Freeman et.al. (2003) – Key Study

The Study

Aims

• To investigate whether nonclinical individuals have persecutory thoughts in virtual reality;
• To investigate cognitive factors that predict the occurrence of persecutory ideation in virtual reality, with a particular focus on emotional processes.

Method

Sample

• 24 individuals;
• all without a history of mental illness;
• recruited by advertising;
• all from University College London;
• 21 were students;
• 3 were administrative staff;
• 12 males and 12 females;
• paid volunteers

Procedure

Step-by-step outline-

• Consent and Information:
  • Consent obtained from participants for their participation in the study:
  • Participants are not informed that the study specifically examines persecutory thoughts to prevent priming of reactions.

• VR Equipment Training:
  • Participants then received training on how to use the virtual reality (VR) equipment.

• Entering the Virtual Environment:
  • Participants were then asked to enter the virtual environment which was a virtual ;
  • Instructions given: “Please explore the room and try to form some impression of what you think about the people in the room and what they think about you.”

• Selection of Virtual Scene:
  • A neutral library scene was chosen for the study, considering the university population;
  • The virtual room was designed as a library, but participants were not informed of this during the study to allow them to form their own impressions.

• Avatars in the Library:
  • There are 5 avatars in the library scene;
  • 3 avatars sat at one desk, while 2 avatars sat at another desk on the opposite side of the room.

• Ambiguous Avatar Behavior:
  • Occasionally, the avatars showed potentially ambiguous behavior such as smiling, looking around, and talking to each other.

• Duration in the Virtual Room:
  • Participants spent 5 minutes in the virtual room.

• Exiting the Virtual Room:
  • Participants were instructed to leave the virtual room after the allotted time.

• Questionnaire and Interview:
  • All participants then completed a questionnaire and a short semi-structured interview regarding their experiences in the virtual environment;
  • The interviews were video recorded and later rated by an expert clinical psychologist on a 6-point scale for persecutory ideation

• Handling Priming of Persecutory Thoughts:
  • The study design addressed the possibility of priming persecutory thoughts through the questionnaires measuring cognitive processes (see measures section below);
  • Half of the participants completed the questionnaires after exiting the virtual environment;
  • The other half completed the questionnaires both before and after entering the virtual environment.

• Participant Balance and Compensation:
  • Male and female participants were balanced in each of the two conditions (pre- and post-virtual environment completion of questionnaires);
  • Participants were compensated for their participation in the study.

Measures

1. Brief Symptom Inventory (BSI):

• A 53-item self-report measure to assess 9 symptom dimensions over the past 7 days;
  • 9 dimensions include Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, and Psychoticism;
• Each item is rated on a 5-point distress scale (0–4);
• Total score obtained is the Global Severity Index.

2. Paranoia Scale:

• A 20-item self-report scale to measure paranoia in college students;
• Measures both ideas of persecution and reference;
• Each item is rated on a 5-point scale;
• Scores range from 20 to 100, with higher scores indicating greater paranoid ideation.

3. Spielberger State Anxiety Questionnaire:

• A 20-item self-report measure of state anxiety;
• Each item is rated on a 1–4 scale;
• Scores range from 20 to 80, with higher scores indicating higher levels of anxiety.

4. VR-Paranoia Questionnaire:

• A 15-item self-report questionnaire specifically devised for the study;
• Assesses participants’ views of the avatars in the virtual environment;
• 3 areas assessed –
  • persecutory thoughts about the avatars (VR-Persecution),
  • ideas of reference about the avatars (VR-Reference), and
  • positive beliefs about the avatars (VR-Positive)
• Each item is rated on a 4-point scale (0–3);
• Scores can range from 0 to 15 for each subscale, with higher scores indicating greater endorsement of items.

5. Sense of Presence Questionnaire:

• Assesses the extent to which participants experience a sense of being in the virtual world;
• Consists of 6 questions rated on a scale of 1 to 7;
• Higher numbers indicate greater reported presence;
• A score of 6 or 7 on a question is coded as 1, while all other scores are coded as 0;
• Total score can range between 0 and 6.

Results

• General:
  • Mean score on the Paranoia Scale: 31.8, SD = 10.8, minimum = 20, maximum = 61.
  • No significant difference in Paranoia Scale scores between males and females.

• Persecutory Ideation in the Virtual Library:
  • VR-Persecution scores were positively correlated with VR-Reference scores (r = +0.48) and negatively correlated with VR-Positive scores (-0.54);
  • Persecutory ideation in VR was also positively correlated with blind ratings of persecutory ideation from recorded interviews (r = +0.59).

• Sense of Presence in VR:
  • Participants reported a moderate sense of presence in the virtual library;
  • Anxiety levels did not increase after entering the virtual environment.

Predictors of Persecutory Ideation in VR:

• VR Persecution did not significantly correlated with scores on the Paranoia Scale;
• Higher VR-Persecution scores tended to be associated with higher BSI-Paranoia scores;
• VR Persecution scores correlated with other BSI dimension scores, Spielberger State Anxiety score, and sense of presence score;
• Higher levels of interpersonal sensitivity and anxiety were associated with higher levels of persecutory ideation in virtual reality.

Conclusions

• Nonclinical individuals have persecutory thoughts in virtual reality;
• The cognitive and emotional processes of paranoia, reference and anxiety predict the occurrence of persecutory ideation in virtual reality.

Methodological Evaluation

Sampling

Sample Characteristics

• Strengths
  • Study involved non-clinical individuals, broadening understanding of persecutory ideation beyond diagnosed mental health patients;
  • Equal gender recruitment ensured representative sample and minimized gender biases in study findings.
• Weaknesses
  • With only 24 individuals, findings may lack generalizability. A larger sample ensures stronger results;
  • Mainly university students and staff were included, limiting generalization to non-university  populations.

Sampling Technique

• Paid Volunteer
• Strengths
  • Participants easier to recruit as too many people would be fearful of VR or find the experiment too time consuming and refuse to participate;
  • Participants more cooperative for a lengthy study that required many self report questionnaires to be answered sincerely.
• Weaknesses
  • Participant recruitment introduced bias as those interested in virtual reality were more likely to participate;
  • Participants knew about participating in a virtual environment beforehand, potentially changing their behaviour to watch the avatars too closely

Operationalization of Variables

• Strengths
  • The study employs recognized and validated tools (BSI, Paranoia Scale, etc.) for accurate assessment, increasing validity;
  • Combining semi-structured interviews and observer ratings added qualitative depth to quantitative measures, increasing scope of findings
• Weaknesses
  • No standard questionnaire for measuring paranoia in virtual reality; researchers created their own, challenging reliability;
  • Study used ambiguous avatars in a library scene, potentially influencing participants’ perceptions of persecution, reducing ecological validity

Examples of Controls

1. Non-clinical individuals were recruited to study persecutory ideation in virtual reality without preexisting mental illness;
2. A neutral library scene was used to explore persecutory thoughts without explicit hostility;
3. Questionnaires were completed before and after the virtual environment to assess potential priming effects;
4. An expert clinical psychologist conducted a semi-structured interview and rated participants’ responses for persecutory content.

Research Method (Correlational Study)

• Strengths
  • Study used multiple measures like surveys, interviews, and observations to understand worry and sadness, increasing validity;
  • Study looks at how personality and emotions relate to persectory thoughts, offering new insights for research
• Weaknesses
  • Only 24 people were part of the study, who were not mentally ill. Results may not apply widely;
  • Participants weren’t randomly assigned for different groups, making it harder to conclude that paranoia causes persecutory ideation.

Ethical Evaluation

1. Informed consent: Participants consented but knowledge of study was unclear;
2. Right to withdraw: not explicitly mentioned;
3. Deception: Researchers hid their focus on persecutory thoughts;
4. Protection from physical harm: No apparent physical harm mentioned;
5. Protection from psychological harm: Potential distress to people having persecutory ideation in relation to the avatars in the virtual library;
6. Debriefing: Questionnaire and interview, but debriefing not mentioned;
7. Privacy: Virtual environment privacy measures not specified;
8. Confidentiality: Handling of personal data and identity not addressed.

Issues and Debates

Individual and Situational Explanations

Both explanations supported

• Individual Explanation
  • Paranoia as explaining persecutory ideation
• Situational Explanation
  • VR environment explaining persecutory ideation

• Strengths of Individual Explanation
  • Encourages treatment of paranoia to stop persecutory delusions;
  • Encourages delusional patients to take responsibility for reducing their paranoid thinking.

• Weaknesses of Individual Explanation
  • Use of self-report methods to understand paranoid thinking, subject to social desirability, reducing validity
  • Separating the influence of individual and situational factors is difficult – whether VR environment causes persecutory ideation or paranoia

• Strengths of Situational Explanation
  • The study used a special computer room with lifelike characters to simulate real-life situations, increasing ecological validity;
  • Psychologists indirectly encouraged to look at behaviours of people around a patient also while diagnosing and treating schizophrenia, increasing social responsibility 

• Weaknesses of Situational Explanation
  • People only used the virtual world for 5 minutes, so it may not show long-term effect of situation;
  • The study didn’t compare virtual experiences with real-life situations, which could confirm paranoid thoughts in the real world.

Idiographic versus Nomothetic

Both approaches explanation supported

• Idiographic Approach
  • Study included individual comments (qualitative data) to understand unique experiences and subjective perspectives of participants;
• Nomothetic Approach
  • Study examined correlations (quantitative data) between variables to identify general patterns and trends applicable to a broader population.

• Strengths of Idiographic Approach
  • Provided rich qualitative data through semi-structured interviews, capturing individual experiences and perceptions;
  • Allowed for personalized assessment of persecutory thoughts and beliefs, providing a detailed understanding of participants’ unique perspectives

• Weaknesses of Idiographic Approach
  • Subjectivity in scoring and interpreting qualitative data may introduce bias and affect the reliability of the findings;
  • Limited generalizability due to the small sample size and specific characteristics of the participants from one university.

• Strengths of Nomothetic Approach
  • Provides quantitative data for statistical analysis, allowing for generalization and comparison between participants;
  • Allows for identification of correlations between variables, such as persecutory thoughts and emotional distress.

• Weaknesses of Nomothetic Approach
  • Limited depth of understanding due to reliance on quantitative measures, potentially missing nuanced experiences and perspectives;
  • Lack of contextual information and individual variability might overlook important factors influencing persecutory thoughts and emotional distress.

Generalizability of Findings

• Strengths of Generalizability
  • The use of virtual reality (VR) creates a realistic environment, increasing the ecological validity of findings;
  • The study included an equal number of male and female participants, allowing for potential gender-related differences to be considered in the generalizability of the findings

• Weaknesses of Generalizability
  • With only 24 participants, the findings may not fully represent the broader population, limiting generalizability;
  • The study took place in a virtual reality setting with avatars, which may not fully reflect real-life interactions and situations.

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