VIRTUAL REALITY BIOFEEDBACK - OR?                       
                 (A Brief Concept Paper)

                     Thomas H. Budzynski, Ph.D.
             Center for Behavioral Medicine
               University of West Florida

Fred edged very slowly toward the railing. With pounding heart and 
moist palms he knew only too well that the view from that railing 
was an ernormous abyss that separated him from the Golden Gate 
bridge wreathed by fog in the distance. All his life Fred had been 
terrified by heights, especially the monstrous environments often 
found in nature. A flat-lander from Kansas, Fred was not challenged 
by such frightening natural surrounds until he left his comfortable 
home state to take an irresistable new job in Vail, Colorado. Just 
looking out the window of his rented room at the nearby mountains 
brought a lump to his throat. Fred however had learned to walk the 
streets among the happy skiers while keeping his eyes focused on 
the street no more than 12 feet ahead, thus avoiding adrenalin-
generating glances at the steep snow-covered slopes. Fred may have 
continued his extremely limited lifestyle had he not met Amy, a 
gloriously tanned skier, who soon thereafter attempted to integrate 
Fred into her very active sporting life.

Though skiing-challenged, infatuated Fred knew he had to make a 
valiant attempt to shed the acrophobia that seemingly had dogged 
him all his life. A new alternative medicine clinic was advertising 
Virtual-Reality Therapy at a reasonable rate even though the ad 
boasted a $200,000 V-R system. Amy practically dragged the mildly 
objecting Fred to the clinic. And so it was that Fred found himself 
standing on a sort of small platform with a railing and with an HMD 
(head mounted display) over his head. The V-R system could detect 
the positioning of his head in space and thus adjust the virtual world 
accordingly. It was very much like being there, after one adapted to 
the slightly lagged movement and the crudeness of the objects and 
vistas in that world. 

The available "acrophobic" virtual worlds included looking out from 
mezzanines, ladders of various heights, glass-enclosed elevators, 
and the present VR scene. In fact, this was Fred's third try at 
approaching the railing and he was moving closer than ever before. 
This time there wasn't the extreme paralysis that seemed to 
immobilize his limbs in the first 2 sessions.

                                                                                             

Fred would move a step forward, stop and look around. He was 
amazed to see that the virtual world responded appropriately, in 
other words, the scene changed as Fred turned his head. If he moved 
too quickly however, the slight delay in the changing scene made him 
feel queasy. Fred rapidly learned not to do that.  He was also aware 
that his view of the Golden Gate bridge was somewhat rough, in 
other words, a crude approximation of the actual bridge. The same 
was true of the rest of the virtual world, in fact, the scenery away 
from the main feature, in this case the bridge, was even more 
simplistically drawn. Nevertheless, Fred was moving closer and 
closer to the railing. Each time his heart began to race he stopped, 
breathed deeply and slowly from the abdomen as he was taught, then 
proceeded when he calmed down a bit. In about 10 sessions Fred will 
have overcome his fear of heights. 


V-R Therapy is Here Now!

Sound too futuristic? Too fantastic? Actually, this sort of therapy 
is being done today in several clinics and in research settings. As an 
example, a brief report by Rothbaum et al. in the April, 1995 
American Journal of Psychiatry, described a study which showed 
that the V-R therapy illustrated above resulted in reductions in 
self-reported anxiety and avoidance of heights and improvements in 
attitudes toward heights compared to waiting list controls who did 
not change. Only seven sessions were required.             

Why is V-R therapy apparently so effective? First of all there are 
several well known facts about the brain that may be relevant: for 
one, the right or nondominant hemisphere has been identified as the 
mediator of the more negative emotions such as fear, anxiety and 
even depression. Secondly, this same cerebral hemisphere is 
specialized for the processing of spatial aspects of our world. 
Therefore, the three dimensional V-R representation of the world, 
combined with the realistic feeling of movement toward the feared 
situation, allows an extremely effective desensitization. In other 
words, the V-R pocedure impacts exactly the part of the brain in 
which the anxiety process is being mediated. The more realistic the 
desensitization scene, the more effective the fear reduction. 


                                                                                                 

Can Bio-Signals Drive a V-R Display?

The only reason there has not been an explosion of research with 
what I have called BIOVIR, or bio-driven V-R, is that the V-R system 
itself is so costly that only those groups of people closest to the 
equipment (usually the computer science folks) have any chance of 
actually using it. Not many biofeedback researchers or clinicians 
occupy that privileged place as yet. An exception is Dan Chartier in 
Raleigh, North Carolina, a neurotherapy clinician who has begun some 
pilot work with a rather expensive system. Dr. Chartier reported on 
this very preliminary work at the 1995 Key West Neurotherapy 
Conference. 

Approximately 6 years ago I managed to get a biofeedback system 
placed in the V-R lab (called the HIT or Human Interface Technology 
lab) at the University of Washington. We spoke of possible linkages 
with the electronics and computer people and of virtual displays 
with the programmers, but other priorities took precedence and the 
system was never used.

Yes, alpha EEG signals from the left and right hemispheres could 
control two separate figures in the virtual world. Dual EDRs and 
temperatures could also be represented, and why not heart rate as 
well? A long time ago Barbara Brown speculated that biofeedback 
skills were mediated by the nondominant hemisphere and I agreed. 
Hasn't it always seemed as though we first learned to control 
biofeedback responses before we could verbalize how we did it? 
With BIOVIR we will be learning to control objects in three-
dimensional space - - ready-made for the nondominant brain.


Alas, All is Not Perfect in the Virtual World

Wouldn't it be great if there were V-R systems that would cost less 
than $10,000, permitted true real time apparent movement without 
the confusing delay, and could present virtual displays that were 
clear, sharp and  brightly colored? Then perhaps one could convert 
them to a BIOVIR system without too much trouble. To give an idea 
of how complex such a V-R system would be, the V-R show at the 
Epcot Center, a kind of short Alladin-like interactive cartoon, 
requires the computer storage of over 80,000 assorted polygons 
                                                                                              4.

alone just to process the moving images in this short episode. And, 
of course we haven't even considered the cost of programming such a 
system. Let's not even consider it! Instead, let's compromise just a 
bit.

What about Bio-Driven 3-D Motion Graphics?

No, not the kind of 2-dimensional computer graphic with perspective 
that looks sort of 3-D, but a real 3-D display that is sharp, clear, in 
beautiful color, and moves! Technology for this type of system is 
available now in bits and pieces. It will be something like this: bio-
signals will drive a 3-D display which is viewed by very light 
weight stereo glasses which look into a flicker-free 3-D world.
These are not your old blue/red cardboard glasses but a real 
technological breakthrough by a company called Seattle I-O. With 
this system one needs to have a special type of screen presentation 
that looks fuzzy to the naked eye but is transformed into a truly 
"fall into" 3-D world with the "Virtual I-O" glasses. 

A young company from Ketchum, Iowa called Motion Graphics, LCC, 
has developed a new stereo video camera which makes videos that 
can be viewed with the Virtual I-O glasses. This might revolutionize 
instructional videos. It will be especially valuable where a 3-D view 
is important such as sports, architecture, surgery instruction, etc. 
Remember that anything photograhed by this camera can be viewed 
in 3-D at a much higher resolution than with virtual reality. 

OK so far, but how does the bio-signal fit in? Well, wouldn't it be 
great if a bio-signal could drive some aspect of those 3-D video 
displays? Actually, there are at least two (Thought Technology of Montreal and IBVA of New York), and 
possibly several other biofeedback companies that now have the 
capability of assigning, through their software, particular frames of 
CD-ROM vignettes to be driven by a given level of bio-signal. By 
combining the Virtual I-O glasses with the stereo video-to-CD-ROM, 
and the Thought Technology or IBVA system, one has, for example, the capacity for viewing 
with light weight glasses a beautiful three dimensional graphical 
representation of changes in left and right alpha for depression ala 
Peter Rosenfeld's approach at Northwestern.



                                                                                             

Instead of a virtual world the user of this sort of system can employ 
actual video vignettes that he/she has filmed with the Motion 
Graphics stereo video camera. These actual scenes can be used alone 
or combined with computer graphics to provide a totally enthralling 
3-D world that changes with the client's brainwaves or autonomic 
responses. This total system, which should be available in late '95, 
will be well within the price range of most clinics and even 
individual clinicians.













Rothbaum, B.O., Hodges, L.F., Kooper, R., Opdyke, D., Williford, J.S., & 
North, M. (1995). Effectiveness of computer-generated (virtual 
reality) graded exposure in the treatment of acrophobia. American 
Journal of Psychiatry, 152, 626-628.










































                                                                                            5.



ITHE DEPRESSED/IMMUNOSUPPRESSED  BRAIN
* We except the premise that negative emotions are mediated 
primarily by the right or nondominant cortical hemisphere and the 
limbic system.  Depression, for example, is said to be characterized 
by an overactivation of the right frontal area of the cortex and a 
relatively decreased activation of the corresponding left side. 

* It is also generally accepted that hopeless, helpless, depressed 
emotions can weaken the immune response. Perhaps then one could 
infer that the right cortical hemisphere and the underlying limbic 
system have some degree of influence over the immune system.

* Given that negative emotional states  (especially if chronic) might 
weaken the immune response thus allowing us to get sick, it would 
seem to be a very logical step to investigate what could change this 
dangerous brain state. In other words what could normalize the 
negative arousal pattern manifesting in the right brain?

* If we could increase the left/right activation ratio we should see 
a decrease in depression.

* The split-brain research showed that the nondominant hemisphere 
is a visual processor whereas the left brain converts visual images 
into words.

* The right brain can understand verbal language but of a childlike 
sort. Its real medium is visual imagery.

* Another feature of the right brain is its ability to process three-
dimensional space.

* Virtual Reality (VR) is a computer generated 3-D display that you 
can not only control but appear in!

* The EEG and EDR (electrodermal response) signals can drive the VR 
display. We thus have an exquisite biofeedback system.

Budzynski                                                                                  2.

*  The trainee thus can learn to generate an optimal brain state with 
the VR display.

* We hypothesize that the optimal brain state will strengthen the 
immune response.

* Additionally, visual display and audio affirmations will rescript 
the brain so that more long-term positive attitudes will result.

* The VR display, representing both left and right aspects of the 
brain, can be used to reduce interhemispheric conflict as well.

 
THE TELEOLOGIC BRAIN
* The brain is a teleological organ which strives to attain whatever 
goal(s) we "present" to it.

* Question: Why therefore don't we usually carry through on our 
positive affirmations and goals?

* Answer: Because another part of the brain has a different plan. 
Split-brain research showed that interhemispheric conflict was 
indeed probable.

* Question: Why then don't we just change that part's plan to bring in 
it line with the conscious mind?

* Answer: Because that dissenting part is usually in the unconscious 
and therefore is hard to reach.

* David Galin of the Langley-Porter Institute published a landmark 
paper which concluded that the split-brain studies strongly 
suggested that the unconscious existed largely in the right or 
nondominant hemisphere.

* If we could get more directly and quickly to the unconscious we 
perhaps could negotiate a compromise and reduce the conflict.

* The right brain (unconscious?) is strongly influenced by 3-D 
(spatial) information because it is a spatial processor.

* Virtual Reality (VR) can generate a 3-D computerized display that 
can be driven by the EEG and ANS (autonomic) signals.
Budzynski                                                                                      3.

* By assigning VR symbols to left and right EEG and ANS signals we 
can experience (see, hear, feel) the unconscious as well as the 
conscious mind.

* Questioning by a trainer (therapist?) will result in relevant 
changes in the VR display. In other words, both the unconscious and 
conscious are more directly experienced in VR and a compromise can 
be reached, e.g., "Yes, I'll go along with the plan IF you'll just do . . . . 
" by observing the unconscious VR reaction on the screen.

* By eliminating interhemispheric conflict we pave the way for a 
smooth, unsabotaged path to our goals.

* Some researchers feel that chronic, unresolved conflict, often on 
the unconscious level, may be a causal factor for cancer 
development.

* In general, reducing interhemispheric conflict may be the most 
optimal way to restore or maintain both mental and physical health 
as well as the attainment of our goals.

* Virtual Reality Biofeedback should prove to be the most efficient 
approach to reducing such conflict.
 


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