Visuo-spatial perspective-taking, avatar embodiment and the ability to cultivate compassion using

183 Pages·2015·2.53 MB·English

by  Nicola Brown

Visuo-spatial perspective-taking, avatar embodiment and
the ability to cultivate compassion using virtual reality and
mental imagery

Nicola Alden

D.Clin.Psy. thesis (Volume 1), 2015

University College London
UCL Doctorate in Clinical Psychology

Thesis declaration form

I confirm that the work presented in this thesis is my own. Where information has
been derived from other sources, I confirm that this has been indicated in the thesis.

Signature:

Name: Nicola Alden

Date: 19.06.2015

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Overview

The use of immersive virtual reality (IVR) as a tool for treating psychological
difficulties is a rapidly developing field. Presence, the sense of being in a virtual
environment, is regarded as a key mechanism underlying the efficacy of treatment
using IVR. Part 1 of this thesis is a systematic review and meta-analysis of the
relationship between presence and the outcome of treatment using IVR with clinical
populations. Variables which potentially moderate this relationship were examined
using narrative synthesis. Greater presence during IVR was associated with a more
positive treatment outcome but this association may be moderated by treatment type.
Part 2, an empirical study, examined the relationship between allocentric
visuo-spatial perspective-taking ability, sense of embodiment and the ability to
cultivate self-compassion in self-critical individuals using an IVR or analogue
mental imagery intervention. Change in self-compassion and self-criticism
following the intervention was examined. Experience of the intervention and effects
related to practicing imagining the intervention for two weeks were assessed. Self-
criticism reduced after both interventions but self-compassion increased only after
the mental imagery intervention. Rather than visuo-spatial perspective-taking ability
or embodiment it seems the experience of the intervention may have contributed to
these findings. This study was part of a joint project (see Holden, n.d.).
Part 3 is a critical appraisal of parts 1 and 2. It reflects on processes involved
in carrying out part 1 then expands on methodological choices made in part 2.
Finally, issues with using IVR in the empirical study and therapy more generally are
discussed.

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Table of Contents

Part 1: Literature Review 10
Abstract 11
1: Introduction 12
1.1 Psychological Treatment Using Immersive Virtual Reality 12
1.2 Presence 15
1.3 The Relationship Between Presence and the Outcome of Treatment
Using IVR 15
1.4 Aims 17
2: Method 17
2.1 Criteria for Considering Studies for this Review 17
2.2 Search Methods for Identification of Studies 19
2.3 Data Collection and Analysis 20
3: Results 25
3.1 Description of Studies 25
3.2 Assessment of Methodological Quality 35
3.3 Data Synthesis 42
4: Discussion 49
4.1 Results of the Meta-Analyses and Narrative Synthesis 49
4.2 Overall Completeness and Applicability of Evidence 53
4.3 Quality of the Evidence 54
4.4 Potential Biases in the Review Process 55
4.5 Implications for Practice 56
4.6 Implications for Research 56
4.7 Conclusion 58
References 59
Part 2: Empirical Study 70
Abstract 71
1: Introduction 73
1.1 Perspective-Taking 73
1.2 Self-Compassion and Perspective-Taking 74
1.3 Self-Compassionate Mental Imagery 75
1.4 Immersive Virtual Reality 77
1.5 Embodiment 77
1.6 The Current Study 79
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2: Method 80
2.1 Design 80
2.2 Sample Size 81
2.3 Participants 81
2.4 Procedure 82
2.5 Ethics 89
2.6 Measures 89
2.7 Data Analysis 93
3: Results 96
3.1 Baseline Data 96
3.2 Visuo-Spatial Perspective-Taking 96
3.3 Embodiment 100
3.4 State Self-Compassion and State Self-Criticism 101
3.5 Experience of the Intervention 106
3.6 Effects at Two Week Follow-Up 106
4: Discussion 110
4.1 Main Findings 110
4.2 Statistical Considerations 110
4.3 Interpretation of Findings 111
4.4 Limitations 115
4.5 Future Research 117
4.6 Clinical Implications 119
4.7 Conclusion 121
References 122
Part 3: Critical Appraisal 135
1: Introduction 136
2: The Literature Review 136
2.1 The Literature 136
2.2 Conducting the Meta-Analysis 137
3: The Empirical Study 139
3.1 Removing a Condition 140
3.2 Sample Size 140
3.3 Designing the Mental Imagery Condition 141
3.4 Measures 142
4: Immersive Virtual Reality 146
5
5: Conclusion 148
References 149
Appendices 152
Appendix A: Studies Excluded From the Literature Review 153
Appendix B: The Author’s Contribution to the Joint Project 155
Appendix C: Participant Information Sheets 157
Appendix D: Script for the Mental Imagery Intervention 169
Appendix E: Ethics and Consent Forms 172
Appendix F: Data for the VREQ and MIEQ 179

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Table of Tables

Part 1: Literature Review
Table 1 Categorisation of Treatment Outcome Measures 24
Table 2 Characteristics of Included Studies 31
Table 3 Assessment of Methodological Quality 41
Table 4 Findings for the Relationship Between Presence and the
Outcome of Treatment Using IVR for Studies Ineligible for Meta-
Analysis 43

Part 2: Empirical Study
Table 1 Means, Standard Deviations and Difference Between the IVR
and MI Conditions for Demographic and Pre-Intervention Measures 98
Table 2 Means, Standard Deviations and Difference Between
Individuals Who Did or Did Not Complete the Intervention for
Demographic and Trait Self-Criticism Measures 99
Table 3 Means, Standard Deviations and Correlations with Pure
Allocentric Memory for State Self-Compassion and State Self-Criticism
Change Scores 99
Table 4 Post Hoc Pairwise Comparisons for the Main Effect of
Condition for State Self-Compassion and State Self-Criticism 104
Table 5 Post Hoc Pairwise Comparisons for the Main Effect of Time for
State Self-Compassion and State Self-Criticism 105
Table 6 State Self-Compassion and State Self-Criticism at Each Time
Point 105
Table 7 Medians, Interquartile Ranges and Difference Between the
Conditions for Ease of Recall, Frequency of Practice and Image
Vividness 106
Table 8 Correlations for Ease of Recall, Frequency of Practice and
Image Vividness with Pure Allocentric Memory, Sense of Embodiment
and State Self-Compassion and State Self-Criticism Change Scores 108

7
Table of Figures

Part 1: Literature Review
Figure 1. Study flow diagram. 26
Figure 2. Forest plot of the relationship between presence and the
outcome of treatment using IVR. 44
Figure 3. Forest plot of the relationship between presence and the
outcome of treatment using IVR for studies reporting bivariate
correlations. 44
Figure 4. Participant characteristics grouped by finding for the
relationship between presence and the outcome of treatment using IVR. 46
Figure 5. Dose-response relationship grouped by finding for the
relationship between presence and the outcome of treatment using IVR. 48

Part 2: Empirical Study
Figure 1. Flow of participants through the study. 84
Figure 2. A female participant embodied in the adult avatar observing
the child avatar’s disposition during different stages of the
compassionate response. 87
Figure 3. Example stimuli from the egocentric VSPT task. 90
Figure 4. Example stimuli from the Four Mountains tasks. 91
Figure 5. Pre-intervention, post-intervention and two week follow-up
state self-compassion scores for the IVR and MI conditions. Error bars
represent 95% CIs. 103
Figure 6. Pre-intervention, post-intervention and two week follow-up
state self-criticism scores for the IVR and MI conditions. Error bars
represent 95% CIs. 104

8
Acknowledgments

I would like to thank my supervisor, Dr John King, for his kindness and
enthusiasm throughout this project and his thoughtful and nurturing approach to
supervision. Thanks also to my caring and supportive partner for the empirical
study, Anneka Holden, whom it was an absolute pleasure to work with.
I am grateful for help from Dr Caroline Falconer who gave her time to teach
me how to use the immersive virtual reality technology and talk through aspects of
the empirical study. I am also grateful to Aitor Rovira whose expertise in immersive
virtual reality helped the experimental sessions to run smoothly. I wish to thank
those who participated in the empirical study for their generosity with their time and
interest in the project.
I would especially like to thank my family for their love and support.

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Part 1: Literature Review

The relationship between presence and the outcome of
treatment using immersive virtual reality: A systematic
review and meta-analysis

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