Controlling social stress in virtual reality environments

Hartanto, Dwi; Kampmann, Isabel L.; Morina, Nexhmedin; Emmelkamp, Paul G. M.; Neerincx, Mark A.; Brinkman, Willem-Paul

doi:10.1371/journal.pone.0092804

Cited by 115Virtual Reality Applications and ImpactsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesDigital Mental Health Interventions

Controlling social stress in virtual reality environments

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Hartanto, Dwi, Kampmann, Isabel L., Morina, Nexhmedin, Emmelkamp, Paul G. M., Neerincx, Mark A., Brinkman, Willem-Paul·2014·PLoS ONE

DOI 10.1371/journal.pone.0092804PMC PMC3966821

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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.

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VRET significantly reduces the resource investment needed for exposure-based treatments, including time and finances.
“This significantly reduces the resource investment needed for exposure-based treatments, including time and finances (Hartanto et al., 2014; Carl et al., 2019; Emmelkamp, 2005; Miloff et al., 2016; Reeves et al., 2022; Boeldt et al., 2019; Robillard et al., 2011).”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Hartanto et al., 2014
The Introduction (page unavailable) says VRET makes exposure elements more manageable to control, but it does not say treatment requires significantly less time or money. Searches for treatment costs, time, and resource investment found no passage addressing those reductions. (LLM, conf=0.73)
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Dozio, N., Marcolin, F., Scurati, G. W., Ulrich, L., Nonis, F., Vezzetti, E., Marsocci, G., Rosa, A. L., & Ferrise, F. (2022) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2022.102791 · Cited by 125 · see citing works
Can Virtual Reality Effectively Elicit Distress Associated with Social Anxiety Disorder?
Owens, M. E., & Beidel, D. C. (2014) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-014-9454-x · Cited by 103 · see citing works
Salivary cortisol and cardiovascular reactivity to a public speaking task in a virtual and real-life environment
Kothgassner, O. D., Felnhofer, A., Hlavacs, H., Beutl, L., Palme, R., Kryspin‐Exner, I., & Glenk, L. M. (2016) · Computers in Human Behavior · doi:10.1016/j.chb.2016.03.081 · Cited by 104 · see citing works
360° Video virtual reality exposure therapy for public speaking anxiety: a randomized controlled trial
Reeves, R., Elliott, A., Curran, D., Dyer, K., & Hanna, D. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102451 · Cited by 82 · see citing works
A meta-analysis of the efficacy of virtual reality and in vivo exposure therapy as psychological interventions for public speaking anxiety
Reeves, R., Curran, D., Gleeson, A., & Hanna, D. (2022) · Behavior Modification · doi:10.1177/0145445521991102 · Cited by 69 · see citing works
“, 2016) and facilitates easy access to stimuli which can be controlled by the therapist (Hartanto et al., 2014).”
Background
Evoking stress reactivity in virtual reality: A systematic review and meta-analysis
van Dammen, L., Finseth, T., McCurdy, B. H., Barnett, N. P., Conrady, R. A., Leach, A. G., Deick, A. F., Steenis, A. L. V., Gardner, R., Smith, B. L., et al. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104709 · Cited by 69 · see citing works
Potential and challenges of immersive virtual environments for occupant energy behavior modeling and validation: A literature review
Zhu, Y., Saeidi, S., Rizzuto, T. E., Roetzel, A., & Kooima, R. L. (2018) · Journal of Building Engineering · doi:10.1016/j.jobe.2018.05.017 · Cited by 62 · see citing works
The use of virtual reality in assessment and treatment of anxiety and related disorders
Meyerbröker, K., & Nexhmedin Morina, B. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2623 · Cited by 60 · see citing works
“Although, different OCD themes (e.g., control, contamination, etc.) make different environments necessary to apply broad ERP, these themes seem to be universal (Hunt, 2020).”
Background
Classifying Presence Scores: Insights and Analysis from Two Decades of the Igroup Presence Questionnaire (IPQ)
Tran, T. Q., Langlotz, T., Young, J., Schubert, T. W., & Regenbrecht, H. T. (2024) · ACM Transactions on Computer-Human Interaction · doi:10.1145/3689046 · Cited by 55 · see citing works
“…64]); here, the IPQ was used to investigate “… whether the virtual world in this experiment established a reasonable level of presence to evoke the anxiety…” [23, p. 7] or “…different components of presence are associated with the experience of fear and treatment response to VRE[T]…” [47, p. 7].”
Effects of mixed reality head-mounted glasses during 90 minutes of mental and manual tasks on cognitive and physiological functions
Cometti, C., Païzis, C., Casteleira, A., Pons, G., & Babault, N. (2018) · PeerJ · doi:10.7717/peerj.5847 · Cited by 43 · see citing works
“Virtual environments should be carefully selected not to increase uselessly individuals’ anxiety levels (Hartanto et al., 2014).”
Background
Virtual reality exposure therapy for treating social anxiety: a scoping review of treatment designs and adaptation to stuttering
Chard, I., & van Zalk, N. (2022) · Frontiers in Digital Health · doi:10.3389/fdgth.2022.842460 · Cited by 46 · see citing works
Exploring thermal state in mixed immersive virtual environments
Saeidi, S., Rentala, G. S., Rizzuto, T. E., Hong, T., Johannsen, N. M., & Zhu, Y. (2021) · Journal of Building Engineering · doi:10.1016/j.jobe.2021.102918 · Cited by 39 · see citing works
Comparisons of Stress Physiology of Providers in Real-Life Resuscitations and Virtual Reality–Simulated Resuscitations
Chang, T. P., Beshay, Y., Hollinger, T., & Sherman, J. M. (2019) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0000000000000356 · Cited by 38 · see citing works
Users’ psychophysiological, vocal, and self-reported responses to the apparent attitude of a virtual audience in stereoscopic 360°-video
Barreda-Ángeles, M., Aleix-Guillaume, S., & Pereda-Baños, A. (2019) · Virtual Reality · doi:10.1007/s10055-019-00400-1 · Cited by 38 · see citing works
A Quality of Experience assessment of haptic and augmented reality feedback modalities in a gait analysis system
Rodrigues, T. B., Catháin, C. Ó., O'Connor, N. E., & Murray, N. (2020) · PLoS ONE · doi:10.1371/journal.pone.0230570 · Cited by 38 · see citing works
The effect of virtual reality therapy and counseling on students' public speaking anxiety
Sarpourian, F., Samad‐Soltani, T., Moulaei, K., & Bahaadinbeigy, K. (2022) · Health Science Reports · doi:10.1002/hsr2.816 · Cited by 38 · see citing works
Self-identification with a Virtual Experience and Its Moderating Effect on Self-efficacy and Presence
Kang, N., Ding, D., van Riemsdijk, M. B., Nexhmedin Morina, B., Neerincx, M. A., & Brinkman, W. (2020) · International Journal of Human-Computer Interaction · doi:10.1080/10447318.2020.1812909 · Cited by 41 · see citing works
“For example, they can deliver a speech in front of a virtual audience (Aymerich-Franch et al., 2014) or answer questions as candidate in a job interview (Hartanto et al., 2014).”
Background
Virtual Bystanders in a Language Lesson: Examining the Effect of Social Evaluation, Vicarious Experience, Cognitive Consistency and Praising on Students' Beliefs, Self-Efficacy and Anxiety in a Virtual Reality Environment
Qu, C., Ling, Y., Heynderickx, I. E. J., & Brinkman, W. (2015) · PLoS ONE · doi:10.1371/journal.pone.0125279 · Cited by 35 · see citing works
“Still others have shown that providing positive or negative feedback in a dialogue can affect people’s emotion and behavior [8, 71].”
Same same but different? Replicating the real surroundings in a virtual trier social stress test (TSST-VR) does not enhance presence or the psychophysiological stress response
Zimmer, P., Wu, C. C., & Domes, G. (2019) · Physiology & Behavior · doi:10.1016/j.physbeh.2019.112690 · Cited by 34 · see citing works
Targeted Memory Reactivation During REM Sleep in Patients With Social Anxiety Disorder
Borghese, F., Henckaerts, P., Guy, F., Mayo, C., Delplanque, S., Schwartz, S., & Perogamvros, L. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.904704 · Cited by 33 · see citing works
“, positive compliments) regarding the patient’s performance, which represents extinction-related violation of expectancy (5), was also found to reduce social anxiety (15), and is an integral part of self-focused exposure therapy (16).”
Background
Anxiety detection from Electrodermal Activity Sensor with movement & interaction during Virtual Reality Simulation
Kritikos, I., Tzannetos, G., Zoitaki, C., Poulopoulou, S., & Koutsouris, D. (2019) · International IEEE/EMBS Conference on Neural Engineering · doi:10.1109/ner.2019.8717170 · Cited by 34 · see citing works
Social interactions in virtual reality exposure therapy: A proof-of-concept pilot study
Nexhmedin Morina, B., Brinkman, W., Hartanto, D., Kampmann, I. L., & Emmelkamp, P. M. G. (2015) · Technology and Health Care · doi:10.3233/thc-151014 · Cited by 30 · see citing works
“Recent work indicates that more elaborate conversations with virtual humans can also elicit arousal, comparable to conversations in real life [14,15].”
Assessing Social Anxiety Through Digital Biomarkers Embedded in a Gaming Task
Dechant, M., Frommel, J., & Mandryk, R. L. (2021) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3411764.3445238 · Cited by 31 · see citing works
“people that manifest in physical contexts may transfer into virtual worlds [53].”
Background
Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder
Seuling, P. D., Czernin, N. S., & Schiele, M. A. (2024) · Neuroscience Applied · doi:10.1016/j.nsa.2024.104074 · Cited by 28 · see citing works
“This significantly reduces the resource investment needed for exposure-based treatments, including time and finances (Hartanto et al., 2014; Carl et al., 2019; Emmelkamp, 2005; Miloff et al., 2016; Reeves et al., 2022; Boeldt et al., 2019; Robillard et al., 2011).”
The influences of virtual social feedback on social anxiety disorders
Kishimoto, T., & Ding, X.-F. (2019) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465819000377 · Cited by 23 · see citing works
“In one study, Hartanto and colleagues investigated a series of affective verbal feedback (0∼100% negative dialogue style conditions) for higher and lower social anxiety individuals (Hartanto et al., 2014).”
Background
Utility of virtual reality environments to examine physiological reactivity and subjective distress in adults who stutter
Brundage, S. B., Brinton, J. M., & Hancock, A. B. (2016) · Journal of Fluency Disorders · doi:10.1016/j.jfludis.2016.10.001 · Cited by 26 · see citing works
Exploring the impact of green wall and its size on restoration effect and stress recovery using immersive virtual environments
Sedghikhanshir, A., Zhu, Y., Beck, M. R., & Jafari, A. (2024) · Building and Environment · doi:10.1016/j.buildenv.2024.111844 · Cited by 26 · see citing works
Virtual Reality Exposure Therapy as a Treatment Method Against Anxiety Disorders and Depression-A Structured Literature Review
Hawajri, O., Lindberg, J., & Suominen, S. (2023) · Issues in Mental Health Nursing · doi:10.1080/01612840.2023.2190051 · Cited by 26 · see citing works
“The results of some of the included articles showed that VRET is a treatment that can work to reduce stress in treated patients (Hartanto et al., 2014; Kampmann et al., 2016).”
Result
A Comparison of Active and Passive Virtual Reality Exposure Scenarios to Elicit Social Anxiety
Sekhavat, Y. A., & Nomani, P. (2017) · International Journal of Serious Games · doi:10.17083/ijsg.v4i2.154 · Cited by 24 · see citing works
“arousal as well as self-reported distress [20].”
The Medical Metaverse, Part 1: Introduction, Definitions, and New Horizons for Neuropsychiatry
López-Ojeda, W., & Hurley, R. A. (2023) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.20220187 · Cited by 23 · see citing works
Home-Based Virtual Reality Exposure Therapy with Virtual Health Agent Support
Hartanto, D., Brinkman, W.-P., Kampmann, I. L., Morina, N., Emmelkamp, P. G. M., & Neerincx, M. A. (2016) · Communications in Computer and Information Science · doi:10.1007/978-3-319-32270-4_9 · Cited by 21 · see citing works
Self-citation
Mild stress stimuli built into a non-immersive virtual environment can elicit actual stress responses
Alghamdi, M. A., Regenbrecht, H. T., Hoermann, S., & Swain, N. (2017) · Behaviour and Information Technology · doi:10.1080/0144929x.2017.1311374 · Cited by 21 · see citing works
“2007), for instance, eliciting anxiety (e.g. Pertaub, Slater, and Barker 2002; Hartanto et al. 2014; Seinfeld et al. 2016), stress (e.”
Background
Virtual reality exposure therapy for reducing school anxiety in adolescents: Pilot study
Beele, G., Liesong, P., Bojanowski, S., Hildebrand, K., Weingart, M., Asbrand, J., Correll, C. U., Morina, N., & Uhlhaas, P. J. (2024) · JMIR Mental Health · doi:10.2196/56235 · Cited by 20 · see citing works
“This finding aligns with previous research demonstrating that virtual social-evaluative situations can evoke anxiety in both adults [40,74-77] and youth [44].”
Result
Digital Intervention for the Management of Alzheimer’s Disease
Manchanda, N., Aggarwal, A., Setya, S., & Talegaonkar, S. (2022) · Current Alzheimer Research · doi:10.2174/1567205020666230206124155 · Cited by 20 · see citing works
“I’d rather drink in VRChat”: Understanding Drinking in Social Virtual Reality
Chen, Q.-J., Bellucci, A., & Jacucci, G. (2024) · International Conference on Human Factors in Computing Systems · doi:10.1145/3613904.3642405 · Cited by 29 · see citing works
“However, VR has shown the ability to provoke experiences of social distress and can be used as a tool to diagnose social anxiety [41, 48, 57].”
Virtual Reality Interventions for Mental Health
Kothgassner, O. D., Reichmann, A., & Bock, M. M. (2023) · Current Topics in Behavioral Neurosciences · doi:10.1007/7854_2023_419 · Cited by 19 · see citing works
RETRACTED ARTICLE: Quality assessment for virtual reality technology based on real scene
Jiang, B., Yang, J., Jiang, N., Lv, Z., & Meng, Q. (2016) · Neural Computing and Applications · doi:10.1007/s00521-016-2828-0 · Cited by 17 · see citing works
“As known, Most of the virtual reality display [13] through the way of stereo images, which is shown in Fig.”
Retracted
Fear, psychophysiological arousal, and cognitions during a virtual social skills training in social anxiety disorder while manipulating gaze duration
Reichenberger, J., Wechsler, T. F., Diemer, J., Mühlberger, A., & Notzon, S. (2022) · Biological Psychology · doi:10.1016/j.biopsycho.2022.108432 · Cited by 14 · see citing works
Effects of different real-time feedback types on human performance in high-demanding work conditions
Cohen, I., Brinkman, W., & Neerincx, M. A. (2016) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2016.03.007 · Cited by 13 · see citing works
“VR seems to be able to elicit physiological stress responses in individuals (Busscher et al., 2011; Hartanto et al., 2014) but leaves out the risk of real-life crisis and disasters (Kinateder et al., 2014).”
Background
Design and Implementation of Home-Based Virtual Reality Exposure Therapy System with a Virtual eCoach
Hartanto, D., Brinkman, W., Kampmann, I. L., Nexhmedin Morina, B., Emmelkamp, P. M. G., & Neerincx, M. A. (2015) · Lecture notes in computer science · doi:10.1007/978-3-319-21996-7_31 · Cited by 13 · see citing works
Preliminary study of efficacy and safety of self-administered virtual exposure therapy for social anxiety disorder vs. Cognitive-behavioral therapy
Stefaniak, I., Hanusz, K., Mierzejewski, P., Bieńkowski, P., Parnowski, T., & Murawiec, S. (2022) · Brain Sciences · doi:10.3390/brainsci12091236 · Cited by 12 · see citing works
“In the literature to date, there are preliminary studies on the use of therapeutic programs with virtual reality but without the aid of an actual therapist in the treatment of social phobia [36].”
Background
Inmersión y activación de estados emocionales con videojuegos de realidad virtual
Fernández, D. T., Moya, E. B., & Sánchez, R. P. (2021) · Revista de Psicología · doi:10.18800/psico.202102.002 · Cited by 12 · see citing works
Impact of Outdoor Temperature Variations on Thermal State in Experiments Using Immersive Virtual Environment
Rentala, G. S., Zhu, Y., & Johannsen, N. M. (2021) · Sustainability · doi:10.3390/su131910638 · Cited by 12 · see citing works
“To assess the suitability of their findings, researchers often compare their presence scores with the available literature scores [63,64].”
Method
Application of Causal Inference to the Analysis of Occupant Thermal State and Energy Behavioral Intentions in Immersive Virtual Environments
Rentala, G. S., Zhu, Y., & Mukhopadhyay, S. (2021) · Frontiers in Sustainable Cities · doi:10.3389/frsc.2021.730474 · Cited by 11 · see citing works
“The virtual experience factors are a collection of characteristics that indicate the quality of experience in immersive virtual environments (IVEs).”
ResultInfluential
Effects of Image Realism on the Stress Response in Virtual Reality
Weiß, S., Klassen, N., & Heuten, W. (2021) · ACM Symposium on Virtual Reality Software and Technology (VRST) · doi:10.1145/3489849.3489885 · Cited by 11 · see citing works
The impact of virtual images of coastal landscape features on stress recovery based on EEG
Shi, J., Zhang, N., Sun, Y., Jiang, J., Duan, H., & Gao, W. (2025) · Scientific Reports · doi:10.1038/s41598-025-02224-3 · Cited by 10 · see citing works
Application of time series analysis to improve the validity of Immersive virtual environments for collecting occupant thermal state and adaptive behavioral intention data
Rentala, G. S., Zhu, Y., & Mukhopadhyay, S. (2024) · Advanced Engineering Informatics · doi:10.1016/j.aei.2024.102449 · Cited by 9 · see citing works
Influence of Interactive Questions on the Sense of Presence and Anxiety in a Virtual-reality Job-interview Simulation
Shotaro, S., Jincho, N., & Kikuchi, H. (2019) · International Conference Virtual and Augmented Reality Simulations · doi:10.1145/3332305.3332307 · Cited by 9 · see citing works
“A job-interview simulation system in a virtual environment can help control a user’s anxiety by making the virtual interviewer’s response positive or negative [11].”
Background
Using Run-Time Biofeedback During Virtual Agent-Based Aggression De-escalation Training
Blankendaal, R., & Bosse, T. (2018) · Lecture notes in computer science · doi:10.1007/978-3-319-94580-4_8 · Cited by 9 · see citing works
A paradigm description of virtual reality and its possible applications in psychiatry
Kruk, D., Mętel, D., & Cechnicki, A. (2019) · Postępy Psychiatrii i Neurologii · doi:10.5114/ppn.2019.86255 · Cited by 8 · see citing works
“In one of them, individual differences in the sense of presence did not affect the level of social stress during the interview for a job with a virtual person [39].”
BackgroundInfluential
Das Potenzial der virtuellen Realität in der Verhaltenstherapie
Diemer, J. (2019) · Nervenheilkunde · doi:10.1055/a-0928-0734 · Cited by 8 · see citing works
“Mittlerweile ist die VR-Technik so weit fortgeschritten, dass eine glaubwürdige soziale Interaktion simuliert werden kann [45, 46].”
Background
Correction: Controlling Social Stress in Virtual Reality Environments
Hartanto, D., Kampmann, I. L., Nexhmedin Morina, B., Emmelkamp, P. M. G., Neerincx, M. A., & Brinkman, W. (2019) · PLoS ONE · doi:10.1371/journal.pone.0223988 · Cited by 8 · see citing works
Enhanced location tracking in sensor fusion-assisted virtual reality micro-manipulation environments
Prada, J. D. P., Im, J., Oh, H., & Song, C. O. (2021) · PLoS ONE · doi:10.1371/journal.pone.0261933 · Cited by 7 · see citing works
“Currently, VR has been investigated for managing stress caused by anxiety disorders [1], navigation and tracking systems [2], minimizing hand tremor [3], and in medical simulators that teach subjects how to use surgical tools through realistic scenarios in virtual environments [4].”
Background
Technological Competence is a Precondition for Effective Implementation of Virtual Reality Head Mounted Displays in Human Neuroscience: A Technological Review and Meta-Analysis.Preprint
Kourtesis, P., Collina, S., Doumas, L. A. A., & MacPherson, S. E. (2021) · doi:10.36227/techrxiv.13858154 · Cited by 8 · see citing works
Characterizing Consumer Smartphone Apps for Virtual Reality–Based Exposure Therapy: Content Analysis
Sunkara, C., Thakkar, R. N., Ong, T., & Bunnell, B. E. (2023) · Journal of Medical Internet Research · doi:10.2196/41807 · Cited by 6 · see citing works
“The computer simulations of VR provide therapists with control and flexibility for the delivery of exposure therapy [19].”
Trial of a desktop virtual reality application as a method of exposure for test anxiety: a qualitative study
Serafini, M., & Chittaro, L. (2024) · Behaviour and Information Technology · doi:10.1080/0144929x.2023.2299738 · Cited by 6 · see citing works
“While the studies of Hartanto et al. (2014) and Kwon et al. (2009) focused exclusively on job interview scenarios, other authors explored di ﬀ erent scenarios but none of them addressed oral exams.”
Influential
Agent-based social skills training systems: the ARTES architecture, interaction characteristics, learning theories and future outlooks
Owayyed, M. A., Tielman, M. L., Hartholt, A., Specht, M. M., & Brinkman, W. (2024) · Behaviour and Information Technology · doi:10.1080/0144929x.2024.2374891 · Cited by 5 · see citing works
“Human initiative occurs when the trainer acts as a supervisor guiding the agent and intervening when necessary, for example, if the virtual child does not exhibit the expected behaviour or if Robin wishes to control parts of the agent (e.g. Hartanto et al. 2014).”
Impact of visual preferences for indoor green walls on emotion and brain activity of college students
Wang, M., Zhang, N., Yang, L. C., Zhang, W., & Gao, W. (2025) · Scientific Reports · doi:10.1038/s41598-025-19425-5 · Cited by 5 · see citing works
“These findings support the validity of the virtual model 39 .”
The Role of Speaking Anxiety on L2 English Speaking Fluency, Accuracy and Complexity
Sosa-López, G., & Mora, J. C. (2022) · Pronunciation in Second Language Learning and Teaching Conference (PSLLT) · doi:10.31274/psllt.13362 · Cited by 5 · see citing works
“Therefore, receiving signs of misunderstanding or indifference as one speaks may generate stress (higher HR and self-reported anxiety levels), as one gets a negative response from an audience to one's speech (i.e., constant frowning or an unfriendly response in a dialogue) (Hartanto et al., 2014).”
Background
Detecting Public Speaking Stress via Real-Time Voice Analysis in Virtual Reality: A Review
Arushi, Dillon, R., Teoh, A. N., & Dillon, D. (2023) · Springer eBooks · doi:10.1007/978-981-99-2909-2_7 · Cited by 5 · see citing works
Um programa de intervenção para transtorno de ansiedade social com o uso da realidade virtual
Perandré, Y. H. T., & Haydu, V. B. (2018) · Temas em Psicologia · doi:10.9788/tp2018.2-12pt · Cited by 5 · see citing works
Review of Psychophysiological and Psychotherapeutic Studies of Stress Using Virtual Reality Technologies
Kosonogov, V., Efimov, K., Rakhmankulova, Z., & Zyabreva, I. (2023) · Neuroscience and Behavioral Physiology · doi:10.1007/s11055-023-01393-w · Cited by 7 · see citing works
“In the study by Hartanto et al. [2014] cited above, as part of an interview scenario, the authors changed the ratio of the virtual character’s positive and negative responses as the interview progressed.”
Background
Internet-Based Cognitive Behavioral Therapy and Virtual Reality Exposure Therapy for Social Anxiety Disorder: Protocol for a Randomized Controlled Trial in Hong Kong
Pan, J. (2023) · JMIR Research Protocols · doi:10.2196/48437 · Cited by 5 · see citing works
“The commonly used psychological indicators include self-reported anxiety and fear, distress, and self-confidence [33,34].”
Background
Psychophysiology in Studying VR-Mediated Interactions: Panacea or a Trick? Valuable Applications, Limitations, and Future Directions
Sterna, R., Siry, A. M., Pilarczyk, J., & Kuniecki, M. (2021) · Frontiers in Virtual Reality · doi:10.3389/frvir.2021.648318 · Cited by 5 · see citing works
“Isomorphic assumption is made in many papers, both relatively old (Meehan et al., 2002) and recent (Hartanto et al., 2014, p. 2–10; Athif et al., 2020; Gill, 2020).”
BackgroundMethod
A Treatment Program for Social Anxiety Disorder by Using Virtual Reality
Perandré, H. H. T., & Haydu, V. B. (2018) · Temas em Psicologia · doi:10.9788/tp2018.2-12en · Cited by 5 · see citing works
“…relating to positive correlation between sense of presence and measurements of anxiety Trends Psychol., Ribeirão Preto, vol. 26, nº 2, p. 867-882 - June/2018 (see Hartanto et al., 2014; Morina et al., 2014; Powers et al., 2013; Price et al., 2011) contradict the third hypothesis mentioned above.”
Background
Using Extended Reality to Enhance Effectiveness and Group Identification in Remote Group Therapy for Anxiety Disorders: A Critical Analysis
Bouguettaya, A., & Aboujaoude, E. (2024) · JMIR Formative Research · doi:10.2196/64494 · Cited by 5 · see citing works
“Meanwhile, a VR-based group therapy (with avatars representing other group members in a virtual environment) could be helpful in engaging patients with social anxiety disorder, as they could use avatars to not be “observed” [67].”
Background
Comparing the Restoration Effect and Stress Recovery in Real and Virtual Environments with a Green Wall
Sedghikhanshir, A., Chen, Y., Zhu, Y., Beck, M. R., & Jafari, A. (2025) · Sustainability · doi:10.3390/su17062421 · Cited by 4 · see citing works
A VR Game for Obsessive-Compulsive Disorders Therapy
Torrão, A. R., Natário, J., Carvalho, P. S., Silva, C. M., & Silva, F. G. M. (2021) · International Conference on Graphics and Interaction (ICGI) · doi:10.1109/icgi54032.2021.9655282 · Cited by 4 · see citing works
Desktop virtual reality as an exposure method for test anxiety: quantitative and qualitative feasibility study
Chittaro, L., & Serafini, M. (2023) · Multimedia Tools and Applications · doi:10.1007/s11042-023-16917-2 · Cited by 4 · see citing works
“…controlled by the experimenter with a Wizard-of-Oz technique (i.e., the user perceives a direct interaction with the virtual job interviewer, while in fact the experimenter decides and commands the responses of the virtual interviewer in real-time), can elicit different levels of anxiety [52].”
VR communication simulation with scripted dialog elicits HPA axis stress
Ban, Y., Inazawa, M., Kato, C., & Warisawa, S. (2024) · Frontiers in Virtual Reality · doi:10.3389/frvir.2023.1302720 · Cited by 3 · see citing works
“Previous studies con ﬁ rmed that the level of ANS stress, judging from heart rate information, changes depending on the dialog feedback response (positive or negative) between humans and virtual characters (Hartanto et al., 2014).”
Physiological correlates of stress induced by virtual humans in a naturalistic virtual reality scenario
Giron, J., Mladenović, J., Hanrieder, M., Golland, Y., & Friedman, D. A. (2023) · International Conference on Affective Computing and Intelligent Interaction Workshops and Demos (ACIIW) · doi:10.1109/aciiw59127.2023.10388148 · Cited by 3 · see citing works
“Hartanto et al. [5] explored physiological responses in three interactive dialogue scenarios: blind date, job interview, and a neutral control condition, and report differences in reported anxiety as well as mean heart rate (HR).”
Background
Exploring Green Wall Sizes as a Visual Property Affecting Restoration Effect and Stress Recovery in a Virtual Office Room
Sedghikhanshir, A., Zhu, Y., Beck, M. R., & Jafari, A. (2024) · ASCE International Conference on Computing in Civil Engineering (i3CE) · doi:10.1061/9780784485231.023 · Cited by 3 · see citing works
LingoVerse: virtual language learning through gamification
Špruk, N. J., Žnideršič, K., Marolt, M., & Pesek, M. (2025) · Virtual Reality · doi:10.1007/s10055-025-01250-w · Cited by 2 · see citing works
“These technologies can be used for various purposes, such as gaming, learning, therapy, and relaxation (Emmelkamp and Meyer-bröker 2021 ; Hartanto et al. 2014 ; Howard 2017 ).”
Virtual Humans in Virtual Reality Mental Health Research: Systematic Review
Wei, S., Freeman, D. H., & Rovira, A. (2025) · JMIR XR and spatial computing. · doi:10.2196/75087 · Cited by 2 · see citing works
“Researchers also manipulated the dialog responses (positive or negative) [57] and responsive frequency (high or low) [4] in conversation agents.”
Development of Immersive 360° Virtual Reality Videos for Intervention with Test Anxiety
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Nexhmedin Morina, B., Brinkman, W., Hartanto, D., Kampmann, I. L., & Emmelkamp, P. M. G. (2000)

Authors: Hartanto, D., Kampmann, I. L., Morina, N., Emmelkamp, P. G. M., Neerincx, M. A., & Brinkman, W.-P.
Affiliations: Delft University of Technology (NL)
University of Amsterdam (NL)
Netherlands Organisation for Applied Scientific Research (NL)
Corresponding author: Hartanto, Dwi
ORCID: Kampmann, Isabel L.
Neerincx, Mark A.
Brinkman, Willem-Paul
Venue: PLoS ONE
Publisher: Public Library of Science (PLoS)
Published: 2014-03-26
Volume: 9
Issue: 3
Pages: e92804
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0092804
PMC: PMC3966821
OpenAlex: W2148863487
Cited by: 115
References: 58
Citations by year: 2026: 6 · 2025: 9 · 2024: 13 · 2023: 10 · 2022: 12 · 2021: 16 · 2020: 6 · 2019: 12 · 2018: 8 · 2017: 5 · 2016: 7 · 2015: 7 · 2014: 4
FWCI: 14.86
Type: journal article
Language: en
Update notices: correction (2019-10-11)
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (unspecified)
Locations: PLoS ONE (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, other-oa)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
UvA-DARE (University of Amsterdam) (acceptedVersion, other-oa)
TNO Repository (submittedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Repository hosted by TU Delft Library (TU Delft) (submittedVersion)
Research Repository (Delft University of Technology) (submittedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
Funders: Nederlandse Organisatie voor Wetenschappelijk Onderzoek (655.010.207)
Topics: Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords: virtual reality exposure therapy, social anxiety disorder, virtual characters, anticipatory anxiety, heart rate, self-reported anxiety, speech length
MeSH terms: Adult, Female, Heart Rate, Humans, Interviews as Topic, Male, Stress, Psychological, User-Computer Interface, Young Adult

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