CyberPsychology & BehaviorVolume 2, Number 4, 1999Mary Ann Liebert, Inc.

Virtual Reality and PsychopathologyR.M. BAÑOS,1 C. BOTELLA,2 and C. PERPIÑÁ1

ABSTRACT

Progress in the development of Virtual Reality (VR) is faster than has been forecast, which makesdeep reflection on its potential uses and abuses absolutely necessary. The current article focuseson the analysis of some of the applications and implications of VR on psychopathology. It is ob¬vious that they could be many, but we are only focusing on: (a) VR as a model to answer some

central questions that traditionally have intrigued psychopathologists; and (b) VR and possiblepsychopathological experiences. We believe that VR has the potential of becoming a tool thatwill allow psychopathology to challenge and modify theoretical positions already established,and to pose new ones. This new way of experience can help us to find the answers to old ques¬tion, and, at the same time, it can make new answers arise on the psychopathological and psy¬chological horizon. Such answers are not only related to empirical and theoretical issues, but tomoral ones as well. This road of research has just started.

INTRODUCTION

The last century witnessed technologicaladvances that could be called incredible.

However, it is highly probable that these ad¬vances would be faster and more impressive inthe next millenium. One of the progresses thatstarted in this century and whose developmentwill continue in the future is Virtual Reality(VR). It is difficult to doubt that VR will be¬come a very important tool for research inmany and different fields.1 However, it is notso evident whether we have come across a toolthat will answer any question we ask, no mat¬ter the field of interest concerned. That is whywe think it necessary that each area of study,in our case the psychological areas, considerthe uses (and abuses) that can be made of thisnew technology.

The present work focuses on the analysis ofsome of the applications and implications that

VR has in psychopathology. In such a disci¬pline it seems easy, at least at a simple glance,to think of the multiple possibilities of VR.However, many of them would still be sciencefiction today. This does not mean that in an im¬mediate future they could not be accomplishedbecause in technology "futures" seem to benearer and nearer to present. Furthermore, we

are used to seeing how science goes beyond our

fictions. Nonetheless, we would not wish thatthese observations become excessively specu¬lative, although we, probably could not help a

little (or a lot) of speculation. In this sense, we

will try to keep our feet on the ground (orrather in the virtual environment) and focus on

two possible applications: (a) VR as a creatorof useful models to study basic processes andtheir disturbances; and (b) the possible psy¬chopathological experiences, infrequent or

anomalous, that can be produced in VR. Apartfrom these, there would also be other more

Universität de Valencia, Valencia, Spain, and 2Universitat Jaume I, Castellón, Spain.

283

284 BAÑOS ET AL.

"practical" or "applied" applications, as for in¬stance, understand VR as a setting lab whereto study anomalous behaviors, emotions, andbeliefs. We have already treated the latter issueelsewhere,2 and thus, in this occasion, we are

going to focus on more theoretical and/or spec¬ulative implications'.

VR AS A CREATOR OF USEFUL MODELSTO STUDY BASIC PROCESSES AND

THEIR DISTURBANCES

As we pointed out elsewhere,3 VR has a po¬tential to stimulate scientific knowledge be¬cause it is capable of being used as a model forthe understanding of human mind in the same

way that the telephone or the computer did inthe past. If an analogy or a model can be use¬

ful to describe how the human mind works, itcan be useful to understand and define itsanomalies. In the case of psychopathology, thisis already taking place. For instance, Tart1'4makes a very suggestive, although somehowpretentious, proposals that allows for distin¬guishing even among normality, neurosis, andpsychosis. Tart proposes an analogy of physi¬cal reality and virtual reality and poses that we

are already living in a variety of virtual reali¬ties that are internally created. According tothis author, each of us lives "inside" a machineof simulation of the world, given that our "per¬ceptions" are simulations, and not reality itself.We are aware only of a final pattern of neu¬

ronal events. This is not a new idea: Helmholtzalready pointed it out more than a century ago,and today's psychological theories considerperception as a constructive process that inter¬prets sensorial data. The only novelty of Tart'sproposal rests in the use of a VR analogy andits application to the study of abnormality.

Tart names the neural events of which we are

aware and the other neural events that lead tothat final pattern titled the "Process of Simula¬tion of the World." This is a mechanism thatcreates VR where we are experientially living.According to Tart, the structure of our nervous

system constitutes our stereo headphones, our

glasses, and our glove. That is, he considersthat our consciousness is a mechanism of vir¬tual reality, a simulation of the world. The ba¬

sic function of the process of simulation of theworld is to create, maintain, expand, and actu¬alize internal models of the real world, whichenable us to survive and function efficiently inthe real world. If our process of simulation ofthe world offers to us virtual realities that dif¬fer from the real world in some significant way,we start to behave maladaptively, provokingconsequences in the real world and /or psy¬chological suffering in ourselves or in others.That is, for Tart, the psychopathological devi¬ations are due to unusual processes of simula¬tion of the world. Tart clarifies that the VR thatconstitutes our perception of the world is a par¬ticular type of VR: a reality whose general char¬acteristics are widely shared by other membersof a certain culture. More specifically, Tart4asks what constitutes a "normal" person. Thisis someone who apparently has a single, welldeveloped pattern to support his/her processof simulation of the world. The daily unitarypersonality that implicitly controls the processof simulation of the world produces a VR anda consequent action within the "normal" range.On the other side, a "neurotic" person is some¬

one whose process of simulation of the worlddiffers significantly from those of "normal"people in "such a way that some areas of life,where normal people function well, become ar¬

eas of suffering and maladaptive functioning.Finally, a "psychotic" person is someone wholives in a VR so dramatically different from therange of VR in which "normal" people live thatit is considered just like that: dramatically dif¬ferent.

Following with the same analogy, Tart getseven deeper in the field and defines specificdisorders. Particularly, he refers to multiplepersonality disorder. According to this model,it would be characterized by the person havingtwo or more well developed patterns, or con¬

stellations of patterns, that control the processof simulation of the world. The person livestemporarily in a VR that constitutes an iden¬tity, a personality, and a state of consciousness.We believe that this idea is quite suggestive, al¬though we doubt that the DSM or the ICDwould introduce it as a classification criterionin their next editions.

On the other hand, research in VR, beyondhelping us to define what is pathological, could

VR AND PSYCHOPATHOLOGY 285

also help us to approach the study of certain is¬sues, maybe more specific but of central im¬portant in psychopathology. For instance, VRcan be an important tool to study of theprocesses implied in reality judgment,3 whichwas and still is one of the more intriguing ques¬tions for psychopathologists. Its answer mightunravel some of the most important keys on

the distinction between psychosis and neuro¬

sis, or in a more traditional way of putting it,between "madness" and "normality."

Researching on how VR can influence the re¬

ality judgements people made might shedsome light on how we attach reality to our per¬ceptions, cognitions, and interactions and es¬

pecially what go astray in the same metacog-nitive processes of psychotic individuals.Psychological theories on reality judgementsuch as Brickman's model5 or Johnson andRaye's6 theories on reality monitoring could of¬fer a useful set of related terms when appliedto VR. These terms would be helpful to de¬scribe the tasks and tests to use in the researchon this field and also to predict or define theappropriate behavior for the comparison witha particular subject's performance.

If it would be empirically proved that "nor¬mal" people follow the guidelines of these the¬ories, we could assert that, from a descriptivepoint of view, these are valid at least in a cer¬tain level. If we consider the current theorieson reality judgement as normative frame¬works, the deviation of each specific compo¬nent hypothesized in these models could pro¬duce a different error in the reality judgementfor each case. In psychopathology, having thereference of a normative theory on realityjudgement would help us 'to identify the spe¬cific performance deficits of people sufferingfrom particular problems. But, even if "nor¬mal" people did not behave as theories pre¬dict, these sub-optimum (to name them some¬

how) behaviors could render manypsychological clues about how individualsmake their reality judgements, and wouldmake us wonder whether their behavior can

be described as a systematic deviation fromthe theory. In this sense, theories on realityjudgement would not help as normativeschémas, but would enable us to study em¬

pirically the judgement errors and biases

stemming logically from those theories. Froma practical point of view, such deviationscould suggest constructive interventions lead¬ing to a better judgement. That is, theoriesproposed by psychology could help psy¬chopathology that, in turn, could offer possi¬ble ways of intervention from therapy.

Let us see particular examples of the possi¬ble utility of that research for psychopathology.Brickman's5 theory is framed around two cen¬

tral elements for the reality attribution: inter¬nal and external correspondence of behavior.According to Brickman, people will attributereality to their experiences as long as their be¬haviors correspond to substantial and appro¬priate emotions (internal correspondence), andto important consequences (external corre¬

spondence). That is, situations will appearmore real as long as there is emotion in them,and as long as the mistakes or successes haveimportant consequences.

Internal correspondence would be playingan important role in the understanding of par¬ticular disorders. For instance, in some disso¬ciative states occurring in highly stressing andthreatening situations, the individual can react

by building a wall between his/her emotionsand his/her behavior, preventing the latterfrom being disturbed by the intense fearhe/she is experiencing. According to themodel, this would produce a low internal cor¬

respondence, and thus the reality attribution ofthis situation would be altered. Actually, thiskind of state was described in psychopathol¬ogy as "detachment from reality". The modelwould explain that detachment occurs due toa low internal correspondence together with a

high external correspondence (because, mostoften, one's survival is at stake; i.e., behaviorcan have serious consequences). As a result, theindividual behaves as an automaton, as if theexperience was not real. In fact, one of the tar¬gets of therapy and psychological counselingin this kind of situation is to provoke emotionalexplosions. Namely, to succeed in supplying an

appropriate internal correspondence to the sit¬uation. When the individual relives the situa¬tion and succeeds in providing an emotionalresponse, he or she would be, according to themodel, considering the situation as more real.On the contrary, the opposite would be the case

286 BAÑOS ET AL.

in the phobic disturbances: the individual be¬lieves that danger is real because his/her be¬havior keeps a high internal correspondencewith his/her emotion. The person feels a highanxiety in the situation, which leads him/herto make disproportionate judgements aboutthe reality of danger. Actually, we believe thata phobic person placed in a VR environment ofhis/her feared situation will make reality attri¬butions faster and with greater confidence. Inone of the works we are carrying out we are

testing this hypothesis by comparing the real¬ity attributions of normal participants to that ofclaustrophobic patients in a claustrophobic vir¬tual environment. We ask them all for verbalreports of reality in different moments of theirimmersion in VR. We hypothesize that claus¬trophobic patients will assign more reality as

the environment turns more dangerous. Theclaustrophobic patients will believe with more

intensity that the virtual situation is real. Thatis, their intense emotional state in the situationwill make them feel "trapped" by the sensationof reality. However, this will not happen so in¬tensely in the case of normal participants be¬cause the closed rooms will be nothing more

than virtual rooms for them.On its hand, external correspondence can

play an important role in other disorders, suchas depression. Some depressed patients com¬

plain of a certain detachment from reality, as ifthey were watching the occurring events like a

movie. In some cases this could be explainedbecause of a low external correspondence. Forinstance, in the hopelessness depression pro¬posed by Abramson, Metalsky, and Alloy7 it isstated that the individual feels helpless, his orher behavior has no consequences in the world.No matter what he or she does, it is not goingto change anything. According to Brickman's5model, there would be a low external corre¬

spondence and helplessness correlates with a

sense of unreality in the situation. In delusionalpatients, the opposite would be case. In a situ¬ation of high anxiety where it is considered thatone's behavior has consequences on the world,is more likely that the individual ascribes real¬ity to such a situation. Therefore, if an indi¬vidual thinks that his neighbors are stalkingand chasing him (which make him anxious),and he hides so his pursuers cannot find him

(which does not happen: nobody catches himas nobody is chasing him), he will attribute re¬

ality to that situation because it has both highinternal and external correspondence. Theproblem is that the person enters into a viciouscircle, into a self-fulfilled prophecy. His suspi¬cious behavior provokes similar behaviors inthe others, which leads to a still higher exter¬nal correspondence. This might play an im¬portant role in the confirmation of the delusion,in the reality attribution to his/her own VR.

Those theories on reality judgement stem¬ming from research on the VR field could beapplied to the study of hallucinations, as well.A theory that gives a satisfactory explanationof hallucinations does not yet exist. However,in spite of their differences, all of the existingtheories agree that hallucinations represent a

rupture of the process that allows people to dis¬tinguish between private mental events andpublicly observable ones.8 This statement pre¬supposed that, under normal circumstances, itis possible to discriminate between these twotypes of events. However, as Bentall8 pointsout, the current theories on hallucinations donot explain first how normal people can dis¬tinguish between these two types of events. Infact, it is difficult to differentiate between howhallucinators believe that their hallucinationsare real and how normal people believe thatobjects are real and outside of themselves. Pro¬cessing occurs inside for normal people, andyet, dreams, imagination, or thoughts are ex¬

perienced from inside.9 If we were able to an¬

swer to that question, we would have some

clues regarding why psychotics fail so often tomake such a distinction. It is supposed that anyfeature or deficit affecting the individual's abil¬ity to make judgements about the source of hisperceptual experience would increase theprobability of hallucinations.8 Actually, au¬

thors such as Slade, Bentall, and Strauss8'10'11state that a continuum exists between halluci¬natory and non-hallucinatory experiences.Judgement and discrimination of reality is pre¬sumably a skill that admits degrees in its ac¬

curacy, as is demonstrated by the fact that theseprocesses can fail in normal individuals. There¬fore, all knowledge stemming from research inVR that helps to know how and why individ¬uals fail or succeed in attributing reality is com-

VR AND PSYCHOPATHOLOGY 287

pletely "portable" to the field of hallucinations.In fact, as Bentall8 points out, it is difficult toexplain a deficit without understanding, atleast partially, how the normal operationworks.

Most theories state that people infer whetheran event is real or imaginary on the basis of a

broad range of information. However, whenthe available evidence is confusing, this kind ofjudgment will tend to be erroneous. The abil¬ity to judge the source of a perceived event wascalled reality discrimination in the past and it isintimately related to the topic of reality moni¬toring.6 There are several works on hallucina¬tions within this field12 that have found thathallucinators fail in those tasks that require dis¬crimination between memories of internalevents (i.e., thoughts) and memories of exter¬nal events. In this case, we could ask ourselveswhat will happen when, apart from havingmemory traces of events generated by our¬

selves and memory traces of real events, we

will also have memory traces of events that oc¬

curred in VR. Would normal people be able todiscriminate among these three types ofsources? And what about hallucinators? Wouldthere be differences between their performanceand that of normal people?

Leaving aside these speculative questions,VR can also help us to answer to what sort ofinformation the individual uses to attribute an

event to a real external source and, therefore,to give reality judgement to it. In a VR envi¬ronment, all perceptual signs show that whatwe are experiencing is real. Furthermore, theperson can even have the impression of beingpart of the events (actually, this is what is in¬tended). Then, how does* that person distin¬guish what is real from what is not?13 In thiscontext the normal individual will surely use

some type of contextual clue or sign to attributewhat he is perceiving or has perceived to VRand not to physical reality. That is, VR is dis¬closing that experience and clues from thoughtare more important than perceptual richness.This way, the memory a pefson has of havingentered in a VR environment can help as a signthat the experience is not real. It does not mat¬ter how real the experience is. For instance,most people know that they are not really fly¬ing by hang-glider, they know it is virtual.

However, it does not mean that such experi¬ences cannot change us in certain ways.13 In theparticular case of hallucinations, this couldshow that the hallucination's perceptual rich¬ness it is not imperative for the individual tobelieve that what he or she is perceiving is notreal: other cognitive skills come into play. Fur¬thermore, those mistakes might have to do withthe hallucinator's bias to attribute events toexternal sources. That is, mental imagery theo¬ries in the field of hallucinations (such as

Horowitz's14) that are based on the importanceof the vividness and richness of sensorial cluesfor the discrimination of reality, would besomehow called into question.

The role of contextual information in the fail¬ures of reality discrimination has been outlinedin the work of social psychologists interestedin suggestion.8 Suggestibility has been pro¬posed as a predisposing factor to experiencinghallucinations. In this case, if individual differ¬ences in the ascription of reality judgement inVR contexts were found in suggestible subjects,we could state with greater confidence the in¬fluence of contextual information and sug-

•gestibility in the attribution of reality judge¬ment.

On the' other hand, suggestibility is inti¬mately related to expectations and, in thissense, there are many authors proposing thatthe decision about whether an event is real or

imaginary is influenced by the perceived prob¬ability of occurrence of such an event.8 In thisarea, Arieti's15 work stands up. In 1974, on thebasis of his psychotherapeutic work with schiz¬ophrenic patients, he maintained that theyheard voices only in certain circumstances:when they expected to hear them. It is quitelikely that the same happens in VR. That is, themore improbable the event that individual isexperiencing in VR, the less reality attributionshe or she will make. Keeping with the hang-glider example, we can believe that we are not

really flying because we remember we put thehead display on or because hang-glider flyingis something we do not expect to happen to us

in the real world.Another variable, whose importance in the

production of hallucinations has been hypoth¬esized, is stimulus ambiguity. This variable iseasily manipulated in a controlled way in VR.

288 BAÑOS ET AL.

If we add it to the role played by suggestibil¬ity, it is possible to create ambiguous VR envi¬ronments and produce expectations about dif¬ferent perceptions by means of instructions.This way we can test if these factors affect re¬

ality judgement.Another factor supposed to be playing a role

in hallucinations is- arousal due to stress. Itseems that under a state of acute anxiety, indi¬viduals are more likely to be suggestible to in¬formation that usually would be regarded as

false.13 It seems that arousal, or intense emo¬tions in general, play an important role in theascription of reality. This would be congruentwith Brickman's5 model, which supposes thathigh internal correspondence would yield tomore attributions of reality judgement.

All these lines of research about the dis¬criminatory errors associated to hallucinatoryexperiences that we are proposing as sensibleto be undertaken in the context of VR do not

imply the disregard for biological factors. Inany case, we do not think either that biologicalfactors rule out the descriptions and explana¬tions made in psychological terms. If we foundsome factor of systematic individual differ¬ences in the ascription of reality judgement inVR, it is possible that we would be facing a vul¬nerability factor to suffer from hallucinations.Also, if we study the processes, mechanisms,and operations implied in the confusions whenattributing reality judgement, we will be in abetter position to understand, from psycholog¬ical concepts, the hallucination phenomenon.

Another "star" topic in psychopathology isdelusions. Every theory intending to bring for¬ward some understanding to this subjectshould describe, among other things, how thedelusional person gathers and interprets the in¬formation coming from his or her social envi¬ronment, and how he or she uses the evidenceto support or disregard experiences.15 It shouldbe also investigated how aberrant beliefs are

formed in healthy individuals. In fact, a veryfruitful strategy in the study of delusion is theuse of analogues and the manipulation of be¬liefs in the lab. The goal is to test which condi¬tions would lead people to become suspicious,hostile, and critical with others. In this line are

those works addressing the issue of whetherdelusions appear as normal explanations for

unusual experiences.16-18 With this aim, the ex¬

planations that normal subjects give to non-

voluntary behaviors have been studied as theproducts of hypnotic suggestion. In a parallelway we could study what kind of explanationsindividuals give to virtual environments whereunusual events occur. In any case, we shouldnot disregard the fact that people induced bythese means do not develop delusional beliefs.That is, there are important differences be¬tween people whose beliefs have been manip¬ulated and people who are delusional. One ofthese differences is that experimental partici¬pants are aware that they taking part in an ex¬

periment (which in our case would be VR). Ifit is true that delusions are secondary to anom¬

alous experiences with no explanation,16'17 theparticipants already have a satisfactory expla¬nation for any occurring unusual experienceand, therefore, do not need to elaborate a delu¬sional explanation.

Finally, VR would not only be useful in re¬

search on reality judgement but also in the un¬

derstanding of other psychopathological phe¬nomena. For instance, Tart4 outlines thepossibilities of VR in the study of disorderedstates of consciousness. Anyhow, it is unlikelythat a simulation would be as complex as thephenomenon it models.19 VR could be a finetool to a better understanding of such a phe¬nomenon even though it is an. abstraction.However, it is necessary to bear in mind Tart's8warning that models in science are danger¬ously convenient and could escort us intowrong roads. Models can fascinate us. Eventhough the map is not the territory, as Ko-rzybski19 stated, most times we choose themap.8 Therefore, it is important to rememberthat models are just· models. We should createthem, use them, and get rid of them when theystart limiting us.

VR AS A CREATOROF PSYCHOPATHOLOGY

Finally, VR can also have less positive effects.Actually, several authors20'21 assert that VR isa medium defined in terms of its effects on bothbasic and major psychological processes. ManyVR community members accept the principle

VR AND PSYCHOPATHOLOGY 289

that a "computer's purpose is insight, no num¬

bers."22 Therefore, this tool can have both pos¬itive and negative applications.

First of all, and as Shapiro and McDonald13stated, as virtual environments become part ofour natural environments, the distinction be¬tween the computer's reality and the conven¬tional reality will fade away, and humans willneed to become more sophisticated in our re¬

ality judgements. In the case of VR, even itsname suggests a possible psychological effectthat sometimes is not welcome: the growingconfusion between virtual reality and physicalreality. According to Osberg24 VR could be de¬fined not as a perception based on reality, butas an alternative reality based on perception.As Carr25 points out, if one of the most impor¬tant aspects of human thinking has been itsability to distinguish between internal and ex¬ternal events, VR is the achievement of the op¬posite: to lead people to accept as real whatthey are only perceiving. If VR can affect cog¬nitive development, for good or bad, would itbe able to lead to a cognitive development dif¬ferent from the current one? To answer thisquestion we should take VR very seriously as

perhaps it has the potential to remodel our

minds.25As we have already stated, this form of ex¬

perience can raise many questions on realityjudgement and on moral issues as well. The factthat people believe that what they are experi¬encing in VR is not real does not mean that suchexperiences do not have the potential of chang¬ing them.13 For instance, would somebody feelguilty for cheating on his/her spouse in VR?How would the spouse feel about it? Couldsomebody who has lived'a virtual war sufferfrom "virtual" posttraumatic stress disorder? Itwill be necessary to be especially cautious withthose groups of people suffering from psy-chopathologies characterized precisely by a

disturbance on their reality judgement. There¬fore, when it is about working in VR with psy¬chotic, bipolar, paranoid, substance abuse, andother disorders where reality judgement andidentity problems are evident, an ethically-based screening procedure is absolutely neces¬

sary in order to lessen the possibility of induc¬ing harmful psychological consequences.26

Another important future application of VR

includes playing with the concept of personalidentity. This means that VR could be used forexperiencing another identity (real or fantastic)and for experiencing other shapes, figures, ob¬jects, and even other forms of self, as well. Ac¬cording to Lanier and Biocca27 the VR perspec¬tive body is that part one can move as fast as

one thinks. This type of definition makes it dif¬ficult to delimit the body boundaries. This sortof VR application could facilitate the learningof certain new cognitive skills. However, and aswe have already mentioned, VR applied thisway could be especially harmful to those whoneed to face reality and not to escape from it.

On the other hand, and recognizing that thecases are not precisely the same, somethingsimilar to what occurs with certain drugs, es¬

pecially the psychodelic ones, could happen.Such substances allow the individual to havetotally new experiences where their selves meltwith the world, their perceptions are distorted,and even new perceptions are created. The dif¬ference is shown in that drugs directly influ¬ence the body's biochemical functioning andVR does not. Nonetheless, it is not clear that

the relation is exclusively unidirectional.Namely, it could be that the experiences we

have are able to modify somehow our organicsystem. One of the risks of this kind of drug isthat use can turn into abuse. However, even

without an excessive and/or disproportionateintake, the individual can experience severalunpleasant experiences as flashbacks consist¬ing in the involuntary recalling of mnemonictraces of those experiences. These flashbacksproduce distress in the person enduring them.Could VR provoke this phenomenon? We donot know it yet.

Currently, we reckon an important body ofresearch that examines the effects of the mediaon the individual. Part of this research mightbe applied to VR. For instance, we could hy¬pothesize that VR creates dependence, as othermedia do. In fact, it seems that humans tend tobe fascinated by all those situations in whichwe confound reality. Magic and perceptual il¬lusions fascinate us, and it goes without sayingthat hallucinogenic drugs awoke curiosity inmore than one generation. Unfortunately, sucha fascination turned into a real problem inmany cases. In VR, apart from fascination,

290 BAÑOS ET AL.

other distinctive elements from other mediaconverge. It is enough to remember the de¬pendence that TV, video games, computers,and the Internet are capable of producing. It ismore than likely that VR will also be misusedand abused by certain populations. In any case,as it has occurred with other innovations anddiscoveries, and we-will have to learn how touse it.

Research on other media (especially TV) hasalso dealt with the effects of the prolonged in¬teraction with the media, concluding that itscontinuous use biases the way the individualsees and thinks about the world.28 Further¬more, although it is unknown how a person'spsychological mechanisms change, it is com¬

monly accepted that the nature of the media isof great importance. That is, the mind's mech¬anisms are not different from the means

through which most of information is received.Let us pay attention to the many studies point¬ing that the mean time a person spends watch¬ing TV is 7 years of his/her life. If this is to beapplied to VR, it means that some peoplewould spend 20 or more years in virtual reali¬ties.28 Even managers of the VR business suchas Jaron Lanier propose to set limits to the ac¬

cess of children to this media.27 This technol¬ogy could be especially dangerous to thispopulation, as could be the use of video, com¬

puters, or video games. Furthermore, this tech¬nology has an additional risk. Children need to

develop many cognitive skills in order to in¬teract with the real physical world (e.g.,hand-eye skills, motor reflexes). Those abilitiesare at risk of not being completely establishedif the child uses and abuses.VR at an early age.

VR can be an excellent scenario for dysfunc¬tional or antisocial behaviors to be easily in¬corporated into the person's behavioral reper¬toire. That is, VR will also have an importantimpact in our society, as other media have had.For instance, much has been written about thepotential danger of adult TV programming be¬ing viewed by children and adolescents. Theviewing of violent scenes has been regarded as

particularly harmful, although as Bandura29pointed out in 1965, the aggressive content ofTV can be witnessed without it being trans¬

ported to one's personal behavior. In contrastto TV, VR requires a direct action. In the vir¬

tual pseudolife, a person can kill or be killedand, as a consequence, the aggressive actioncan be directly incorporated into the behavioralrepertoire when one is playing VR games.Calvert and Tan30 proved it in their study on

the impact of watching violent scenes com¬

pared to the impact of playing a violent gamein VR. Physiological activity (measured by thecardiovascular rate), feelings of hostility (mea¬sured by the Multiple Affective AdjectiveChecklist), and aggressive thoughts (measuredby a thought list questionnaire) were assessed.Results showed that the physiological re¬

sponses and the number of aggressive thoughtswere higher in the participants who were play¬ing VR games, but there were no differencesbetween both groups in their feelings of hos¬tility. The results pointed out that interactionsin VR lessened the relevance of personal char¬acteristics such as gender or personality traits.Namely, VR produced similar aggressive ef¬fects in all players. Therefore, the authors con¬

cluded that VR was even more powerful thanevil TV when the issue was to supply aggres¬sion. Although the symbolic nature of this in¬teraction suggests that participants will not

generalize these actions to real life, the truth isthat research on the TV field suggests the op¬posite (for instance, Friederich-Cofer and Hus¬ton31). Works such as those by Schutte, Malouf,Post-Garden, and Rodasta,32 or .Silvern andWilliamson33 point that interaction with vio¬lent video games could also produce interper¬sonal aggression. Therefore, it is not strangethat Calvert and Tan30 wonder what will hap¬pen now that we have an even more realisticmedia: one where the person can really be per¬ceptively immersed in a world of violent ac¬tivities. These authors encourage research on

this field in order to increase the knowledge on

the potential behavioral consequences of thesenew interactive technologies, and thus to havesome sort of guidance about the most appro¬priate procedures to be employed.

According to the present days' predictions,children born in the 1990s will grow up in a

world where VR will be as at hand and cheapas the telephone.27 It might be that then, theDSM and the ICD will have to include some

disorder related to this technology. In a simi¬lar way, therapeutic handbooks will include

VR AND PSYCHOPATHOLOGY 291

packages about its use. In any case, we wishnot to end this issue without outlining that thistechnology is no more than a technology. Tech¬nology does nothing by itself, that is, it is not"moral" or "ethical" by itself.

On the other hand, among the adverse effectsof VR, it should not be forgotten that this toolcan provoke important side effects. Rizzo,Wiederhold, and Buckwalter26 point to two es¬sential ones: cybersickness and after effects.Cybersickness is related to sensory cue incon¬gruity, which occurs when perceptions in dif¬ferent sense modalities are in conflict or whensensory cue information in VR is incongruentwith what the body feels or what is expectedto be felt. After effects are related to the intentsthe user makes to adapt himself to sen¬

sory/motor requirements of VR.26 These sideeffects seem to lessen along repeated gradedexposures. They depend on factors such as thetype of VR program used, the kind of move¬ment (passive or active), and the user's gen¬der.26 Wiederhold34 recommends the realiza¬tion of a medical pre-screening before a personis immersed into VR, especially if he/she be¬longs to a risk population such as children, theelderly, or debilitated patients. Furthermore,Wiederhold insists as well in the necessity of a

post-VR observation session, in order to treatthe effects that may have arisen during the im¬mersion.

To end up, we would like to conclude withour starting point: We believe that VR can be¬come a tool that will permit psychopathologyto challenge and modify theoretical views al¬ready established. This new form of experiencecan help us to find answers to old questionsand, at the same time, could pose many new

questions on the psychological and psy¬chopathological horizon. In any case, as Den¬nett35 pointed out, it is unlikely that an artifi¬cial environment could approach by far thecombinatory explosion of possibilities that hu¬man actions can take on.

ACKNOWLEDGMENTS

The realization of this work has been possi¬ble thanks to the funding from the FEDER pro¬gram (1FD97-0260-C02-01).

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Address reprint requests to:Dr. Rosa María Baños

Departamento de Personalidad, Evaluación yTratamientos Psicológicos

Facultad de Psicología. Universität de ValenciaAvda. Blasco Ibáñez, 21

46010 Valencia, SpainE-mail: banos@uv.es

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