I.   Introduction

Since Virtual Relaity has been a recognized tool in treating certain mental health imbalances such as PTSD, this study examines its further potential as a supportive tool for existential anxiety and fear of death. Within existential psychotherapy, CBT and Terror Management Theory fear of death or existential anxiety is deemed to be at the root of neuroses and fears. Long term anxiety is correlated with a tendency towards depression as well (Jacobson and Newman, 2017, Sapolsky, 2001). In the study different psychophysiological states were examined. Two were induced by Virtual Reality and one by meditation. From the results it seems that VR could be useful to address existential anxieties and depression, but further research needs to be conducted.

A.   Virtual Reality is a recognized tool for treating imbalances

Virtual Reality has been used in a myriad of psychotherapeutic applications successfully. It also has a long history of use for Post Traumatic Stress Disorder (PTSD) as a tool within exposure therapy (Cukor J. et al., 2015).

The elements that make VR so compelling in the mental health arena are:

The ability to generate a relaxing experience that stimulates the senses while it integrates with the polyvagal system (Porges, 2011). Therefore, it can help to provide a deep sense of muscle relaxation. This in turn facilitates autonomous stress regulation. Integrating aspects of phenomenology may well provide a myriad of additional psychophysiological possibilities that need to be further researched.

A.   Fear of death/existential anxiety is considered to be a basis for anxiety and depression in existential psychotherapy, CBT and Terror Management Theory.

At its core, the existential perspective has the belief that dread is the basis of human emotional life. It proposes that it is the fear of death that motivates our reality, and is the core of human experience, which results in existential anxiety. This in turn sets up a filter to create a specific experience of reality. However, these processes are typically nonconscious.

Nonconscious fear processes cannot not be approached in the same manner as conscious fear processes (LeDoux, 2014) and may need a different approach to uncontrolled fear states. Existential Psychotherapy focuses specifically on this area (Yalom, 2009). Fear of death is considered to be at the basis of nonconscious, uncontrolled fear states (Lewis, 2014, Beck & Weisshaar, 1995, Ottens & Hanna, 1998).

A.   Existential Perspective

The existential psychotherapist and writer Yalom (1980) outlines what he considers to be the ultimate concerns of humankind: 1) Death, 2) Isolation, 3) Meaninglessness, and 4) Freedom. As a psychotherapist, Yalom is primarily interested in how these existential concerns inform the therapeutic process. He believes that our psychological difficulties stem from an inability to reconcile ourselves with these existential concerns. Thus, his sessions include a thorough examination of the way every individual accommodates these concerns. Yalom believes that the liberation of suffering and sorrow would occur once the client has made peace with their circumstances.

According to psychodynamic theory, Yalom’s view represents the specific tension of dual instincts of ego and libidinal instincts (Greenberg, 1983, Kindle location 98). The demands of the external and internal environments are the birthplace of the superego. This is the force that manages interpersonal demands and the need of the child for approval from their security-providing adults. Failure to find balance may freeze life enhancing movement forward that resides in the libido. It seems that the character structure rests in part on the role of the super ego. The super ego manages the safekeeping of its owner. According to Greenberg (1983), “Growth is always compromised for the sake of security” (Kindle Location 107). Therefore freezing, whether it be muscles themselves or the lack of movement that comes from a suppressed libido, could easily lead to frozen expressions, frozen muscles, and frozen facial traits. In other words, the frozenness itself becomes a “being”, blocking movement forward as growth is compromised for security. Greenberg (1983) says, “In Freud’s revised view, meaning is determined by the ebbs and flows and, a complex interplay of life and death instincts” (Kindle Locations 552-553).

In the end, Yalom (2009) provides a solution to the existential psychologists’ dilemma: “A denial of death at any level is a denial of one’s basic nature and begets an increasingly pervasive restriction of awareness and experience. The integration of the idea of death saves us; rather than sentence us to existences of terror or bleak pessimism, it acts as a catalyst to plunge us into more authentic life modes, and it enhances our pleasure in the living of life.” (Kindle Locations 89-91).

This causes stress, anxiety and possibly depression in the individuals experiencing “death denial”. The physiological effects of this should become measurable because stress stimulates the sympathetic nervous system while inhibiting the Vagus Nerve (Porges, 1995; Sahar et al., 2001). Therefore, typical stress related brain wave patterns could be analyzed to understand the effects of the fear of death, relaxation and VR as a psychotherapeutic tool.

A.   VR may provide an compelling modality to treat anxiety and depression based on existential fears/fear of death

VR may well prove to be a major mental health tool in the future. Immersive virtual environments technology has already been used in therapy for phobias (Côté and Bouchard, 2008, Wiederhold, Jang, Gevirtz, Kim, Kim, and Wiederhold MD, 2002), stress (Bouchard, Baus, Bernier, and McCreary, 2010, Riva, Raspelli , Algeri, Pallavicini, Gorini, Wiederhold and Gaggioli 2006, Villani, Preziosa, and Riva, 2006), anxiety (Harris, Kemmerling, and North, 2002, Repetto and Riva, 2011), exercising (Bryanton, Bossé, Brien, Mclean, McCormick, & Sveistrup, 2006), and memory problems (Brooks BM and Rose FD, 2003, Klinger, Chemin, Lebreton and Marié, 2006). Additionally, the effects of VR on anxiety symptoms has been examined as well. In their study Gorini, Pallavicini, Algeri, Repetto, Gaggioli, and Riva (2010) reached the conclusion that VR for relaxation represents a promising approach in the treatment of General Anxiety Disorder (GAD). This is because VR enhances the quality of the relaxation experience through the elicitation of the sense of the sense of presence generated within the immersive experiences. These types of studies underline the fact that clinical cases such as GAD can also benefit from the VR treatments.

The elements that make VR so compelling in the mental health arena are the ability to generate a relaxing experience that stimulates the senses while it integrates with the polyvagal system (Porges, 2011). Therefore, it can help to provide a deep sense of relaxation and give patients the ability to build their vagal muscle. This in turn facilitates autonomous stress regulation. Integrating aspects of phenomenology may well provide additional psychophysiological possibilities that need to be further researched in this context.

The use of VR to facilitate the relaxation process, in this case the visual presentation of a virtual calm, helps facilitate patients' practice and their proficiency in relaxation. VR facilitates a more vivid relaxation experience than the one most subjects can create using their own imagination and memory. VR triggers a broad empowerment process, especially if used daily, although daily use is not part of this study.

A high sense of presence induces an embodied relaxation response. In this study we use of the VR mobile application StarflightVR, which provides the relaxation experience. In a past research project, 20 subjects who were suffering from anxiety symptoms were asked to use the application daily for six weeks. The response was positive. The study showed a significant change in immediate anxiety and a significant change in depression patterns over the long term. Daily usage showed this VR methodology to effective. Although there is also evidence of this positive use of VR Rizzo (2010) for example, further research needs to be done in this area.

  Anxiety and depression seem to be correlated (Jacobson and Newman, 2017). Influencing one appears to influence the other. According to Sapolsky (2001), there is a correlation between chronic stress and anxiety that has been shown to contribute to patterns that lead to depression. In turn the affective and cognitive symptoms of depression influence the physiology of the brain. Sapolsky (2001) points to a change in the hippocampus that is both morphological and functional. The Hippocampus is crucial to memory and learning. As Rizzo (2017) explains, “Regardless of the technical approach, the key aim of these immersive systems is to perceptually replace the outside world with the virtual world to psychologically engage users with simulated digital content designed to create a specific user experience.”

A. Description of Experiment

The purpose of this research is to assess the degree to which there is an impact on brain activity on the sensory awareness of death and the effect of mobile VR to remedy possible mental imbalances resulting from death awareness/existential anxiety. All participants will be exposed to the experience of meditation, DeathVR (Jurassic Park), and RelaxVR (StarflightVR).

A.   Group 1)

Participants will have their brainwaves measured, this will be used as a baseline.

Participants will be introduced to a brief meditation session while measuring brainwaves.

A.   Group 2)

Participants will have their brainwaves measured, this will be used as a baseline.

Participants will be exposed to a calming mobile Virtual Reality experience (StarflightVR) and brain activity will be measured.

A.   Group 3)

Participants will have their brainwaves measured, this will be used as a baseline.

Participants will be exposed to the VR experience Jurassic Park, which is an experience that is meant to stimulate the fear of death.

A. methods

These experiments will be conducted using a GEARVR headset VR system and the VR mobile application StarflightVR and Jurassic Park VR. Participants wear a lightweight headset that displays a stereoscopic (3D), immersive environment provided by StarflightVR.

A.   Subjects’ selection

In this research project, we propose to record the brain activity of 9 participants to establish brainwave differences for a meditative state, a VR fear of death experience, and a VR induced meditative state. We will randomly select subjects by asking possible participants. The subjects will at least be 18 years of age.

A.   Experimental protocol

EEG data will be collected for a baseline measurement as subjects are in a natural state of attention looking straight ahead. EEG data will be collected during the meditation, which consists of focusing on the breath while eyes are closed. EEG data will be collected during both the DeathVR (Jurassic Park) and the RelaxVR (StarflightVR). The order is as follows: Baseline, Meditation, DeathVR and RelaxVR.

A.   Psychometric measures

Brainwave changes will be measured for the meditation, the VR relaxation experience state and the VR death fear state.

A. Results

DeathVR measurements were inconclusive using EEG analysis due to the nature of the sympathetic NS response which includes vast physiological fluctuations that are then removed in the filtering process of the data. Further investigation is necessary to understand the nature of the response to a perceived threat, maybe using HRV or breath analysis through sensors (eg. Spire, Heartmath, etc)

The response to meditation was in range with already existing research in the field (Brabosz,et al, 2010). It showed a significant increase of brainwave activity in the lower ranges, from theta to beta. Since most participants were subjects with a meditation practice, it is also necessary to collect further data from non-meditators. There was only one subject who was a non-meditator.

Fig. 1. Baseline vs. meditation

The response to the RelaxVR category was ranked significant for several lower brainwaves. From theta to beta and alpha as well. This is in line with the data collected for the meditation category. The meditation category showed more significance in the lower ranges, again possibly due to the fact that the subjects could attain a meditative state on their own. When compared the state of meditation vs RelaxVR showed no significant statistical difference.

Fig. 2. Baseline vs RelaxVR

Fig. 3. baseline vs RelaxVR - AF8

Fig. 4. Baseline vs RelaxVR - TP10

Fig. 5. Meditation vs RelaxVR

When comparing all categories: meditation, RelaxVR and DeathVR there was significant difference across the board. Possibly showing that the states were vastly different in all brainwave ranges.

A. Conclusion

Further research needs to be undertaken in the area of Virtual Reality’s possibilities for alleviating symptoms from fear of death, anxiety and neurosis. However, it was noticed that the subject with no meditation experience reacted very positively to the VR option and that the brainwaves showed a picture of relaxation, vs the data gathered from the meditation portion were there was a significant increase in higher range brainwave activity. Two further subjects with less meditation experience also showed this same picture, albeit not as drastic. This suggests that, in this case, VR may be more interesting as a mental health tool for the fear of death with non-meditators.

Meditators it seems will still benefit from the VR application but can reach deeper levels of meditation without the VR. Additional research needs to be conducted to determine how the level of meditation practice affects the effectiveness of VR as a mental health tool for fear of death/existential fears and depression.

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