The Effects of Immersive Virtual Reality in Reducing Public Stigma of Mental Illness in the University Population of Hong Kong: Randomized Controlled Trial

Anna S Y Yuen, Winnie W S Mak, Anna S Y Yuen, Winnie W S Mak

Abstract

Background: Public stigma in mental health often brings various adverse effects on people with mental illness. Researchers have been developing different interventions in combating public stigma.

Objective: This study investigates the effects of immersive virtual reality (IVR) in reducing the public stigma of mental illness using a single-blinded randomized control trial.

Methods: A pre-post experimental design with a 1-week follow-up was conducted. Participants (N=206) were recruited through the mass mail system of The Chinese University of Hong Kong and randomized into 3 conditions: immersive animation, text, and control. In the immersive animation condition (n=72), participants experienced the simulation of daily life and the stigma experienced as an animated story protagonist with mixed anxiety and depressive disorder with IVR. In the text condition (n=65), participants experienced an identical story to the immersive animation condition with first-person audio narration using the same virtual reality headset. In the control condition (n=69), participants watched a video about planets with IVR. All participants received interventions with a researcher-assisted Oculus Go virtual reality headset. Participants' public stigma was measured through self-administered online questionnaires and compared across conditions and at different time points using repeated measures analysis of variance. Simple and sequential mediation analyses on the relationship of condition (immersive animation vs text) and follow-up public stigma with possible mediators, including sense of embodiment and story transportation, were conducted using PROCESS.

Results: Public stigma did not differ significantly across conditions at pre-experiment (P>.99). In the immersive animation and text conditions, public stigma was significantly reduced at postexperiment and at the 1-week follow-up compared to pre-experiment (all with P<.001). Public stigma in the control condition at postexperiment and follow-up remained unchanged compared with pre-experiment (P=.69). Immersive animation had significantly lower public stigma than the control at postexperiment (P=.003) and follow-up (P=.02). Text also had lower public stigma than the control at postexperiment (P=.007) and follow-up (P=.03). However, immersive animation did not significantly differ from text in public stigma at postexperiment and follow-up (both P>.99). In simple mediation models, both sense of embodiment (95% CI -0.22 to 0.46) and story transportation (95% CI -0.18 to 0.00) were not significant mediators. In the sequential mediation model, both sense of embodiment and story transportation were significant sequential mediators. Sense of embodiment was positively associated with story transportation (P<.001), while story transportation was negatively associated with public stigma (P<.001). The indirect effect of the sequential mediation model was significant (95% CI -0.38 to -0.11).

Conclusions: This study provides novel findings and a rigorous comparison in understanding the effects of IVR on public stigma. The findings showed that IVR and text with audio narration performed similarly and significantly in stigma reduction. Sense of embodiment and story transportation were found to be sequentially associated with public stigma reduction.

Trial registration: Centre for Clinical Research and Biostatistics Clinical Trial Registry CUHK_Ccrb00638; https://www2.ccrb.cuhk.edu.hk/registry/public/632.

Keywords: immersive virtual reality; mental health stigma; narrative persuasion; public stigma; sense of embodiment; stigma intervention; story transportation.

Conflict of interest statement

Conflicts of Interest: None declared.

©Anna S Y Yuen, Winnie W S Mak. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 14.07.2021.

Figures

Figure 1
Figure 1
Screenshot of participants seeing the female protagonist’s, Yan’s, body in the immersive animation condition.
Figure 2
Figure 2
Screenshot of Yan talking to her uncle, and showing how messages pop up to illustrate problematic issues in the uncle’s speech in the immersive animation condition.
Figure 3
Figure 3
Screenshot of the text condition.
Figure 4
Figure 4
Screenshot of the space control condition.
Figure 5
Figure 5
CONSORT (Consolidated Standards of Reporting Trials) diagram of participant recruitment.
Figure 6
Figure 6
Simple mediation model of the condition, sense of embodiment, and public stigma.
Figure 7
Figure 7
Simple mediation model of the condition, story transportation, and public stigma.
Figure 8
Figure 8
Sequential mediation model of the condition, sense of embodiment, story transportation, and public stigma.

References

    1. Kosyluk KA, Al-Khouja M, Bink A, Buchholz B, Ellefson S, Fokuo K, Goldberg D, Kraus D, Leon A, Michaels P, Powell K, Schmidt A, Corrigan PW. Challenging the stigma of mental illness among college students. J Adolesc Health. 2016 Sep;59(3):325–331. doi: 10.1016/j.jadohealth.2016.05.005.
    1. Rüsch N, Angermeyer MC, Corrigan PW. Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. Eur Psychiatry. 2005 Dec;20(8):529–39. doi: 10.1016/j.eurpsy.2005.04.004.
    1. Goffman E. Stigma: Notes on the Management of Spoiled Identity. New York: Touchstone; 1986.
    1. Chan JYN, Mak WWS, Law LSC. Combining education and video-based contact to reduce stigma of mental illness: "The Same or Not the Same" anti-stigma program for secondary schools in Hong Kong. Soc Sci Med. 2009 Apr;68(8):1521–6. doi: 10.1016/j.socscimed.2009.02.016.
    1. Thornicroft G, Mehta N, Clement S, Evans-Lacko S, Doherty M, Rose D, Koschorke M, Shidhaye R, O'Reilly C, Henderson C. Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet. 2016 Mar 12;387(10023):1123–1132. doi: 10.1016/S0140-6736(15)00298-6.
    1. Crisp AH, Gelder MG, Rix S, Meltzer HI, Rowlands OJ. Stigmatisation of people with mental illnesses. Br J Psychiatry. 2000 Jul;177:4–7. doi: 10.1192/bjp.177.1.4.
    1. Corrigan PW, Green A, Lundin R, Kubiak MA, Penn DL. Familiarity with and social distance from people who have serious mental illness. Psychiatr Serv. 2001 Jul;52(7):953–8. doi: 10.1176/appi.ps.52.7.953.
    1. Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA. Public conceptions of mental illness: labels, causes, dangerousness, and social distance. Am J Public Health. 1999 Sep;89(9):1328–33. doi: 10.2105/ajph.89.9.1328.
    1. Pinfold V, Toulmin H, Thornicroft G, Huxley P, Farmer P, Graham T. Reducing psychiatric stigma and discrimination: evaluation of educational interventions in UK secondary schools. Br J Psychiatry. 2003 Apr;182:342–6. doi: 10.1192/bjp.182.4.342.
    1. Seeman N, Tang S, Brown AD, Ing A. World survey of mental illness stigma. J Affect Disord. 2016 Jan 15;190:115–121. doi: 10.1016/j.jad.2015.10.011.
    1. Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol. 2001 Aug;27(1):363–385. doi: 10.1146/annurev.soc.27.1.363.
    1. Wahl OF. Stigma as a barrier to recovery from mental illness. Trends Cogn Sci. 2012 Jan;16(1):9–10. doi: 10.1016/j.tics.2011.11.002.
    1. Corrigan PW, Watson AC. Understanding the impact of stigma on people with mental illness. World Psychiatry. 2002 Feb;1(1):16–20.
    1. Wahl OF. Mental health consumers' experience of stigma. Schizophr Bull. 1999;25(3):467–78. doi: 10.1093/oxfordjournals.schbul.a033394.
    1. Livingston JD, Boyd JE. Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Soc Sci Med. 2010 Dec;71(12):2150–61. doi: 10.1016/j.socscimed.2010.09.030.
    1. Mak WWS, Cheung RYM. Self-stigma among concealable minorities in Hong Kong: conceptualization and unified measurement. Am J Orthopsychiatry. 2010 Apr;80(2):267–81. doi: 10.1111/j.1939-0025.2010.01030.x.
    1. Corrigan PW, Larson JE, Rüsch N. Self-stigma and the "why try" effect: impact on life goals and evidence-based practices. World Psychiatry. 2009 Jun;8(2):75–81. doi: 10.1002/j.2051-5545.2009.tb00218.x.
    1. Pinfold V, Thornicroft G, Huxley P, Farmer P. Active ingredients in anti-stigma programmes in mental health. Int Rev Psychiatry. 2005 Apr;17(2):123–31. doi: 10.1080/09540260500073638.
    1. Corrigan PW, Morris SB, Michaels PJ, Rafacz JD, Rüsch N. Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatr Serv. 2012 Oct;63(10):963–73. doi: 10.1176/appi.ps.201100529.
    1. Clement S, van Nieuwenhuizen A, Kassam A, Flach C, Lazarus A, de Castro M, McCrone P, Norman I, Thornicroft G. Filmed v. live social contact interventions to reduce stigma: randomised controlled trial. Br J Psychiatry. 2012 Jul;201(1):57–64. doi: 10.1192/bjp.bp.111.093120.
    1. Corrigan PW, Larson J, Sells M, Niessen N, Watson AC. Will filmed presentations of education and contact diminish mental illness stigma? Community Ment Health J. 2007 Apr;43(2):171–81. doi: 10.1007/s10597-006-9061-8.
    1. Kalyanaraman SS, Penn DL, Ivory JD, Judge A. The virtual doppelganger: effects of a virtual reality simulator on perceptions of schizophrenia. J Nerv Ment Dis. 2010 Jun;198(6):437–43. doi: 10.1097/NMD.0b013e3181e07d66.
    1. Kilteni K, Groten R, Slater M. The sense of embodiment in virtual reality. Presence Teleoperators Virtual Environments. 2012 Nov;21(4):373–387. doi: 10.1162/pres_a_00124.
    1. Peck TC, Seinfeld S, Aglioti SM, Slater M. Putting yourself in the skin of a black avatar reduces implicit racial bias. Conscious Cogn. 2013 Sep;22(3):779–87. doi: 10.1016/j.concog.2013.04.016.
    1. Petkova VI, Khoshnevis M, Ehrsson HH. The perspective matters! Multisensory integration in ego-centric reference frames determines full-body ownership. Front Psychol. 2011;2:35. doi: 10.3389/fpsyg.2011.00035.
    1. Yee N, Bailenson JN. Walk a mile in digital shoes: the impact of embodied perspective-taking on the reduction of negative stereotyping in immersive virtual environments. Presence 2006: The 9th Annual International Workshop on Presence; August 24-26, 2006; Cleveland, OH. 2006.
    1. Ando S, Clement S, Barley EA, Thornicroft G. The simulation of hallucinations to reduce the stigma of schizophrenia: a systematic review. Schizophr Res. 2011 Dec;133(1-3):8–16. doi: 10.1016/j.schres.2011.09.011.
    1. Brown SA. Implementing a brief hallucination simulation as a mental illness stigma reduction strategy. Community Ment Health J. 2010 Oct;46(5):500–4. doi: 10.1007/s10597-009-9229-0.
    1. Brown SA, Evans Y, Espenschade K, O'Connor M. An examination of two brief stigma reduction strategies: filmed personal contact and hallucination simulations. Community Ment Health J. 2010 Oct;46(5):494–9. doi: 10.1007/s10597-010-9309-1.
    1. Cangas AJ, Navarro N, Parra JMA, Ojeda JJ, Cangas D, Piedra JA, Gallego J. Stigma-Stop: a serious game against the stigma toward mental health in educational settings. Front Psychol. 2017;8:1385. doi: 10.3389/fpsyg.2017.01385.
    1. Fisher S, Cleveland SE. Body Image and Personality. 2nd edition. Michigan: Dover Publications; 1968.
    1. Biocca F. The cyborg's dilemma: progressive embodiment in virtual environments. J Computer-Mediated Commun. 1997 Sep 01;3(2):1. doi: 10.1111/j.1083-6101.1997.tb00070.x.
    1. Maister L, Slater M, Sanchez-Vives MV, Tsakiris M. Changing bodies changes minds: owning another body affects social cognition. Trends Cogn Sci. 2015 Jan;19(1):6–12. doi: 10.1016/j.tics.2014.11.001.
    1. Green MC, Kass S, Carrey J, Herzig B, Feeney R, Sabini J. Transportation across media: repeated exposure to print and film. Media Psychol. 2008 Dec 23;11(4):512–539. doi: 10.1080/15213260802492000.
    1. Tal-Or N, Cohen J. Understanding audience involvement: conceptualizing and manipulating identification and transportation. Poetics. 2010 Aug;38(4):402–418. doi: 10.1016/j.poetic.2010.05.004.
    1. Green MC, Brock TC. The role of transportation in the persuasiveness of public narratives. J Pers Soc Psychol. 2000 Nov;79(5):701–21. doi: 10.1037//0022-3514.79.5.701.
    1. Caputo NM, Rouner D. Narrative processing of entertainment media and mental illness stigma. Health Commun. 2011 Oct;26(7):595–604. doi: 10.1080/10410236.2011.560787.
    1. Mann CE, Himelein MJ. Putting the person back into psychopathology: an intervention to reduce mental illness stigma in the classroom. Soc Psychiatry Psychiatr Epidemiol. 2008 Jul;43(7):545–51. doi: 10.1007/s00127-008-0324-2.
    1. Oliver MB, Dillard JP, Bae K, Tamul DJ. The effect of narrative news format on empathy for stigmatized groups. Journalism Mass Commun Q. 2012 Mar 14;89(2):205–224. doi: 10.1177/1077699012439020.
    1. Winterbottom A, Bekker HL, Conner M, Mooney A. Does narrative information bias individual's decision making? A systematic review. Soc Sci Med. 2008 Dec;67(12):2079–88. doi: 10.1016/j.socscimed.2008.09.037.
    1. Kaufman GF, Libby LK. Changing beliefs and behavior through experience-taking. J Pers Soc Psychol. 2012 Jul;103(1):1–19. doi: 10.1037/a0027525.
    1. Appel M, Richter T. Transportation and need for affect in narrative persuasion: a mediated moderation model. Media Psychol. 2010 May 28;13(2):101–135. doi: 10.1080/15213261003799847.
    1. Green MC, Brock TC, Kaufman GF. Understanding media enjoyment: the role of transportation into narrative worlds. Commun Theory. 2004 Nov;14(4):311–327. doi: 10.1111/j.1468-2885.2004.tb00317.x.
    1. Schutte NS, Stilinović EJ. Facilitating empathy through virtual reality. Motivation Emotion. 2017 Oct 16;41(6):708–712. doi: 10.1007/s11031-017-9641-7.
    1. Mak WWS, Chong ESK, Wong CCY. Beyond attributions: understanding public stigma of mental illness with the common sense model. Am J Orthopsychiatry. 2014 Mar;84(2):173–81. doi: 10.1037/h0099373.
    1. Ehrsson HH. The experimental induction of out-of-body experiences. Science. 2007 Aug 24;317(5841):1048. doi: 10.1126/science.1142175.
    1. Slater M, Spanlang B, Sanchez-Vives MV, Blanke O. First person experience of body transfer in virtual reality. PLoS One. 2010 May 12;5(5):e10564. doi: 10.1371/journal.pone.0010564.
    1. Longo MR, Schüür F, Kammers MPM, Tsakiris M, Haggard P. What is embodiment? A psychometric approach. Cognition. 2008 Jun;107(3):978–98. doi: 10.1016/j.cognition.2007.12.004.
    1. Hayes A. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. New York: The Guilford Press; 2013.
    1. Lysaker PH, Davis LW, Warman DM, Strasburger A, Beattie N. Stigma, social function and symptoms in schizophrenia and schizoaffective disorder: associations across 6 months. Psychiatry Res. 2007 Jan 15;149(1-3):89–95. doi: 10.1016/j.psychres.2006.03.007.
    1. Sarge MA, Kim H, Velez JA. An intervention: the role of perspective taking in combating public stigma with virtual simulations. Cyberpsychol Behav Soc Netw. 2020 Jan;23(1):41–51. doi: 10.1089/cyber.2019.0678.
    1. Rohrer MW. Seeing is believing: the importance of visualization in manufacturing simulation. The 32nd Conference on Winter Simulation; December 2000; Orlando, FL. 2000.
    1. Corrigan PW, Bink AB, Fokuo JK, Schmidt A. The public stigma of mental illness means a difference between you and me. Psychiatry Res. 2015 Mar 30;226(1):186–91. doi: 10.1016/j.psychres.2014.12.047.
    1. Reinke RR, Corrigan PW, Leonhard C, Lundin RK, Kubiak MA. Examining two aspects of contact on the stigma of mental illness. J Soc Clin Psychol. 2004 Jun;23(3):377–389. doi: 10.1521/jscp.23.3.377.35457.
    1. Thornicroft G, Rose D, Kassam A, Sartorius N. Stigma: ignorance, prejudice or discrimination? Br J Psychiatry. 2007 Mar;190:192–3. doi: 10.1192/bjp.bp.106.025791.
    1. Gillath O, McCall C, Shaver PR, Blascovich J. What can virtual reality teach us about prosocial tendencies in real and virtual environments? Media Psychol. 2008 Jun 25;11(2):259–282. doi: 10.1080/15213260801906489.

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