This experiment was designed to examine whether self-conversation through embodied perspective taking (body swapping) might account for helping participants to overcome a personal problem, or whether the result found in the previous paper2 was only due to participants talking about their problem. We therefore compared two methods of counselling – either with a pre-scripted virtual Sigmund Freud, or a Freud in which the participants were embodied alternately with their own virtual representation, thus supporting a self-conversation. The results show a positive impact of the SC method compared to the S at the assessment point immediately after the VR. The combined variable (Y) representing the questions in Table 1 shows a high probability of the positive impact of the SC condition. At the assessment point one week after the VR session, compared to just before the VR session, there was a strong increase in the extent to which participants reported doing, feeling or thinking differently (the variable changes4) for the SC condition compared to the S. The SC method was associated with a positive increase in a combined variable based on the degree of help and the significance of the problem (the variable Yhelp4).

As would be expected, across almost all indicators, the initial level of distress (at InitialMeeting or PriorVR) is strongly positively related to the outcomes after the intervention. Moreover, irrespective of condition, the evidence suggests an overall reduction in distress. These results are well in accord with decades of research in the area of the efficacy of psychological interventions and treatments of all kinds, including clinical psychological methods that exploit VR23.

The results suggest that there were no marked differential effects of the S or SC conditions on the general clinically related psychological variables, and nor were such effects expected. The method was not designed to result in general psychological changes in participants, but these instruments were primarily deployed in order to check in case there might be (whether positively or negatively). There is evidence of a positive change irrespective of condition.

These results support the previous findings regarding the efficacy of the method2.

A simplified version of the self-dialogue method has also been used in24 with participants who had high levels of self-criticism. They first gave a speech, based on compassion therapy, to a virtual crying child where the child eventually stopped crying and appeared comforted, and then in the second phase were embodied as that child on the receiving end of the compassionate speech, after which the intervention ended. The same technique was later successfully applied to patients with depression25. They did not repeatedly body swap to maintain a conversation. The participants in these studies were not scanned, so that they were represented by an arbitrary virtual body. An area for further work is to understand the importance of the lookalike virtual body for the success of the paradigm.

The SC method provides one type of objectification of the distancing approach discussed in the opening paragraph, which has proven effective in dealing with personal problems or conflictual situations. For example, Kross and Grossmann26 carried out a study with college students who had recently failed to find a job. They were asked to consider their situation either from an immersed perspective (imagining the events as ‘unfolding before your own eyes as if you were right there’) or a distanced perspective (‘imagine the events unfolding as if you were a distant observer’). Compared to the immersed group, participants in the distanced perspective group were found to be more likely to show greater wisdom in their deliberations – greater ‘intellectual humility’ (recognising the limits of their knowledge), and ‘dialecticism’ (recognising that the future is likely to change). However, irrespective of the experimental condition, participants were generally more distressed after the experiment compared to the baseline. A similar technique was used for assessing the political situation in the United States, where participants were invited to consider this from a first person perspective as someone in the US, or from the imagined point of view of someone in Iceland. The results were confirmed – those with the distance perspective showed wiser evaluation of the situation compared with those in the immersed condition. As previously, participants nevertheless generally felt worse about the situation (in 2008) after compared to before the experiment under both conditions. This general reduction in positive affect found in these methods contrasts with the general positive effect of the method we have used.

In a further study Grossmann and Kross1 replicated Solomon’s Paradox - that individuals will reason more wisely about the problems of other people than their own. Participants were asked to reflect on how to respond to the discovery of the unfaithfulness of a romantic partner – either from the point of view that this was happening to themselves, or to a friend. Participants in the distance condition scored more highly with respect to a pre-defined specification of a wise response compared to those in the immersed condition. A follow-up study replicated this finding and showed that the wisest outcomes were made by those considering the situation as if it were happening to a friend, and with the distance perspective (talking about the situation by referring to ‘he’ or ‘she’ rather than ‘I’).

Solomon’s Paradox has also been replicated by Huynh, et al.27, where participants were asked to reflect on a personal conflict in which they were involved, or a conflict of one of their friends. The results also show that the difference between the immersed and distance conditions was diminished to the extent that participants pursued a higher level striving towards virtue (as assessed by a questionnaire).

Kross, et al.28 applied the distancing technique to participants experiencing depression. They pointed out that although generally when confronting personal psychological problems, it is typically beneficial for patients to analyse them, in the case of depressive patients this can lead to a cycle of increasingly negative thoughts that makes them feel worse. Depressed patients who were assigned to a distance perspective condition, with respect to an incident that made them feel overwhelming sadness, subsequently showed lower levels of depressive thoughts and negative feelings than those assigned to a self-immersed condition. There were no negative effects on a non-depressed control group.

Leitner, et al.29 shows that participants following a self-distancing technique when administering criticism tend to show decreased activity in the medial prefrontal cortex (MPFC), associated also with the giving of helpful feedback. This is similar to our argument in2 that the self-distancing involved in adopting the embodied standpoint of Freud would be likely to be associated with the ability to see the self and the problem from the outside.

A review of self-distancing theory and methods can be found in30. It has been applied to many situations – for example, helping people in the US cope with worries during the Ebola crisis31, coping with criticism29, post-traumatic stress disorder32, emotional regulation33, and it has been shown self-distancing can even reduce bias in assessing probabilities of lotteries34. Hence overall there is ample evidence that the self-distancing technique can result in positive outcomes with respect to decision making, conflict resolution and addressing personal and psychological issues.

Our embodied technique though is different to the method of self-distancing in several ways. The first, and most obvious is that the distance from the self is made explicit through being embodied in another character and actually seeing and hearing a representation of the self. Nothing is left to the imagination and the conversation is self-driven. Second, the self-distance technique compares first person perspective (from the point of view that ‘I’ is doing or thinking something) with a third person perspective (‘he’ or ‘she’ is doing or thinking something). The VR SC allows participants to alternately experience both first person perspective and a ‘second person perspective’ - from the viewpoint of another person rather than from the perspective of someone completely outside of the frame – it is ‘you’ are doing or thinking something, rather than ‘he’. Third, the VR technique results in a conversation, it is dynamic, involving voice and body movements rather than only thoughts. It is not a process of reflection, but one of dialogue. Fourth, the conversation is via a person, in this case, known universally as the founder of a school of psychotherapy. The previous study2 found that this was advantageous compared to the counsellor being another copy of the self. However, further work needs to be carried out in order to establish whether the representation of the counsellor as someone reputedly wise is essential, or whether it could just be another person. We would predict that the representation of the counsellor matters, and in another study we found that when participants are self-represented as Albert Einstein this improved their performance on a cognitive task compared to being represented in an anonymous virtual body of approximately their own age35, at least for participants with low self-esteem. However, further studies are needed to address this issue in the self-counselling context.

We argue that the embodiment technique includes elements that the distancing technique cannot. Participants - listening to their problem from the perspective of Freud, expressed from a virtual body that looked like themselves and with their own voice - could access information about their problem but from a different embodied perspective. It has been shown that embodiment as another person can lead to the internalization of the qualities associated to that person as mentioned in the introduction – that changing bodies, changes minds – for example Maister, et al.9. Prior beliefs associated to the ‘figure’ of Sigmund Freud (including idealization) might have enabled participants in the SC to reach a more objective and rational analysis of the problem leading to the decrease of negative automatic thoughts we observed in the results.

Moreover, when embodied in Freud, participants could perceive a representation of themselves speaking and moving (seeing the replay of what they had just said) from the perspective of someone else, including better understanding of the emotional issues involved. During the SC, participants could observe the mechanisms of their own behaviour as if it were the behaviour of someone else, which would have triggered psychological distance33. In this respect it is important to note that participants when embodied as Freud, addressed themselves as ‘you’, instead of ‘I’. It was shown by Dolcos and Albarracin36, that imagining giving an advice in the second person led to better performance and motivation than imagined speech in the first person. The important point is that the embodied method forces participants into this situation – they do not have to imagine it.

In contrasting the distancing technique with the VR embodiment technique we are not implying that one is preferable to the other. However, we are emphasising their fundamentally different ways of realising a similar underlying approach to personal problem solving. The two methods are complementary, but they are not rigorously experimentally comparable except in a very broad sense. The issue is that whereas in the embodiment technique the self-dialogue is explicit, in the distancing technique it is imaginal. We cannot know for sure the mental process that people enter into in the distancing technique beyond the instructions given to them. In the body swapping method, and indeed in the simpler scripted version, we know what was said by participants, how long they spoke, their voice inflection, and whether the conversation converged to a successful outcome. A rigorous experiment comparing the efficacy of the two techniques would have to try to control for many of these elements. It can be argued in any case that our method provides further confirmation of the success of distancing, but via another method of its realisation.

It is further important to note that we are not attempting to test the value of virtual embodiment for self-counselling in contrast to other methods. In fact the purpose was specifically to test the difference between two different versions of VR technology: a conversation with a virtual counsellor, and a conversation with a virtual counsellor where the participant was alternately embodied in their own and the counsellor body (body swapping). In each case the participants were embodied in virtual bodies that closely resembled their own appearance. From previous results2 we already had evidence that the body swapping technique can be effective. In particular we had shown that (i) body swapping is generally effective in the sense that independently of the experimental conditions participants generally improved in their response to their personal problem; (ii) these results were improved if the embodied counsellor was Freud rather than another self-copy; (iii) the results were improved when the participant was embodied as Freud with visuomotor synchrony (producing a strong body ownership over the Freud body). That previous experiment could not answer the question, however, as to whether the body swapping itself was important, or whether the results might be due to participants simply talking about their problem with a virtual counsellor. The specific issue of this new study was to address this question – rather than demonstrate the value of embodied VR technology in general – as to whether the body swapping technique is itself useful. The results together with the earlier study suggest that the body swapping is effective, rather than improvements only being caused by talking to a virtual counsellor.

Most of the effects we found were not overwhelmingly supported in terms of probability, although the posterior probabilities were high, and the credible intervals much narrower than the priors. The evidence does suggest that immediately after the VR session there was an important advantage of the SC method over the Scripting (Table 1), and absolute levels were impressive (Fig. 3), and one week after the VR session there was a substantial response by participants that they were thinking differently about the problem and that the method had helped (Table 2, Fig. 4).

An important follow-up from this study would be to examine the role of a professional with clinical or counselling experience. In this regard it should be noted that the problem definition was constructed after a semi structured interview performed by a clinical psychologist in the first session. The sentence that summarizes the problem was created following the ABCDE model37,38. It was focused on the “activating event/situation”, “the thoughts/beliefs about this event/situation”, the “emotional/ behavioural consequences”, and the goal of the participant regarding this problem. This standardized format chosen to define the problem can be considered as a limitation in terms of how common personal problems are expressed in their natural context, but this limitation was imposed for the sake of experimental rigor, in order to have homogeneity across individuals and between both conditions. Moreover, it was applied to all participants; therefore, it did not bias the effect in favour of one or other condition. Additionally, if this technique were to be used (after experimental validation) as an adjunctive procedure in real counselling or psychotherapy practice, therapists would not need to adhere to this standardized format and would be able to use their clinical skills to match the expressions and narratives of clients for a more attuned application of this tool. In this case, assuming good therapeutic alliance and therapeutic skills, we can reasonably speculate that outcomes would be better than in the rigid experimental application of our study.

Following on from this an important issue is whether it would be advisable to allow people to use this method unsupervised, or whether a clinical psychologist is always needed. We have no evidence on this, and it was not at all addressed in the current study, but amongst the many people who have experienced a demonstration of the system (under non-experimental conditions) very few have found themselves ‘stuck’ – not knowing what to say, or quickly running out of things to say, when embodied as Freud. In one example, the dialogue at first spiralled out of control, with the participant becoming more and more angry with himself, until the demonstrator gave him some advice about how to approach this method39. Another illustration of the method at work can be found in40 where the participant reportedly resolved an issue about guilt. Based on our experience with this method, we believe that the framing of the problem itself is likely to be vital, and initial guidance to participants about how they might engage in the session is likely to be important at least for some. However, it is feasible that eventually this guidance could itself be integrated into the system, following on the lines of the cognitive behavioural therapy for fear of heights accomplished with a virtual counsellor41.