# Immersive Phobia Therapy through Adaptive Virtual Reality and Biofeedback
## 4 Testing the PhoVR System
### Results  
After applying the STAI questionnaire, we observed that most of the subjects, 16 out of the 19 participants, had high scores on the S-Anxiety scale (anxiety as a state). According to the interpretation instructions, increased scores on the S-Anxiety scale indicate a possible reaction in the case of exposure to situations considered dangerous from a physical point of view and to psychological stress, but it may decrease as a result of a therapeutic intervention. State anxiety is a \"transient\" anxiety, and it can be triggered and induced in an experiment or in everyday situations. Also, high scores were recorded in most subjects (16 out of the 19 participants) on the T-Anxiety scale (anxiety as a trait). This scale measures the stability of anxiety, that is, anxiety as a trait. High scores on this scale require a more complex evaluation because they can indicate depression. Comparing the scores of S-Anxiety (anxiety as a state) and T-Anxiety (anxiety as a trait), we obtained the following results:  
* Most subjects (16 people) had both anxiety as a trait and anxiety as a state;
* One subject with a high score (58) on the T-Anxiety scale (anxiety as a trait) had an average score (40) on the S-Anxiety scale (anxiety as a state), which can be interpreted as good self-control;
* One subject with an average score on the T-Anxiety scale (38) had a high score (50) on the S-Anxiety scale, which indicates that some situations can have a strong emotional impact on this individual;
* One subject had average scores on both scales, which indicates a balance in terms of anxiety. Based on these results, the psychotherapists selected the optimal virtual therapy scenario for each individual and performed one virtual therapy test session. At the end of the tests, the psychologists filled in a questionnaire that aimed to evaluate the level of realism of the therapy scenarios and their therapeutic efficiency, the facilities offered for patient and therapy session management, and they provided suggestions and comments to improve the system. None of the seven psychotherapists had ever used VR technology before in their therapy sessions. Six of them were inspired as a result of the experiment and expressed their desire to integrate VR technology occasionally in their current practice. Four out of the seven psychotherapists claimed that the control panel offers the functionalities necessary for patient and exposure session management, and three of them indicated that additional functionalities are necessary. All seven psychotherapists concluded that the biophysical data acquisition system is useful for monitoring the evolution of patients' emotional states. Achieving a high degree of realism is currently possible by generating the scenarios on a computer equipped with a powerful graphic card; however, the cost of the system would increase significantly. As a result, this option can be taken into consideration if the system is purchased by a clinical center that will later make it available to several psychotherapists. In the case of the session management module, the following additional functionalities identified by psychotherapists were mentioned:  
* Comments from each session should be made available in a more centralized way at the end of the patient file;
* An analysis of the patient's progress;
* A preconfiguration module for psychologists with different levels depending on the progress of the patient;
* Advanced search;
* Accessing past appointments. Four out of seven psychotherapists stated that the VR device and the biophysical data acquisition device do not affect the therapy process, while three psychotherapists indicated that they hinder the therapy procedure for certain patients. Five psychotherapists claimed that the exposure scenarios are a little artificial, but they are an accurate depictionof the real environment and adequate for therapy purposes.