Full Body Immersive Virtual Reality System with Motion Recognition Camera Targeting the Treatment of Spider Phobia

  • Jacob KritikosEmail author
  • Stavroula Poulopoulou
  • Chara Zoitaki
  • Marilina Douloudi
  • Dimitris Koutsouris
Conference paper
Part of the Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering book series (LNICST, volume 288)


Exposure Therapy (ET) is one of the most widely-used methods for treating Specific Phobias, and, over the past few years, Virtual Reality (VR) has contributed significantly in this field, since the birth of what we call “Virtual Reality ET” (VRET). However, VR systems used in VRET so far do not fully integrate ET characteristics; the reason behind this is that they do not provide sufficient, or occasionally not any at all, interaction with the feared stimulus, which is a key factor for full ET implementation. Objective: The aim of our study is to propose a way to include natural interaction between the patient and the system during the treatment procedure. Method: We propose an addition to current session protocols for mental health professionals through which they can apply ET in full extent with the use of motion tracking sensors. Specifically, we added a Motion Recognition Camera, which tracks the patient’s movements and places their physical body within the virtual environment, increasing their feeling of presence and making the system more immersive. Therefore, clinicians can assign interactive tasks for their patients to practice within a controlled virtual environment. Results: We present the feedback we received regarding the system’s potential utility and efficiency by a group of psychiatry professionals who tried the system. Impact: With real-time interaction and VRET, patients stand a better chance to truly acquire the necessary skills to overcome their phobias.


Virtual reality Cognitive behavioral treatments Exposure therapy Anxiety disorders Specific phobias Motion tracking sensor Motion recognition camera Presence Clinical treatment Immersion 



We would like to thank the executive managers and members of the stuff of the General and Oncology Hospital of Kifissia for agreeing to provide the opportunity to present our work to them and receive their feedback.

At this point, we would like to discuss the expertise of the healthcare facility members we used as evaluators of our system a bit further. The medical staff of the facility we chose consists of experienced, well-trained, highly educated psychiatrists and healthcare attendants, who agreed to test our proposed system and provide their substantial feedback on its efficiency, as well as methods of enhancing it in the future. All of the members have graduated from reputable medical universities and have frequently assisted patients in treating their obsessive/irrational thought and behavioral patterns through exposure therapy sessions. Another important aspect of our preference in this particular psychiatric department is their constant quest for innovative diagnostic and therapeutic techniques. Our system and method are quite original; subsequently, they were highly interested in the new methods in which ET can be enhanced through VR technology. Taking the aforementioned facts into consideration, it is clear that our choice in this particular psychiatric department was everything but coincidental; we strongly believe that the clinic’s specialists were the most fitting to evaluate the efficacy of our system in view of their experience and education.


  1. 1.
    American psychiatric association: diagnostic and statistical manual of mental disorders, 5th edn. (2013)Google Scholar
  2. 2.
    National Institute of Mental Health: Anxiety DisorderGoogle Scholar
  3. 3.
    National Institute of Mental Health: Mental IllnessGoogle Scholar
  4. 4.
    Bandelow, B., Michaelis, S.: Epidemiology of anxiety disorders in the 21st century. Dialogues Clin. Neurosci. 17(3), 327–335 (2015)Google Scholar
  5. 5.
    Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., Walters, E.E.: Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch. Gen. Psychiatry 62, 293–602 (2005)Google Scholar
  6. 6.
    Stinson, F.S.: The epidemiology of DSM-IV specific phobia in the USA: results from the national epidemiologic survey on alcohol and related conditions. Psychol. Med. 37(March), 1047–1059 (2007)CrossRefGoogle Scholar
  7. 7.
    Öst, L.G.: One-session treatment for specific phobias. Behav. Res. Ther. 27, 1–7 (1989)CrossRefGoogle Scholar
  8. 8.
    Scott, J., Beck, A.T.: Cognitive behavioural therapy. In: Essential Psychiatry, 4th edn. (2008)Google Scholar
  9. 9.
    Mayo-Wilson, E., Montgomery, P.: Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults. Cochrane Database Syst. Rev. (2013)Google Scholar
  10. 10.
    Treatment - (ADAA) Anxiety and Depression Association of America.
  11. 11.
    Otte, C.: Cognitive behavioral therapy in anxiety disorders: current state of the evidence. Dialogues Clin. Neurosci. 13(4), 413–421 (2011)Google Scholar
  12. 12.
    Wittchen, H.-U., Mühlig, S., Beesdo, K.: Mental disorders in primary care. Dialogues Clin. Neurosci. 5(2), 115–128 (2003)Google Scholar
  13. 13.
    Kerns, C.M., Read, K.L., Klugman, J., Kendall, P.C.: Cognitive behavioral therapy for youth with social anxiety: differential short and long-term treatment outcomes. J. Anxiety Disord. 27(2), 210–215 (2013)CrossRefGoogle Scholar
  14. 14.
    Riddle-Walker, L.: Cognitive behaviour therapy for specific phobia of vomiting (Emetophobia): a pilot randomized controlled trial. J. Anxiety Disord. 43, 14–22 (2016)CrossRefGoogle Scholar
  15. 15.
    Krebs, G.: Long-term outcomes of cognitive-behavioral therapy for adolescent body dysmorphic disorder. Behav. Ther. 48(4), 462–473 (2017)CrossRefGoogle Scholar
  16. 16.
    Rozental, A.: A randomized controlled trial of internet-based cognitive behavior therapy for perfectionism including an investigation of outcome predictors. Behav. Res. Ther. 95, 79–86 (2017)CrossRefGoogle Scholar
  17. 17.
    Warwick, H.: Complete recovery from anxiety disorders following cognitive behavior therapy in children and adolescents: a meta-analysis. Clin. Psychol. Rev. 52, 77–91 (2017)CrossRefGoogle Scholar
  18. 18.
    Peñate, W., Fumero, A., Viña, C., Herrero, M., Marrero, R.J., Rivero, F.: A meta-analytic review of neuroimaging studies of specific phobia to small animals. Eur. J. Psychiatry 31, 1–44 (2017)CrossRefGoogle Scholar
  19. 19.
    Twomey, C., O’Reilly, G., Meyer, B.: Effectiveness of an individually-tailored computerised CBT programme (Deprexis) for depression: a meta-analysis. Psychiatry Res. 256, 371–377 (2017)CrossRefGoogle Scholar
  20. 20.
    Ollendick, T.H., Öst, L.G., Ryan, S.M., Capriola, N.N., Reuterskiöld, L.: Harm beliefs and coping expectancies in youth with specific phobias. Behav. Res. Ther. 91, 51–57 (2017)CrossRefGoogle Scholar
  21. 21.
    Shiban, Y., Schelhorn, I., Pauli, P., Mühlberger, A.: Effect of combined multiple contexts and multiple stimuli exposure in spider phobia: a randomized clinical trial in virtual reality. Behav. Res. Ther. 71, 45–53 (2015)CrossRefGoogle Scholar
  22. 22.
    Treanor, M., Craske, M.G.: Exposure therapy. In: Encyclopedia of Mental Health, 2nd edn. (2015)Google Scholar
  23. 23.
    Rothbaum, B.O., Rizzo, A.S., McDaniel, D.D., Zanov, M.V.: Virtual reality exposure therapy. In: Encyclopedia of Mental Health, 2nd edn. (2015)Google Scholar
  24. 24.
    Society of Clinical Psychology: What is Exposure Therapy?. American Psychological Association: Division, vol. 12 (2013)Google Scholar
  25. 25.
    Waters, A.M.: Augmenting one-session treatment of children’s specific phobias with attention training to positive stimuli. Behav. Res. Ther. 62, 107–119 (2014)CrossRefGoogle Scholar
  26. 26.
    Rizzo, A., Hartholt, A., Grimani, M., Leeds, A., Liewer, M.: Virtual reality exposure therapy for combat-related posttraumatic stress disorder. In: Computer, Long Beach California (2014)Google Scholar
  27. 27.
    Cardoş, R.A.I., David, O.A., David, D.O.: Virtual reality exposure therapy in flight anxiety: a quantitative meta-analysis. Comput. Hum. Behav. 72, 371–380 (2017)CrossRefGoogle Scholar
  28. 28.
    Bun, P., Gorski, F., Grajewski, D., Wichniarek, R., Zawadzki, P.: Low - cost devices used in virtual reality exposure therapy. Procedia Comput. Sci. 104, 445–451 (2016)CrossRefGoogle Scholar
  29. 29.
    Yiasemidou, M., Siqueira, J., Tomlinson, J., Glassman, D., Stock, S., Gough, M.: Take-home’ box trainers are an effective alternative to virtual reality simulators. J. Surg. Res. 213, 69–74 (2017)CrossRefGoogle Scholar
  30. 30.
    Blakey, S.M., Abramowitz, J.S.: The effects of safety behaviors during exposure therapy for anxiety: critical analysis from an inhibitory learning perspective. Clin. Psychol. Rev. 49, 1–15 (2016)CrossRefGoogle Scholar
  31. 31.
    Krijn, M., Emmelkamp, P.M.G., Biemond, R., Schuemie, M.J., Van Der Mast, C.A.P.G.: Treatment of acrophobia in virtual reality: The role of immersion and presence. Behav. Res. Ther. 42, 229–239 (2004)CrossRefGoogle Scholar
  32. 32.
    Emmelkamp, P.M.G., Krijn, M., Hulsbosch, A.M., Vries, S., Schuemie, M.J.: Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia. Behav. Res. Ther. 40, 509–516 (2002)CrossRefGoogle Scholar
  33. 33.
    Carlin, A.S., Hoffman, H.G., Weghorst, S.: Virtual reality and tactile augmentation in the treatment of spider phobia: a case report. Behav. Res. Ther. 35, 153–158 (1997)CrossRefGoogle Scholar
  34. 34.
    Freeman, D.: Automated psychological therapy using immersive virtual reality for treatment of fear of heights: a single-blind, parallel-group, randomised controlled trial. Lancet Psychiatry 5, 625–632 (2018)CrossRefGoogle Scholar
  35. 35.
    Price, M., Anderson, P.: The role of presence in virtual reality exposure therapy. J. Anxiety Disord. 21, 742–751 (2007)CrossRefGoogle Scholar
  36. 36.
    Morina, N., Brinkman, W.-P., Hartanto, D., Emmelkamp, P.M.G.: Sense of presence and anxiety during virtual social interactions between a human and virtual humans. PeerJ 2, e337 (2014)CrossRefGoogle Scholar
  37. 37.
    Rudaz, M., Ledermann, T., Margraf, J., Becker, E.S., Craske, M.G.: The moderating role of avoidance behavior on anxiety over time: is there a difference between social anxiety disorder and specific phobia? PLoS ONE 12, e0180298 (2017)CrossRefGoogle Scholar
  38. 38.
    Da Gama, A.E.F., de Menezes Chaves, T., Fallavollita, P., Figueiredo, L.S., Teichrieb, V.: Rehabilitation motion recognition based on the international biomechanical standards. Expert Syst. Appl. 116, 396–409 (2019)CrossRefGoogle Scholar
  39. 39.
    Wang, X., Yan, K.: Immersive human-computer interactive virtual environment using large-scale display system. Future Gener. Comput. Syst. 96, 649–659 (2017)CrossRefGoogle Scholar
  40. 40.
    Chen, J., Qiu, J., Ahn, C.: Construction worker’s awkward posture recognition through supervised motion tensor decomposition. Autom. Constr. 77, 67–81 (2017)CrossRefGoogle Scholar
  41. 41.
    Maples-Keller, J.L., Bunnell, B.E., Kim, S.J., Rothbaum, B.O.: The use of virtual reality technology in the treatment of anxiety and other psychiatric disorders. Harvard Rev. Psychiatry 25, 103 (2017)CrossRefGoogle Scholar
  42. 42.
    Morina, N., Ijntema, H., Meyerbröker, K., Emmelkamp, P.M.G.: Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments. Behav. Res. Ther. 74, 18–24 (2015)CrossRefGoogle Scholar
  43. 43.
    Turner, W.A., Casey, L.M.: Outcomes associated with virtual reality in psychological interventions: where are we now? Clin. Psychol. Rev. 34, 634–644 (2014)CrossRefGoogle Scholar
  44. 44.
    Suh, A., Prophet, J.: The state of immersive technology research: a literature analysis. Comput. Hum. Behav. 86, 77–90 (2018)CrossRefGoogle Scholar
  45. 45.
    Freeman, D.: Virtual reality in the assessment, understanding, and treatment of mental health disorders. Psychol. Med. 47(14), 2393–2400 (2017)CrossRefGoogle Scholar
  46. 46.
    Kritikos, J., Tzannetos, G., Zoitaki, C., Poulopoulou, S., Koutsouris, D.: Anxiety detection from Electrodermal Activity Sensor with movement & interaction during Virtual Reality Simulation. In: 9th International IEEE EMBS Conference on Neural Engineering, San Francisco, CA, USA, 20–23 March 2019, pp. 571–576 (2019).

Copyright information

© ICST Institute for Computer Sciences, Social Informatics and Telecommunications Engineering 2019

Authors and Affiliations

  • Jacob Kritikos
    • 1
    Email author
  • Stavroula Poulopoulou
    • 2
  • Chara Zoitaki
    • 3
  • Marilina Douloudi
    • 4
  • Dimitris Koutsouris
    • 1
  1. 1.Biomedical Engineering LaboratoryNational Technical University of AthensAthensGreece
  2. 2.Department of Digital SystemsUniversity of PiraeusPiraeusGreece
  3. 3.School of Electrical and Computer EngineeringNational Technical University of AthensAthensGreece
  4. 4.Department of BiologyNational Kapodistrian University of AthensAthensGreece

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