Cybertherapy: Virtual yet real

For more than a decade,a handful of therapists have been using virtual environments.

For more than a decade,a handful of therapists have been using virtual environments to help people to work through phobias,like a fear of heights or of public spaces. But now advances in artificial intelligence and computer modelling are allowing them to take on a wider array of complex social challenges and to gain insight into how people are affected by interactions with virtual humansor by inhabiting avatars of themselves.

Researchers are populating digital worlds with autonomous,virtual humans that can evoke the same tensions as in real-life encounters. People with social anxiety are struck dumb when asked questions by a virtual stranger. Heavy drinkers feel strong urges to order something from a virtual bartender,while gamblers are drawn to sit down and join a group playing on virtual slot machines. And therapists can advise patients at the very moment those sensations are felt. In a series of experiments,researchers have shown that people internalise these virtual experiences and their responses to themwith effects that carry over into real life.

The emerging field,called cybertherapy,now has annual conferences and a growing international following of therapists,researchers and others interested in improving behaviour through the use of simulations. The Canadian military has invested heavily in virtual-reality research; so has the United States Army,which has been spending about 4 million annually on programmes for training officers and treating post-traumatic stress reactions.

In an office at the Institute for Creative Technologies at the University of Southern California,a virtual woman named Angelina is addressing a college student from a computer screen. Angelina looks to be about 30 or so,a pretty,athletic figure with an open,intelligent face framed by short black hair. Her eyes and expression,guided by video cameras and microphones,stay in sync with the students,as an empathetic therapists would. What are some of the things you hate about yourself? asks the voice. The student stalls for a moment. Well, she says,in a video of the exchange,I dont like that I can be really quiet in social situations. Sometimes people take that as me being rude,but its just me being quiet. Angelina nods sympathetically and then asks another question,about what the student fears most.

Interacting with a virtual human programmed to be socially sensitive in this way is oddly liberating. The figures are clearly not human; some are balky with language,others mute. But the faces are mobile,blinking,alive,the body language and gestures seemingly natural. The result is a living presence that is responsive but not judgemental.

In a recent study using this virtual confidant,researchers at USC have found Angelina elicits from people the crucial first element in any therapy: self-disclosure. People with social anxiety confessed more of their personal flaws,fears and fantasies to virtual figures than to live therapists conducting video interviews,the study found.

The researchers are incorporating the techniques learned from Angelina into a virtual agent being developed for the Army,called SimCoach. Guided by language-recognition software,SimCoachthere are several versions,male and female,young and older,white and blackappears on a computer screen and can conduct a rudimentary interview,gently probing for possible mental troubles. Using SimCoach on a laptop,veterans and family members would anonymously ask about difficulties theyre having,whether due to post-traumatic stress or other strains of service.

Story continues below this ad

It does not give a diagnosis, said Jonathan Gratch,a co-author of the Angelina study with Sin-Hwa Kang,also of USC. But the idea is that the SimCoach would ask people if they would like to see a therapist; and if so,could then guide them to someone in their area,depending on what it has learned. Once people are in treatment,therapists can use virtual technology to simulate threatening situationsand guide patients through them,gradually and incrementally,calibrating the intensity of the experience.

At the Virtual Reality Medical Center in San Diego,psychologists have treated hundreds of patients using gradual virtual exposure,for post-traumatic stress and agoraphobia,among other anxieties. At USC,a program has been designed specifically for veterans of the Iraq war. In one continuing study at the University of California,Davis,researchers are trying to improve high-functioning autistic childrens ability to think and talk about themselves while paying attention to multiple peers. The hope is similar for people with social anxiety: that practice interacting with a virtual boss,suspicious strangers or virtual partygoers who are staring as one enters the room will also lead to increased comfort,with the help of a therapist.

The figures dont even have to be especially realistic to evoke reactions, said psychologist,Stéphane Bouchard,who directs the cybertherapy program at the University of Quebec in Ottawa. Virtual reality can also help shape ones identity in real life. Stanford University researchers have found that people placed in front of a virtual mirrorthe face in the mirror does not look familiar,but lift a hand and up goes its hand simultaneouslyidentify strongly with their body and psychologically inhabit it. And by subtly altering elements of that embodied figure,the scientists have established a principle that is fundamental to therapythat an experience in a virtual world can alter behaviour in the real one.

The remarkable thing is how little a virtual human has to do to produce fairly large effects on behaviour, said Jeremy Bailenson,director of the Virtual Human Interaction Lab at Stanford and the author,with James Blascovich,of the coming book Infinite Reality HarperCollins 2011. In a recent experiment,Bailenson and Nick Yee,had 50 college students enter a virtual environment and acquire a virtual body,an avatar. Each student then participated in a negotiation game with a member of the experimental team,who was introduced as another student.

Story continues below this ad

But all the avatars were not created equal. Some were four inches taller than their human counterparts,and others were four inches shorter. The participants didnt notice this alteration,but those made taller negotiated in the virtual game much more aggressively than the shorter ones. A later study led byYee found that this effect carried over into face-to-face negotiations after the virtual headsets were removed. The researchers have demonstrated a similar effect in the case of attractiveness. What we learn in one body is shared with other bodies we inhabit,whether virtual or physical, they concluded.

This is to me,the most exciting thing about using virtual environments for behaviour change, Bailenson said. Its not only that you can create these versions of reality; its that you can cross boundariesthat you can take risks,break things,do things you could not or would not do in real life.