; future randomized trials should confirm benefit with different visualizations and exposure periods.

Find the full report here.


Tashjian VC, Mosadeghi S, Reid MW, Howard A, Lopez M, Spiegel B. Virtual Reality Reduces Abdominal Pain in Hospitalized Patients: Results of a Controlled Trial. Gastroenterology. 2017;152(5). doi:10.1016/s0016-5085(17)30727-8

Effectiveness of a VR-Based Tai Chi Exercise on Cognitive and Physical Function in Older Adults with Cognitive Impairment

Findings: Compared to a standard control group, a six-month VR Thai Chi program improved multiple assessments of physical function and cognitive performance.


Study link can be found here.


Hsieh C-C, Lin P-S, Hsu W-C, et al. The Effectiveness of a Virtual Reality-Based Tai Chi Exercise on Cognitive and Physical Function in Older Adults with Cognitive Impairment. Dementia and Geriatric Cognitive Disorders. 2018;46(5-6):358-370.

The feasibility and positive effects of a customized video game rehabilitation program for freezing of gait and falls in Parkinson's disease patients

Background: Freezing of gait and falls represent a major burden in patients with advanced forms of Parkinson's disease (PD). These axial motor signs are not fully alleviated by drug treatment or deep-brain stimulation. Recently, virtual reality has emerged as a rehabilitation option for these patients. In this pilot study, we aim to determine the feasibility and acceptability of rehabilitation with a customized video game to treat gait and balance disorders in PD patients, and assess its effects on these disabling motor signs.

Conclusions: This study suggests that rehabilitation with a customized video game to treat gait and balance disorders is feasible, well accepted, and effective in Parkinson's patients. These data serve as preliminary evidence for further larger and controlled studies to propose this customized video game rehabilitation program at home.

Find the full report here.


Nuic D, Vinti M, Karachi C, Foulon P, Hamme AV, Welter M-L. The feasibility and positive effects of a customised videogame rehabilitation programme for freezing of gait and falls in Parkinson’s disease patients: a pilot study. Journal of NeuroEngineering and Rehabilitation. 2018;15(1). doi:10.1186/s12984-018-0375-x

The Application Of Virtual Reality In Geriatric Mental Health: The State Of The Evidence

Conclusions: Currently, existing evidence offers clear support for the use of VR as a screening tool for cognitive impairment in older adults, and as a training tool to improve cognitive skills. VR-based tasks demonstrated validity comparable to some traditional paper-based assessments of cognition. Furthermore, there are indications that VR can play a role in delaying the onset of Alzheimer's Disease (AD), mild cognitive impairment (MCI), and other forms of dementia. More work is needed to refine VR screening capabilities for more specific diagnoses, but the potential for innovation in VR environments and tasks makes VR a promising medium to achieve this specificity. 

Find the full report here.


Mathias L, Rahman A, Skurla M, Vahia I. The Application Of Virtual Reality In Geriatric Mental Health: The State Of The Evidence. The American Journal of Geriatric Psychiatry. 2019;27(3). doi:10.1016/j.jagp.2019.01.085

How Virtual Reality Training Supports Safer Aging

This post is the first installment in a series of blog posts that will cover how virtual reality is being used to change the aging experience for older adults, loved ones and families, and their caregivers in the years ahead.

In fact, virtual reality is already having a tremendous impact on the lives of seniors. This is in large part thanks to outstanding content and applications geared towards combating social isolation by forming connections through travel and therapeutics, for example.

We will continue to focus on the role that training plays in preparing caregivers for what's next. Professional staff and family caregivers alike, the benefits of high-quality training cannot be overstated.

Stay tuned to our blog for more updates as we explore these issues and work towards building a solution to meet the growing demands of our population.



Acceptance of immersive head-mounted virtual reality in older adults


Abstract: Immersive virtual reality has become increasingly popular to improve the assessment and treatment of health problems. This rising popularity is likely to be facilitated by the availability of affordable headsets that deliver high quality immersive experiences. As many health problems are more prevalent in older adults, who are less technology experienced, it is important to know whether they are willing to use immersive virtual reality. In this study, we assessed the initial attitude towards head-mounted immersive virtual reality in 76 older adults who had never used virtual reality before. Furthermore, we assessed changes in attitude as well as self-reported cybersickness after a first exposure to immersive virtual reality relative to exposure to time-lapse videos. Attitudes towards immersive virtual reality changed from neutral to positive after a first exposure to immersive virtual reality, but not after exposure to time-lapse videos. Moreover, self-reported cybersickness was minimal and had no association with exposure to immersive virtual reality. These results imply that the contribution of VR applications to health in older adults will neither be hindered by negative attitudes nor by cybersickness.

Find the full report here.


Huygelier H, Schraepen B, Ee RV, Abeele VV, Gillebert CR. Acceptance of immersive head-mounted virtual reality in older adults. Scientific Reports. 2019;9(1). doi:10.1038/s41598-019-41200-6

Using Immersive Technologies with Children and Older Adult Patients

Human development and normal aging have fascinating effects on the prefrontal cortex – the region of the brain associated with working memory and executive attention.

The prefrontal cortex is slow to develop in humans, not reaching full capacity until an individual is in their mid-20s. In addition, prefrontal cortical function declines with normal aging, in many cases starting in middle age. This means that children and older adults are generally going to be less effective learners when content is presented in text or slideshow format, leading to an increase in errors and serious medical consequences in these populations.

 This report was originally published in Tech Trends.


Maddox T, Bonasio A, Barber T. Using Immersive Technologies with Children and Older Adult Patients. Tech Trends. Published June 17, 2018. Accessed April 5, 2019.

The use of virtual reality in craving assessment and cue-exposure therapy in substance use disorders

Craving is recognized as an important diagnosis criterion for substance use disorders (SUDs) and a predictive factor of relapse. Various methods to study craving exist; however, suppressing craving to successfully promote abstinence remains an unmet clinical need in SUDs. One reason is that social and environmental contexts recalling drug and alcohol consumption in the everyday life of patients suffering from SUDs often initiate craving and provoke relapse. Current behavioral therapies for SUDs use the cue-exposure approach to suppress salience of social and environmental contexts that may induce craving. They facilitate learning and cognitive reinforcement of new behavior and entrain craving suppression in the presence of cues related to drug and alcohol consumption. Unfortunately, craving often overweighs behavioral training especially in real social and environmental contexts with peer pressure encouraging the use of substance, such as parties and bars. In this perspective, virtual reality (VR) is gaining interest in the development of cue-reactivity paradigms and practices new skills in treatment. VR enhances ecological validity of traditional craving-induction measurement. In this review, we discuss results from (1) studies using VR and alternative virtual agents in the induction of craving and (2) studies combining cue-exposure therapy with VR in the promotion of abstinence from drugs and alcohol use. They used virtual environments, displaying alcohol and drugs to SUD patients. Moreover, some environments included avatars. Hence, some studies have focused on the social interactions that are associated with drug-seeking behaviors and peer pressure. Findings indicate that VR can successfully increase craving. Studies combining cue–exposure therapy with virtual environment, however, reported mitigated success so far.

Find the full study here.


Hone-Blanchet A, Wensing T, Fecteau S. The Use of Virtual Reality in Craving Assessment and Cue-Exposure Therapy in Substance Use Disorders. Frontiers in Human Neuroscience. 2014;8. doi:10.3389/fnhum.2014.00844

The application of VR technology in rehabilitation

Abstract: Virtual reality (VR) is an emerging technology with a variety of potential benefits for many aspects of rehabilitation assessment, treatment, and research. Through its capacity to allow the creation and control of dynamic 3-dimensional, ecologically valid stimulus environments within which behavioral responding can be recorded and measured, VR offers clinical assessment and rehabilitation options that are not available with traditional methods. Initial applications of VR in other aspects of medicine and psychology have yielded encouraging results, but continued research and understanding of this evolving technology will be crucial for its effective integration into rehabilitation. This article provides a brief introduction to VR technology, examines the specific benefits VR offers consumers and providers of rehabilitation services and discusses potential areas of application and important considerations in applying this technology. Finally, 2 examples of current VR applications are presented

You can find the full study here.


Schultheis, Maria & Rizzo, Albert. (2001). The application of virtual reality technology in rehabilitation. Rehabilitation Psychology. 46. 296-311. 10.1037/0090-5550.46.3.296. 

Virtual Restorative Environments: Preliminary Studies in Scene, Sound and Smell

Abstract: Previous restorative environment (RE) research suggests that exposure of individuals to natural settings can reduce stress, improve feelings of well-being, and help individuals to recover from fatigue following intensive mental activities. This paper focuses on possible future opportunities for exploring Virtual Environments (VE) in the pursuit of restorative and rehabilitative therapies. The paper presents early work in developing such a Virtual Restorative Environment (VRE) and includes results from two preliminary studies. The first study compared two VEs (an urban city scene and a rural coastal scene) and showed the effect of ambient sounds on ratings of anxiety and relaxation. The second study explored the opportunity of incorporating odours into a VE using a novel olfactory display system and evaluated methods for measuring their effect on the user. Throughout, the paper discusses human factors and usability issues for VRE technologies and future research opportunities

Find the full paper here.


Knight JF, Stone RJ, Qian C. Virtual Restorative Environments. International Journal of Gaming and Computer-Mediated Simulations. 2012;4(3):73-91. doi:10.4018/jgcms.2012070106

VR exercise on a home-based phase III cardiac rehabilitation program


Purpose: To analyse the effect of a six-month home-based phase III cardiac rehabilitation (CR) specific exercise program, performed in a virtual reality (Kinect) or conventional (booklet) environment, on executive function, quality of life and depression, anxiety and stress of subjects with coronary artery disease.

Conclusions: The virtual reality format had improved selective attention and conflict resolution ability, revealing the potential of CR, specifically with virtual reality exercise, on executive function. Implications for Rehabilitation In cardiac rehabilitation, especially in phase III, it is important to develop and to present alternative strategies, as virtual reality using the Kinect in a home context. Taking into account the relationship between the improvement of the executive function with physical exercise, it is relevant to access the impact of a cardiac rehabilitation program on the executive function. Enhancing the value of the phase III of cardiac rehabilitation.

Find the full report here.


Vieira Á, Melo C, Machado J, Gabriel J. Virtual reality exercise on a home-based phase III cardiac rehabilitation program, effect on executive function, quality of life and depression, anxiety and stress: a randomized controlled trial. Disability and Rehabilitation: Assistive Technology. 2017;13(2):112-123. doi:10.1080/17483107.2017.1297858

Virtual Natural Environments for Restoration and Rehabilitation in Healthcare

Abstract: For over two decades, research and clinical projects have exploited Virtual Reality technologies in the treatment of numerous human conditions, from desensitisation régimes combating phobias to the use of distraction and exposure therapies for burns victims and those suffering from post-traumatic stress disorders. In contrast to previous “high-tech” interface and combat-oriented approaches to using VR in the psychological rehabilitation process, the present chapter advocates the use of virtual restorative environments (VREs)—the recreation of locations and scenes that, by virtue of their natural beauty and peacefulness, can significantly help to reduce the body’s reactivity to stress and restore cognitive or attentional capacities. The chapter also argues that VREs, suitably enhanced with more interactive and dynamic features, could offer significant benefits to patients in physical rehabilitation programmes. This is especially the case for amputees, for example, who, whilst awaiting the fitting of prosthetic limbs, could undertake competitive and motivational “virtual exercises”, thereby avoiding muscle atrophy and related reductions in residual limb capabilities. The report concludes that the exploitation of simulation technologies in psychological therapies is worthy of continued investigation, especially in the pursuit of enhancing patients’ recovery profiles following surgical procedures, from intensive care to the hospital recovery ward. VREs possess a range of important qualities, not least significant of which is real-time interaction and ease-of-editing, supporting the cost-effective generation of engaging and distributable scenarios that can be tailored relatively easily to meet the needs of individual patients.

Find the full report here.


Stone R, Small C, Knight J, Qian C, Shingari V. Virtual Natural Environments for Restoration and Rehabilitation in Healthcare. Virtual, Augmented Reality and Serious Games for Healthcare 1 Intelligent Systems Reference Library. 2014:497-521. doi:10.1007/978-3-642-54816-1_24

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Tim Fitzpatrick

Co-founder & CEO

Hi there! Thanks for taking the time to read through our research page. The results you see here are just a fraction of the mounting evidence that supports VR's growing role in healthcare. I'd like to thank all those clinicians and researchers who continue to push the envelope in the name of improving patient care. And I especially want to thank YOU for your support — it's why we're here.

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