# Manipulating Stress Responses during Spaceflight Training with Virtual Stressors
###### Abstract  
Virtual reality (VR) provides the ability to simulate stressors to replicated real-world situations. It allows for the creation and validation of training, therapy, and stress countermeasures in a safe and controlled setting. However, there is still much unknown about the cognitive appraisal of stressors and underlying elements. More research is needed on the creation of stressors and to verify that stress levels can be effectively manipulated by the virtual environment. The objective of this study was to investigate and validate different VR stressor levels from existing emergency spaceflight procedures. Experts in spaceflight procedures and the human stress response helped design a VR spaceflight environment and emergency fire task procedure. A within-subject experiment evaluated three stressor levels. Forty healthy participants each completed three trials (low, medium, high stressor levels) in VR to locate and extinguish a fire on the International Space Station (VR-ISS). Since stress is a complex construct, physiological data (heart rate, heart rate variability, blood pressure, electrodermal activity) and self-assessment (workload, stress, anxiety) were collected for each stressor level. The results suggest that the environmental-based stressors can induce significantly different, distinguishable levels of stress in individuals. virtual reality; virtual environment; stress; spaceflight; training +
Footnote †: journal: Medical  
memory [7]. All these performance attributes may be critical for conducting an emergency procedure and avoiding harm. Developing strategies to train individuals for stress can reduce the impact on performance. The ability to train with stressors in VREs may provide a safe, reliable, and operationally relevant environment for training resilience in hazardous situations. Stressors are defined as stimuli that are appraised as a threat/challenge and elicit a stress response in humans [11]. Past research on stressful operations in VR has included aerial firefighting [12], municipal firefighters [13], first-responders [14], surgeons [15], and military [16]. Emergency operations can be trained for specific simulated tasks or stressors to strengthen transfer to the real world. Some researchers have found that coping skills developed in simulated stressful task environments may be retained and transferred to environments with novel stressors and novel tasks [17]. However, the high rate of individual variability in perception of stress and lack of understanding the underpinning of stressors, make challenges in manipulating human stress responses via exposure to different stressor levels. While some research exists on virtual reality training for spaceflight emergency operations [18; 19; 20], more research is needed on the stressors present in the emergency and how manipulating stressors in VEs can approximate the physiological and subjective responses expected during a stress response. The appraisal of a stressor cannot occur without experiencing a stressful event [21]. Therefore, task training that integrates stress management or graduated stress exposure often opt to experimentally induce stressful events [11]. This is advantageous with VR as the technology allows for experiencing a hazardous environment in a safe and controlled setting while measurements can be collected before the stress induction is divulged to the participant. However, the integration of VR with stress training has been limited by empirical research. As stated by [22], \"Most of the studies, in fact, have VR-based stress management training programs only in theory, without providing data about trials conducted to test the effectiveness of the proposed approaches\". The authors of [23] found that challenges exist in the selection of effective technologies for delivering stress training, methodological rigor of the training pedagogy, and multi-dimensional assessment of stress. Therefore, more research is needed to verify the efficacy for VR stress training, especially before integration with NASA skill training.