Ultimate VR

Why train skills in XR

• train the untrainable

• more effective than conventional training

training the untrainable

• practically (astronauts) & theoretically untrainable (warzones)

  • issues regarding safety, difficulty & cost

how could XR be more effective than conventional training

• Combined technologies can provide performance feedback

• wow factor boosts engagement

• Everything is manipulable

measuring performance of skills

• interested in the transfer of skills to physical reality

• almost all CR training is indirect

good XR research should measure?

• learning (how much skills has improved in XR)

• transfer (how the training translates to physical reality)

when should we use XR for training 

• Feasible 

  • Can training be done without XR, is it expernsive, will the target group benefit

• transferable

  • can training transfer to the target skill, is it more successful

ideal process of training studies

1. baseline measures

2. blind participants randomisation 

3. different levels (XR, conventional, control)

4. post training & transfer test

5. retention test

probability of skills transfer in XR research depends on

• presence

• validity

• individual differences

presence in XR skills transfer

• immersion

• ease of interaction

• personalisation 

validity in XR skills transfer

• external validity

  • enviromental matching

• internal validity

  • thematic consistency

• physical validity

  • reality physics

individual differences in XR skills transfer

• XR experience

• cybersickness

• experience

• skills experience 

things which must be considered during XR research

• Exclude P w/high likelihood of experiencing cybersickness (e.g., previous history with similar technology)

• Measure any outcome-relevant variables at baseline

• Measure cybersickness symptoms throughout procedure (using biomarkers & self-report)

• Measure transfer & task performance at baseline and post-training Include an active control condition

• Measure presence & cognitive load throughout the procedure If possible, measure skill retention at follow-up

Is XR training actually any good (Bateman, 2005)

• metanalysis which used RCT that tested XR training of psychomotor skill

• passive controls (no training, waiting list)

• active controls (convectional training)

findings of Is XR training actually any good (Bateman, 2025)

• Consistent negative effect (not stat. sig.) of haptic feedback on psychomotor skill learning

• all models found significant positive effects of XR training over non-XR training on task performance 

  • XR more effective than other training interventions

• No clear relationships between methodological features and psychomotor skill learning

  • AR, VR

  • Type of skill (surgical, sport, music, etc.)

what factors predict learning 

• Conducted Bayesian Network analysis

role of haptic feedback

• negative feedback on learning

• haptic was too broad 

XR is not automatically superior in training

• its value depends on cost–benefit trade-offs for the specific skill and context

• it has to beat what you already do (sim labs, supervised practice, on-the-job training), not just “no training”

• worth it when it unlocks things you can’t do cheaply or safely otherwise

Bateman et al (2025)’s recommendations for XR training

• Better, more standardised RCT designs (dose, timing, controls).

• Routine pre-registration and full methodological + technical reporting.

• Systematic measurement of cybersickness and other confounds.

Makransky & Petersen – CAMIL (2021)

• VR is useful when you deliberately use methods that channel presence/agency into learning & manage cognitive load

• otherwise it can be flashy but inefficient

  • IVR can increases extraneous cognitive load compared w/flat-screen/multimedia if badly designed

VR is cognitively demanding

• learners must allocate attention

• manage navigation

• interpret unfamiliar cues

UX design aims to reduce cognitive load in VR

• ensuring predictable responses

• simpler interactions

emotions affect presence in VR

• if learner feels uncertain/overwhelmed → immersion breaks instatnly

what is good UX design

• freeing the brain so it can learn

• not being overwhelmed by cognitive interface

belonging in VR

• psychological safety + familiarity w/enviroment

• when discomfort drop = cognitive focus for learning

• moment headset is forgotten = absorption allowing presence

• belonging = environmental fit

safe-to-fail

what is interoception

• headaches, hunger proprioception

• sensing the inside 

interoceptive awarness

• how we know what’s happening and how we feel inside our bodies

• emotions

• social behaviour e.g self awareness 

Exteroception

• sight, sound, smell, touch taste

• sensing the outside

Interception & exteroception

• combined percept of the body in the world

• located in various brain regions, including the insula, anterior cingulate cortex, somatosensory cortices, thalamus, and brainstem

how do we measure interoception

• heart rate

motor contagion

• involuntary imitation based on observed movements

  • e.g yawning after watching someone else yawn

• consided behavioural manifestation of mirror neuron system

motor contagion supports

• communication

• social interaction

• interpersonal coordination

• motor learning

motor contagion modulated by

• embodiment perspective

• congruency 

body ownership

• phenomenological sense of ‘this is me’

• integrates multisensorial signals

• studies through behavioural, neuropsychological & neurophysiological methods

• e.g rubber hand illusion

motor contagion effects on biological movement actions during humanoid robot mirrored & embodied experiences

• previous work shows motor contagion with humanoids (face-to-face, 2nd person) & virtual hands (1st & 3rd person)

• gap on whether there is a sense of self vs sense of other 

research on the relationship between sense of self vs. sense of other when embodying a physically present humanoid robot

• examined: Perspective (1PP vs F2F), Motion congruency, Motor variability

• Participants stand in front of robot & mimic its motion

• consistent motor contagion 

  • congruent = lower variance

  • incongruent = higher variance

• 1st person perspective amplifies variance

  • suggests stronger motor resonance + altered ownership/agency relationship

interpretation of research on the relationship between sense of self vs. sense of other when embodying a physically present humanoid robot

• suggests flexible self-other boundaries 

• provides partial evidence toward

  • body ownership shift

  • Potential delusion of control framework

Interception, alexithymia & motor congruency in VR (Savickaite, Gupta, Kannan)

• Do interoceptive traits (and alexithymia) modulate embodiment in VR

  • especially when motor cues are congruent vs. incongruent?

• Measures

  • interoceptive awareness (Heartbeat Counting Task),

  • Alexithymia (TAS-20)

  • Body Ownership (questionnaire)

• VR

  • Hand-tracking; seated

  • congruent = avatar mirrors picture

  • incongruent = avatar performs opposition while user pinches

Body ownership (EBO) emerges from

• integrating interoceptive + exteroceptive cues

results of Interception, alexithymia & motor congruency in VR (Savickaite, Gupta, Kannan)

• Motor congruency effect

  • Higher ownership in congruent

• Interoception was positively related to ownership under congruent feedback

• Alexithymia didnt have a significant predictor of ownership; negatively related to interoceptive awareness

• Greater SD in the incongruent condition → heterogeneous responses to sensory–motor mismatch.

• Congruent visual–motor cues robustly enhance embodiment.

• Interoceptive awareness appears to support ownership when cues align

  • less influence when cues conflict

• Alexithymia may have a lesser impact on embodiment in motor-driven VR than in visuo-tactile illusions.

Limits of Interception, alexithymia & motor congruency in VR

• Modest sample; HCT validity debated

• questionnaire included some “third hand” items not perfectly matched to the display

• heterogeneous sample (incl. ADHD/ASD) without subgroup power.

implications of Interception, alexithymia & motor congruency in VR

• ensure motor congruency to strengthen embodiment in VR interventions 

• Training interoceptive awareness could enhance VR-based rehabilitation/therapy relying on body ownership

• Larger, balanced samples; multi-axis interoception (cardiac/respiratory/GSR); refined embodiment scales;

• full-body avatars - limited to hands

• objective motor accuracy; test motor contagion paradigms - limited studies

User engagement

• Smooth navigation and intuitive design are essential for keeping users engaged

• Tailoring the interface to user needs boosts satisfaction and compliance

Cross-Device Adaptability

• Responsive design ensures functionality across various devices

FrameVR, UX & accessibility 

Designing for the brain not the headset

• our job is to observe before we build

• understand their motivations, fears and mental models

• design the experience in their language at their pace through reality

UX/UI designer

• develop the future and what it would look like

• designing for the brain/person

• working closely with developers and the company

user persona

• a fictional, realistic character created from research to represent a specific segment of a target audience

• Behaviourally designed user persona = what would motivate them

• allows designs to develop scale

• wont always be told what people want

creating user persona

1. professional goals

2. behavioural lense & cognitve motivators

3. behavioural pains

4. descion making patterns 

5. adaptability & learning behaviour 

6. upspoken wishes

7. influnce opporunites 

rule of belonging

• Don’t focus on technology → focus on people

• helping users forget the hardware and feel at home in VR world

• humanise the journey of learning VR through a story

• Immersion starts when discomfort ends

• When they forget the headset exists, thats when the design begins to work 

Cinderella’s story 

safe to fail learning

• allows for improved confidence

• create checkpoints & clear progress cues to prevent feeling stuck

• predict frustration points & provide gentle help

• allow mistakes

• safety isn’t absence of risk = presence of trust

emotional connection in VR

• leads to stronger memory & retention

• brain suspends disbelief when tasks are meaningful & achievable

• When learner act in a professional rhythm, their focus narrows

  • flow state

rule of alignment

• when analytics look great but emotion disagrees

• a learner could complete all tasks but not want to do it again due to emotional detachment

Data shows performance; psychology reveals experience

• a perfect run in metrics may feel lonely

• align analytics w/emotional truth

  • Pair data dashboard with qualitative debriefs or sentiment surveys

  • watch body language

  • use trust indicators

trust indicators

• voluntary re-engagement 

behavioural designs 

• anticipating behaviour before it happens 

• every prompt should add

• subtle design interventions influence better descions without persuasion 

Use of AI

• designed to guide & not control to support confidence

• goal is to make users feel as though they are talking with a subject matter expert

• trained on verified souces

VR is cognitively demanding

• learners must allocate attention, manage navigation, & interpret unfamiliar cues

• UX design is to reduce cognitive load

  • predictable simple interactions

Emotions affect presence

• if a learner feels uncertain,self-conscious, or overwhelmed, immersion breaks instantly.

Good UX

• Freeing the brain so it can learn

• not cognitively overloading

Belonging in VR

• psychological safety + familiarity with the environment

• discomfort prevents learning

• forgetting HMD exists allows for attentional absorption

Safe-to-fail VR

• mistakes are expected and supported, not punished

• Predictability reduces anxiety

  • consistent interactions → learners explore more

• error based learning strenghtens memory

• trust stabilises attention

Flow

• psychological state of focus where a person becomes fully immersed in a task & loses awareness of time

data ≠ feeling

• Metrics show performance

• Emotions reveal learning potential

• may have flow during complex tasks but may no have high presence

Key Conditions for Flow

• The learner knows exactly what to do

• Actions produce meaningful responses

• Not too easy, not too difficult

Why Flow Matters in VR

• Enhances learning by sustaining attention

• Reduces cognitive noise & supports presence

• Improves motivation, engagement, & memory retention

• Encourages exploration & problem-solving in immersive environments.

Behavioural design in VR

• Familiar patterns reduce cognitive barriers

• Emotional engagement improves encoding specificity → stronger memory

• Narrative + urgency + closure = deeper learning

• UX shapes learning by shaping emotion

Claustrophobia & MRI

• sight of scanner

• 62% experience anxitey 

• coil placement

• entry in the scanner

• results in reduced scan quality

• means delayed diagnosis, poor experience and additional costs

How is Claustrophobia & MRI usually aided

• being shown around the scanner

• reliance on anxiolytics

  • overuse of drugs & don’t want to give

• lack of time pressure

  • arent ableto look around

what we know about MRI & claustrophobia (Hudson et al, 2022)

• Overall failure to scan rate 0.76%

• Equipment-related failure

  • Open scanner 3.72

  • UpRight scanner OR 0.59

• Exam related

  • Head-first 2.06

  • Head/Neck scan 8.40

• Patient related

  • 45-64yrs old 1.63

  • Female 1.25

  • NHS OR 1.44 – motivation!

• Cost: £549,760 in review

  • Potential £3.2 million + to NHS

Patient journey through MRI

• Many patients note the moment of positioning as memorable, as it is an opportunity for human interaction with another person at a time when they feel most vulnerable

Phobia

• an overwhelming and debilitating fear of anobject, place, situation, feeling or animal

Claustrophobia

• Fear of confined spaces

  • restriction

  • suffocation

Cleithrophobia

• Fear of being trapped and unable to escape

What Matters to Patients? (MRI)

• make it personal

• reduce noise

• need more support if they are panicked

• support with coping

How can we improve MRI

• contact whilst having scan and conversations

• vist before doesnt happen often and doesn’t help

why can VR help MRI phobias

• provides exposure/distraction

• accurate representation of sights & sounds

• shown to be as effective in vivo exposure therapy for many phobias

• opportunity to familiare/practice away from actual scanning lists without pressure

• potential for delivery of relaxation exercises

• non-pharmacological option

• shown to reduce anxiety

• more accesible

Modal model (Gross, 2015)

• how do we generate emotions

• sitaution = scan 

• attention = draws attention to whats happening

• appraisal = i cant do this

• response = leave or move too much

• usually fear or anxitey 

• strategies that may be applied can be regarded as ¼ types

BPSM Challenge & Threat

• individual assessment of

  • demands of situation (primary)

    • this is scary 

  • resources to cope (secondary)

    • can i cope with it 

• will result in 

  • challenge = high resource to cope & low demands

    • what do i do 

  • threat = low resources to cope & high demands

    • they leave

Fear to familiarisation - how can a virtual MRI scan experience support emotional regulation (Hudson, 2025)

• MRI can provoke anxitey due to unfamiliarity/claustophobia

• VR allievate prescan distress as its immersive

• Study examines efficacy of VR for reducing MRI anxitey

• All p lessended anxitey, increased confidence & decreased concern

• Repeated exposure lowered perceived anxitey & indicated faster progression through espcerience increasing familiarity and reducing avoidance

Results of MRI & VR study

• presence = feeling of being somewhere else

• interactivity = high engagement & control

• immersion = levels of sensory inputs

• behavioural consistency 

• made them feel real but improvements can be made

concern of VR & MRI

• Greatest concern over Restriction, less so over Suffocation

• ‘Unable to escape if I had to’

• Importance of being able to escape and see an escape route, even in VR– Cleithrophobia

confidence of VR & MRI

• Improved self-efficacy to cope

• greatest improvement in ‘being able to control fearful thoughts whilst in an MRI scanner’

• able to experience without being in a scanner

• useful preparation to understand what to expect

• provision of additional support 

MR in VR, demand resource evaluation – Challenge vs Threat

• significantly improved

• 6 p were originally in a state of threat 

• Put some did experience a rise in threat after 1st but not after the 2nd  

MR in VR – confidence (Hudson, 2025)

• greatest improvement was ability to control fearful thoughts

• able to experience without stress

MR in VR – avoidant behaviour (Hudson, 2025)

• p were quicker getting into the scanner the 2nd time around

• improvement

VR experience enhancement of MRI experience - future considerations

• sensory inputs

  • scanner noise, headphones

• engagement strategies

  • gamification, instructional content

• coping strategies

  • breathing & mediatation

• avatars

  • personalisation, embodiment

• passive haptics

  • couch use

Student Perspective –In Their Shoes

• found it useful for students to understand the experience of patients

Barriers to VR Implementation (Rizzo, 2017)

• awareness

• accessibility

• availability

• acceptability

• adaptability

• adherence

• affordability

conclusion of VR & MRI

• High level of realism & acceptance by participants

• Elicits emotional response which can be managed through reducing concern but mainly increasing confidence to cope

• Knowing what to expect and familiarise with environment

• Not for everyone – targeted use

• Provides a conduit for providing support away from clinical pressure –establish rapport and build trust

VR for MRI Preparation (Hudson, 2025)

• explored the acceptability of a VE as an alternative method to prepare patients, with a focus on participant feedback to inform future development

• 15 P underwent two exposures to the VE

• Feedback obtained supported perception of the VE to have been engaging, safe, and of benefit, with a willingness to use in the future.

• considered realistic, fostering acceptance & tolerance of the tool with a number of suggestions for improvement made

  • prefer use in a clinical setting w/staff support, rather than at home

• VR could become a commonplace means of patient preparation & help facilitate coping strategies before an actual scan

mixed methods study on practitioner perspectives on the acceptance of a VR tool for preparation in MRI (Hudson, 2023)

• A key part of a radiographer's role within MRI is providing the required emotional support to help patients succeed with a scan

• A mixed methods study was conducted looking at the use of a virtual scan experience for patients prior to MRI.

• 9 radiographers attended 2 focus group sessions to see the tool and undergo a virtual experience.

• Perceived usefulness, ease of use, attitude and intention to use were all positive towards the virtual scan tool

• All practitioners saw value in such a tool and how it could be implemented within practice, highlighting areas for improvement and development.

Understanding the human questions 

• collective of arts practitioners, academics and p w/lived experience of hearing, seeing and sensing thing other dont

Disruptive text 

• educational movement, which encourages teachers to challenge traditional literature curricula by centering culturally responsive and anti-racist texts and pedagogy.

Disrupting the disruptors

• Disruptive tech is more conservative than radical

  • a retrograde set of mechanisms for reproducing and imprinting the basic ideological assumptions of the age

• when applied to mental distress

  • techs regurgiate old delusions and norms 

methodology, ethics, politics 

• using creative methodologies in health research as a democratic mode for engaged research erodes the hierarchy between researchers and p 

AI acts as an actor

• programmed to recognise and respond to prompts

• creates hallucinations in sense of generation of false info, while in humans is perceived in something that isnt in reality

• both involve a disconnect in reality

• can express emotions it doesnt have

Weixbaum (1976)

• therapist not seeing their own presence and reality as forming part of the human interaction 

AVATAR therapy

• novel form of psychological therapy for voice hearing individuals 

• clinicians ventriloquise a hearer’s voice whilst operating a digital puppet (avatar)

• has human operators but created empathy allowing

• build an avatar to match what they can hear  

• series of interactions are staged 

  • based on things that the voices say

• individual is encouarged to push back and make it nicer