Is your virtual self as sensational as your real? Virtual Reality: The effect of body consciousness on the experience of exercise sensations
Introduction
Experiencing pain causes discomfort to the individual as a result of actual or believed tissue injury (Merskey & Bogduk, 1994). As such, pain is both nociceptive and subjective, with the same sensory signal giving rise to different experiences of pain intensity across individuals and situations. Research has shown that psychological factors, such as expectations based on visual information, play a vital role in pain experience (Bayer, Coverdale, Chiang, & Bangs, 1998; Ohrbach, Crow, & Kamer, 1998; Zatzick & Dimsdale, 1990). Moreover, although not all pain represents a danger to the body, the experience of pain may lead to undesirable behavior change. For example, the naturally occurring pain caused by vigorous exercise does not pose physical harm but it may still cause people to steer clear from exercise in order to avoid the painful experience (Mauger, 2014).
Recent research has shown that beyond expectations created on the basis of visual information, the level of pain one experiences depends on other factors such as Private Body Consciousness (PBC), i.e., how well one is aware of internal bodily sensations (Bekker, Croon, van Balkom, & Vermee, 2008; Haugstad et al., 2006; Miller, Murphy, & Buss, 1981). Indeed, studies with both clinical patients and healthy participants have shown that individuals scoring higher on a PBC measure reported greater frequency and intensity of pain symptoms compared to those with lower scores of PBC (Ahles, Pecora, & Riley, 1987; Ferguson & Ahles, 1998; Martin, Ahles, & Jeffery, 1991; Mehling et al., 2009; Pincus, Burton, Vogel, & Field, 2002). These findings suggest that effectiveness of interventions aimed at reducing pain sensations may depend on an individual's PBC level. In the present study we investigate this hypothesis, for an intervention that relies on Virtual Reality (VR) technology.
VR allows users to experience a computer-simulated reality based on visual cues, enhanced with auditory, tactile and olfactory interactions (Li, Montaño, Chen, & Gold, 2011). In recent years, low-cost consumer VR gear has become widely available (e.g., Google Cardboard, Gear VR, Oculus Rift, HTC Vive1), providing a wide range of opportunities for applications, including interventions for reducing exercise-related pain and effort.
Indeed, research shows that VR technology may provide an alternative solution to pain management that does not rely on the use of pharmacological analgesics (Mahrer & Gold, 2009; Malloy & Milling, 2010; Matsangidou, Ang, & Sakel, 2017; Morris, Louw, & Grimmer-Somers, 2009). Although VR has been shown to be effective in reducing the feelings of pain and effort (Matsangidou, Ang, Mauger, Otkhmezuri, & Tabbaa, 2017), the mechanisms by which it does so, remain largely unknown. One possibility is that VR reduces the amount of attention that is allocated to the sensory signal of pain. Our attentional resources are limited and to cope with the vast array of information that gets registered by our senses at any given point in time, we must select only the information that is relevant to our goal and ignore the rest (e.g., Wickens, 2008.) VR provides the senses of the user with a multitude of information while at the same time prevents access to his/her body. This allows the user to be immersed in the virtual environment and disconnect from the actual surroundings (e.g., Eichenberg & Wolters, 2012). As a result, attentional resources may be diverted away from the pain signal, reducing thus the experience of pain (Gold, Belmont, & Thomas, 2007; McCaul & Malott, 1984).
If indeed VR helps to distract users away from the pain signal, then its effectiveness for reducing the feelings of pain would depend on how well the user can inhibit information about his/her body and how well s/he can immerse in the virtual environment. Given that people with higher PBC are believed to be better attuned to their internal physiology and are more affected by nociceptive stimuli (Fenigstein, Scheier, & Buss, 1975; Miller et al., 1981), it may be that VR is less effective in reducing their pain and effort perception compared to those with low PBC. This hypothesis has not yet been tested as, to our knowledge, no study so far has investigated whether PBC can moderate the positive effect of VR on exercise-related pain perception. Therefore, the goal of the current study is (1) to verify that VR can be effective in reducing the feeling of exercise-induced pain, and (2) to examine whether its effect depends on PBC. If PBC influences the levels of presence/immersion in the virtual environment and as a result the attention allocated to pain signal, participants with low PBC scores are expected to report less pain and effort compared to participants with high PBC scores. Alternatively, if PBC does not moderate the effect of VR, based on past VR studies enhanced with several psychological intervention strategies (Mahrer & Gold, 2009; Malloy & Milling, 2010; Morris et al., 2009), we still expect the VR group to report lower pain and effort than the non-VR control group.
Section snippets
Participants
Twenty-one males and 59 females, with a mean age of 23 years (SD = 5) participated in the study. Participants' one-repetition maximum (1RM2), for 180° of dominant arm elbow flexion ranged from 5 to 30 kg, with a mean at 11.9 kg (SD = 6.2). More than half of the participants reported not engaging in regular (3–7 days per week), structured resistance or aerobic exercise (no regular resistance training = 52/80, no regular aerobic training = 51/80 during the
Results
To evaluate the main hypothesis of the study, i.e., that the influence of VR on time to exhaustion (TTE), pain (PIR1 and PIR2, and mPIR) and effort (RPE1, RPE2, mRPE) perception depends on PBC, we conducted a series of one-way ANCOVAs. Additional one-way ANCOVAs were also conducted on ISO HR (HR1 and HR2), mean (mHR) and on end of exercise (fHR) variables, with VR condition as the independent variable and the PBC as a covariate. We present these analyses for each measure of interest.
Discussion
The aim of the present study was to examine whether VR technology reduces the perception of pain and effort during exercise and whether PBC moderates this effect. Findings revealed that VR was effective in reducing exercise-induced pain for this sample of 18–45-year old adults of both genders. Indeed, results showed a substantial decrease in participant PIR and RPE during exercise in VR compared to the control condition of exercise without VR. Notably, this was apparent from the first minute of
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