Self-compassion and Self-criticism: a Virtual Reality Intervention
Condition: Self-Criticism
Study type: Interventional

Summary: 
      The purpose of this study is to investigate two independent Virtual Reality interventions for
      self-criticism and self-compassion and the use of perspective-change in these interventions.
    

Detailed description: 
      The current study will use two novel Virtual Reality (VR) exercises that will be investigated
      through two independent sub-studies. First of all, an exercise that uses the CBT (Cognitive
      Behavioral Therapy) technique called 'Double standards'. People with excessive self-criticism
      often set higher standards for themselves, which makes them more critical towards themselves.
      A way to distance from this, to enable a more nuanced reflection, is to ask the patient what
      they would say to a friend having those same negative thoughts about themselves. Doing this
      utilizing a role play in a realistic VR environment of which the avatar has the
      characteristics of a friend, the effect could be even stronger. Furthermore, VR offers the
      chance to switch perspectives, in which the participants receive their own compassionate
      comments from the perspective of the friend, and experience themselves as a good friend.

      The second exercise, 'Self-criticism avatar', has common grounds with the (two-)chair
      exercises of schema therapy and the voice dialogue method in which a patient enters a
      dialogue between one's inner voices. In the VR exercise, the participant will be able to
      choose a virtual character with a voice that represents their own inner critic and that gives
      them their own self-criticism. By assertively and strictly speaking up to the inner critic,
      after which the virtual character becomes smaller and smaller until it backs down, the
      participant can experience a sense of control over their self-criticism, which leaves more
      room for self-compassion. A discussion with the inner critic enables a more nuanced image
      with more self-compassion. The switch in perspective after the role-play allows the
      participant to see himself/herself speaking assertively to the avatar, which can strengthen
      the increase in self-compassion and decrease in self-criticism.

      Switching of perspectives is a relatively new technique within VR, that can be of added value
      to regular psychological therapies. Regular psychological therapies use switching of
      perspectives by switching roles in a physical role-play between a therapist and a patient or
      in a group. Furthermore, imaginative switches of perspective are used in, for example, schema
      therapy or imagery rescripting. Even though this can bring new insight into another
      perspective, it is not possible to replay the role play where the participant can see
      himself/herself from someone else's perspective. This is, however, possible through VR.

      The current study will investigate the two beforementioned VR exercises using two independent
      sub-studies, to determine whether they contribute to self-compassion and if the switch in
      perspective is of added value. This will be done by comparing two conditions for each VR
      exercise; one with a switch in perspective and one without a switch in perspective. The study
      aims to answer the following research questions:

        -  Do the two VR-self compassion exercises have a positive effect on self-compassion
           (increase) and self-criticism (decrease)?

        -  Is the switch in perspective for the exercise 'Double standards of added value? In other
           words: is receiving one's own compassionate response of added value in addition to
           showing compassion to a vulnerable other.

        -  Is the switch in perspective for the exercise 'self-criticism avatar' of added value? In
           other words: is watching oneself in a strong and resilient manner of added value in
           addition to assertively speaking up to one's inner critic?
    

Intervention name(s): Double Standards; Self-criticism avatar
Intervention type(s): Behavioral; Behavioral
Intervention description(s): We created a VR intervention based on the Cognitive Behavioral Therapy (CBT) technique 'double standards'. In the intervention the participants have to respond to a virtual character they imagine as their friend, who expresses similar self-criticism as they struggle with themselves. Two role-plays are played in Virtual Reality (either with or without perspective change after the role-plays). In the perspective change condition, the perspective is changed with the virtual friend (second person perspective).; We created a VR intervention called 'Self-criticism avatar' that has common ground with two-chair dialogue. Participants have to assertively respond to their inner critic who criticizes them using their own self-critical thoughts. After responding assertively (for example: 'Go away, I don't need you', 'Good is good enough'), the virtual character becomes weaker until they give up. Two role-plays are played in Virtual Reality (either with or without perspective change after the role-plays). In the perspective change condition, the perspective is changed with a bystander (third person perspective).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Virtual Reality; self-criticism; self-compassion; perspective change; Cognitive Behavioral Therapy