Prof. Mariano Alcañiz’ s team has pioneered in applying immersive technologies – notably virtual reality (VR) and augmented reality (AR) – to clinical psychology and mental health interventions. Over the past two decades, his interdisciplinary work has integrated engineering innovations with psychological therapy techniques, leading to new treatment modalities for anxiety disorders, stress-related conditions, and other mental health challenges. A defining feature of his contributions is the emphasis on Virtual Reality Exposure Therapy (VRET) and telepsychology, where VR environments and internet-based platforms are used to treat patients remotely. He has co-developed novel therapeutic systems and conducted rigorous clinical studies demonstrating the efficacy of these technologies. Importantly, his work has introduced methodological innovations (such as objective psychophysiological assessments and adaptive virtual environments) and addressed real-world clinical needs (making therapy more engaging, personalized, and accessible).
Pioneering Virtual Reality Exposure Therapy for Anxiety Disorders
One of Prof. Alcañiz’s earliest breakthroughs was the use of VR to deliver exposure therapy for anxiety disorders, particularly phobias. In the late 1990s, he and his collaborators (including clinical psychologists) conducted some of the first case studies showing that VR could successfully treat phobic fears. For example, in a seminal 1998 case report on claustrophobia, a 43-year-old patient underwent eight sessions of VR-based graded exposure to confined spaces. The outcome was a significant reduction in the patient’s anxiety symptoms, which was maintained at a one-month follow-up. This study was among the first to demonstrate the efficacy of VR exposure as a stand-alone treatment for a phobia, with all standard clinical measures of claustrophobic fear improving after the VR sessions. The success of this case illustrated that a purely virtual experience – navigating simulated enclosed environments – could recreate enough fear to systematically desensitize the patient, overcoming a major limitation of traditional in-vivo exposure (which can be impractical or intolerable for some situations). The authors noted that VR provided a safe yet realistic context for confronting the fear and discussed the need for a solid theoretical framework to guide this new therapy medium. Prof. Alcañiz’ s role in this work was crucial from the technological side: designing realistic virtual environments that could trigger claustrophobic responses and be controlled gradually by the therapist. This early contribution laid the groundwork for treating phobias with VR and underscored the importance of interdisciplinary collaboration between engineers and clinicians in developing evidence-based VR treatments.
Building on that initial success, Prof. Alcañiz expanded VR exposure therapy to other specific phobias. A notable example is the fear of flying (aerophobia), a challenging phobia to address with real-life exposure due to the cost and logistics of repeated flights. In a 2002 study on flying phobia led by Alcañiz’s team, various aeroplane-related VR scenarios were created – such as sitting in a virtual airliner during takeoff, experiencing turbulence, and landing – allowing patients to confront their fear in a controlled, virtual setting. The study’s introduction highlighted the unique value of VR: it can generate significant fear-inducing environments while the patient remains safe in the therapist’s office. This paper presented the first clinical results supporting the effectiveness of VR for fear of flying, using a multiple-baseline design to show that anxiety symptoms decreased with VR treatment . VR overcame many practical hurdles of traditional exposure: patients could experience takeoffs and landings repeatedly without leaving the ground, and the level of exposure could be tuned (e.g. simulating mild turbulence versus severe turbulence) to match the patient’s progress. By 2007, these efforts culminated in a rigorous controlled trial for panic disorder with agoraphobia – a condition where patients fear panic attacks and often avoid places where escape is difficult. In this between-subject study, 37 patients were assigned to either VR exposure therapy (VRET), traditional in vivo exposure, or a waitlist control. Prof. Alcañiz co-developed the VR scenarios for panic symptoms (such as virtual crowds, elevators, or underground stations that might trigger panic) and ensured they were therapeutically graded. The results were encouraging: VR exposure was superior to the waitlist and produced outcomes equivalent to in vivo exposure, with improvements maintained at 12-month follow-up. In other words, the efficacy of VRET matched the gold-standard of real-life exposure for panic/agoraphobia, providing strong clinical validation for the approach. Notably, about a quarter of patients with severe panic disorder typically refuse or drop out of in vivo exposure due to high anxiety; VRET offers a less daunting alternative since patients know the scenario is simulated yet still react emotionally. The 2007 trial, which was part of the EU-funded “VEPSY” project, demonstrated that VRET’s benefits persisted long-term. It highlighted practical advantages: therapists can recreate scenarios (like a crowded bus or a subway ride) on demand, repeat them as often as needed, and adjust difficulty in real time, features not easily achievable with traditional exposure. This controlled study – among the first of its kind – firmly established Prof. Alcañiz and colleagues as leaders in evidence-based VR therapy, showing that immersive digital environments can effectively treat anxiety disorders. These findings have since been echoed by other researchers and meta-analyses confirming that VR exposure is on par with in vivo exposure for phobias, a paradigm shift in clinical psychology that can be traced back to the foundational work in which Alcañiz was instrumental.
Telepsychology and Internet-Based Therapy Innovations
While VR therapy initially took place in specialized labs or clinics, Prof. Alcañiz recognized early on the potential of the Internet to make these interventions more accessible. He contributed to telepsychology innovations that enable patients to engage in therapy remotely or with minimal clinician contact, an approach that foreshadowed the now-common online therapy platforms. In 2003, Prof. Alcañiz co-authored one of the first implementations of an Internet-based telehealth system for agoraphobia. This system was developed under the European project VEPSY Updated and allowed patients to continue VR-enhanced treatment from their home computers as a complement to in-office therapy. The architecture was innovative: during initial sessions at the clinic, the therapist would use VR to expose the patient to anxiety-provoking situations (for example, virtual open spaces or public transit for agoraphobia). Then, for home-based therapy, the patient received a structured online program – named Agoraphobia@Home (as part of VEPSY) – which included psychoeducational modules, relaxation training, and VR exposure exercises that could be run on the patient’s PC. Prof. Alcañiz’s team ensured that the same virtual environments used in the clinic were adapted for home use, but subdivided into smaller, self-guided exposure steps to suit remote delivery. Critically, the system incorporated a secure database on a remote server to track the patient’s progress and responses, allowing the clinician to monitor and regulate the therapy stages through an internet connection. A patient could only access the next VR exposure level after uploading their progress and receiving approval, enforcing therapist oversight despite physical distance. Moreover, to maximize accessibility, the home-based VR did not require any expensive hardware – head-tracking was simulated via mouse or keyboard, so patients only needed a standard PC. This early teletherapy platform demonstrated that remote VR exposure is feasible and can be seamlessly integrated with traditional therapy. It was a significant technological innovation addressing the geographic and scheduling barriers to treatment: patients who could not regularly travel to a clinic (especially relevant for agoraphobia sufferers) could still benefit from high-quality exposure therapy under supervision. Prof. Alcañiz contributed chiefly to developing the VR software and networking solution that made this telepsychology approach possible. The 2003 pilot results indicated that patients could use the system successfully and showed symptom reduction, laying the groundwork for future internet-delivered interventions.
A few years later, Prof. Alcañiz extended the telepsychology concept to self-help therapy programs that required little or no therapist contact – an approach to improve the dissemination of empirically supported treatments. In 2008, he co-authored a paper on “Telepsychology and self-help: the treatment of phobias using the Internet,” which introduced a completely self-applied online program called “Without Fear”. This program targeted small animal phobias (spiders, cockroaches, and mice), and it was structured so that users could go through the entire treatment protocol on their own, with the aid of virtual environments for exposure. The rationale, as described in the publication, was to reduce barriers to care – many people with treatable phobias never seek therapy, so an internet-based self-help solution could reach a broader population. The Without Fear program consisted of multiple components delivered via a web interface: education about phobias, anxiety management techniques, and a series of VR exposure exercises that gradually introduced the feared animal in more challenging contexts. Prof. Alcañiz’s lab provided the VR scenario development – for instance, a virtual kitchen where a spider might appear at increasing proximity or a virtual living room where a cockroach might crawl out, all rendered in 3D and viewable on a home computer. The program automated the progression, requiring users to successfully cope with one level (e.g., seeing a spider at a distance) before moving to the next (closer or more spiders), essentially an adaptive exposure hierarchy managed by software. A preliminary trial with 12 participants was reported: all participants showed improvement in clinical measures after completing the online VR-enhanced self-help program, and these gains were maintained at a 3-month follow-up. The success across cases provided early evidence that internet-delivered VR therapy could be effective even without real-time therapist involvement. This methodological milestone was combining VR with a self-help paradigm – requiring careful design to ensure safety (e.g., clear instructions, panic buttons to exit VR if overwhelmed) and engagement (game-like elements to motivate users). Prof. Alcañiz’s interdisciplinary expertise was key to creating a user-friendly VR application that phobic individuals could navigate independently. The Without Fear project demonstrated the practicality of scalable digital therapies, anticipating the current trends in online cognitive-behavioural therapy (CBT) and VR apps for mental health. It also underscored a clinical innovation: therapy could be “installed” at the patient’s home, widening access while still achieving significant fear reduction.
Around the same time, Alcañiz contributed to an Internet-based therapy for a form of social anxiety, namely fear of public speaking. In 2010, a controlled trial was published evaluating an online self-administered treatment for public speaking anxiety that incorporated VR scenarios. Prof. Alcañiz co-developed the VR content for this system, which likely featured virtual audiences and podium environments to simulate giving a speech. The trial compared a group receiving the VR-enhanced self-help treatment against a control group and found that the treatment group achieved significantly greater reductions in public-speaking fear and anxiety symptoms. This work expanded the scope of telepsychology from specific phobias to social phobias, showing that even complex anxiety problems could be addressed with minimal contact interventions when enriched by VR. By deploying virtual audiences over the internet, Alcañiz and colleagues allowed individuals to practice speeches in front of lifelike avatars at home, an innovative and highly practical approach for users (who could repeat sessions as needed, at their convenience). The success in public speaking fear further cemented the idea that telepresence can substitute for real presence in exposure therapy – patients felt enough social evaluative threat from virtual humans to experience and overcome their anxiety. These telepsychology projects spearheaded by Prof. Alcañiz broke technological ground and had a clear clinical vision: to make effective psychological therapies widely available and cost-effective. The importance of this work became even more evident in the following decade as remote therapy solutions gained prominence. Prof. Alcañiz ‘s early contributions in this arena illustrate an ahead-of-its-time integration of VR with e-health, balancing sophisticated software engineering (e.g., remote data synchronization and user authentication for VR content) with user-centric therapeutic design.
Augmented Reality and Multimodal Therapy Approaches
In addition to fully virtual environments, Prof. Alcañiz explored augmented reality (AR) as a tool for mental health therapy. AR differs from VR in that it overlays virtual stimuli onto the real world, which can be advantageous for certain phobias where seeing the feared object in one’s environment might enhance realism. Around the mid-2000s, AR technology became viable for research, and Alcañiz was among the first to apply it in clinical psychology. A 2005 study by Juan, Alcañiz, and colleagues demonstrated the use of AR for treating phobias. In this work, patients with phobias (for example, fear of small animals or insects) wore a see-through head-mounted display or used a tablet through which they could see their real surroundings with virtual spiders or cockroaches superimposed. The study showed that AR exposure could induce anxiety and that patients treated with AR reported reductions in fear, suggesting AR is a viable alternative to VR or in vivo methods. One advantage noted was that AR preserves the context of the patient’s real environment – for instance, a spider appears to crawl on the patient’s own desk – potentially increasing the sense of presence and relevance of the exposure. Prof. Alcañiz’s team had to solve technical challenges such as accurate tracking (so virtual creatures would appear anchored to real surfaces) and ensuring the virtual stimuli looked realistic enough to provoke fear. By successfully creating these AR scenarios, the project introduced Augmented Reality Exposure Therapy (ARET) to the toolkit of psychological treatments.
Following this proof-of-concept, Prof. Alcañiz contributed to more focused AR therapy applications, including a system specifically designed for cockroach phobia. In 2010, Bretón-López, Alcañiz, and colleagues published a validation of an AR system for cockroach phobia. Using a head-mounted display, the system presented a virtual cockroach in real-world locations (e.g., a table or the floor in front of the patient). The researchers found significant fear reduction after AR exposure sessions in a controlled experiment. This study was one of the first to formally test AR’s efficacy for a specific phobia, and it demonstrated measurable improvements in standard fear and avoidance scales. The clinical significance was that some individuals who refused to handle even a toy cockroach initially could cope with a realistic AR cockroach after gradual exposure, mirroring the outcomes of VR-based exposures. Alcañiz’ s involvement ensured that the AR technology was robust and user-friendly; for instance, virtual cockroaches were programmed with lifelike movement patterns to elicit disgust and fear authentically, and the therapist could adjust the size or number of cockroaches via the system’s interface. This work also highlighted a methodological innovation: using augmented reality for one-session treatments. AR can be set up quickly in any room and doesn’t require the full immersion of VR, so it proved convenient for short, intensive therapy sessions that some phobia treatments favour. The successful AR phobia trials led by Prof. Alcañiz and collaborators positioned AR as an evidence-based tool in mental health, expanding the repertoire beyond VR. Indeed, subsequent research (by other groups inspired by this work) confirmed that AR exposure therapy could be highly efficacious, sometimes even in a single session for small animal phobias.
Prof. Alcañiz also pursued multimodal approaches that combine VR/AR with other technologies to enhance therapeutic outcomes or to validate them scientifically. A striking example is his co-authorship of a neuroimaging study in 2014 that used VR to study the neural correlates of phobic responses. In this study (Clemente et al., 2014), participants with small animal phobia were placed in an fMRI scanner while exposed to spiders or cockroaches through a VR environment. The objective was to verify that VR stimuli elicit real fear-related brain activation, thereby lending neurobiological credence to VR therapy. The results showed activation in regions associated with visual attention (occipital cortex) and self-awareness when the phobic participants encountered the virtual animals. The patterns were consistent with those observed in previous studies that used static images of the feared objects but with the added ecological validity that the subjects felt present in a scenario with the phobic stimulus moving around them. This demonstrated that VR is not only psychologically effective but also engages the brain’s fear circuitry in a manner comparable to real-life exposure. From a methodological standpoint, it was an important validation of VR’s authenticity: therapists and patients can trust that the anxiety in VR is tapping into the same neural pathways as anxiety in vivo. Prof. Alcañiz’s contributions to this study likely involved adapting VR for the MRI environment (e.g., using specialized VR goggles or a projection in the bore and ensuring no ferromagnetic components) and integrating biosignals with VR events. The study concluded that VR provides an immersive yet controlled way to study and treat phobias, offering “an environment closer to the real situation the subject would face in daily life” while still being compatible with laboratory measures. This blend of immersive tech with neuroscience exemplifies Prof. Alcañiz’s interdisciplinary impact – he helped show that virtual exposures are grounded in objective biological responses, silencing sceptics who thought VR fears might be “not real.” It also opened the door to using brain imaging and physiological sensors in therapy (for example, monitoring a patient’s heart rate or galvanic skin response in VR to gauge anxiety), a concept Alcañiz has advocated in various projects.
Another inventive approach was using “projective augmented reality” for phobias, as seen in a 2015 single-case study by Wrzesien, Alcañiz, and colleagues. In projective AR, instead of the user wearing a headset, the environment is augmented via projectors – for instance, projecting a life-sized spider onto a real wall or floor. The 2015 study treated a patient’s small animal phobia by projecting virtual stimuli into a therapy room, creating an illusion of the feared animals being physically present. The case showed positive therapeutic outcomes, with the patient’s fear markedly reduced after the AR sessions. This technique has practical clinical value: multiple people (therapist and patient) can see and interact with the augmented content simultaneously without head-worn devices, and the patient remains grounded in a familiar real space (which can ease the transition to real-world exposures). Prof. Alcañiz’s involvement in such a cutting-edge method underscores his drive to explore all avenues of immersive tech for mental health. Projective AR required solving calibration issues and creating high-quality 3D models visible under various lighting, which his technical team achieved. The single-case nature of the 2015 report suggests this was a preliminary demonstration. Still, it points to a future direction where therapy rooms become part of the technology, an idea very much in line with Alcañiz’s vision of blending the physical and virtual for therapeutic gain.
In summary, Prof. Alcañiz’s contributions to AR and multimodal therapy enriched the field of exposure therapy by adding new dimensions of reality and measurement. AR provided a bridge between virtual simulations and real-life context, potentially increasing patient comfort and acceptability. Integrating VR with objective measures (like fMRI and likely other biometrics) was a methodological innovation that improved how we validate and refine these therapies. Through these works, Alcañiz and colleagues demonstrated a comprehensive approach: not just treating symptoms but also understanding the underlying mechanisms (e.g. confirming the activation of fear centers in the brain) and improving the tools available to clinicians (e.g. AR systems that can be used in ordinary clinic rooms). This holistic approach has influenced many subsequent projects in tech-assisted psychology, cementing Prof. Alcañiz’s reputation as a technical innovator and a clinical researcher in mental health technology.
Virtual Environments for PTSD and Stress-Related Disorders
Beyond phobias and anxiety, Prof. Alcañiz applied immersive technology to posttraumatic stress disorder (PTSD) and other stress-related conditions, areas where virtual environments can be used to recreate trauma cues or stressors under controlled conditions safely. A hallmark contribution here is the development of the EMMA Project and its resulting system known as “EMMA’s World.” The EMMA Project (Engaging Media for Mental Health Applications) was a multidisciplinary effort in the early 2000s that Prof. Alcañiz led, aiming to use VR to treat emotional disorders by harnessing patients’ emotional engagement and sense of presence. EMMA’s World is a flexible VR system for the therapy of PTSD, grief, and adjustment disorders, built on the idea that virtual experiences can be tailored to each patient’s unique emotional needs. Technologically, it allowed therapists to create virtual scenarios populated with symbols and metaphors related to a patient’s trauma or loss. For example, a patient processing grief might be guided to place meaningful objects or images representing their loved one into a virtual environment, or a PTSD patient could gradually approach a representation of the traumatic event in a symbolic form (such as navigating a war-torn virtual city for a combat veteran, or a virtual roadside for a car accident survivor). Prof. Alcañiz’s team provided the engine for these customizations: an adaptive display system that could be configured for different trauma narratives. A 2010 publication described this as “an adaptive display for the treatment of diverse trauma PTSD victims,” indicating that the VR system was designed to be content-flexible. In practice, EMMA’s World contained a library of virtual settings (parks, rooms, landscapes) and a palette of objects (photographs, written phrases, avatars, etc.) that could be introduced as per the therapeutic conversation. This was a significant innovation – unlike phobia VR, which typically uses standardized stimuli (e.g. a virtual airplane is similar for all fear-of-flying patients), EMMA’s World was highly individualized and emotion-focused. It was one of the first VR systems to explicitly incorporate the patient’s emotional context (hence “Emotions as a Determinant of Presence,” the subtitle of one of Alcañiz’s papers on EMMA. Technologically, ensuring that these custom elements could be easily inserted and that the patient could interact with them (for instance, picking up a virtual letter to symbolize saying goodbye) required sophisticated yet user-friendly design – a testament to the LabHuman group’s expertise under Alcañiz.
To evaluate this approach, Prof. Alcañiz and collaborators conducted a controlled trial for treating stress-related disorders (including PTSD, as well as pathological grief and adjustment disorder) using EMMA’s World. The preliminary results were published in 2011 and provided a head-to-head comparison between standard cognitive-behavioural therapy (CBT) and CBT enhanced with EMMA’s World VR exposure. In this study, 39 participants with various trauma-related disorders were randomized to either traditional therapy or experimental therapy that used EMMA’s World as a component. Therapy outcomes were measured in terms of reductions in anxiety, depression, maladaptive trauma coping, and daily functioning interference. The findings were very promising: the VR-enhanced therapy was as effective as standard CBT and, in fact, led to additional improvements in certain measures (). Specifically, the group that used EMMA’s World showed a greater reduction in depression levels and higher relaxation and reported less interference of symptoms in social activities compared to the group that received CBT alone. No adverse effects were noted, indicating that patients tolerated and appreciated the virtual approach. One interpretation of these results is that immersive therapy increased emotional engagement, thereby facilitating the processing of traumatic memories more deeply than talk therapy alone – for example, walking through a symbolic representation of one’s trauma in VR might evoke emotions that can then be addressed and alleviated. Another factor could be personalization: patients often felt the virtual space was “their own world” where they could externalize thoughts and emotions. This was a groundbreaking outcome from a clinical perspective: it suggested that a well-designed VR system can augment established psychotherapy and potentially improve outcomes. Prof. Alcañiz ‘s contribution on the technological front (creating a stable, user-customizable VR platform) directly enabled this clinical advance. It also was an early instance of a “digital therapeutic” passing a controlled trial benchmark in mental health. EMMA’s World illustrates how Alcañiz’s work did not stop at phobias; he ventured into complex disorders that involve memory, emotion, and cognition, bringing innovation there as well.
Another key innovation in the EMMA project was the concept of “personalized virtual therapy displays.” Traditional PTSD therapy often uses imaginal exposure (having the patient visualize or recount the trauma) or in vivo exposure to safe reminders of the trauma. EMMA’s World took this further by providing a mid-way point between imagination and reality: a virtual sandbox where patients and therapists could collaboratively place trauma cues. For instance, the therapist could introduce a virtual object that represents the traumatic event (like a virtual car for a motor vehicle accident survivor) and then adjust aspects of it (maybe time of day, or sudden sounds) to trigger manageable levels of distress in the patient as they narrate their experience. This adaptive control of stimulus intensity was reported in the literature as a novel feature, and it resonates with Prof. Alcañiz’s earlier work on adaptive VR for anxiety. In fact, a through-line in his career is using feedback and tailoring in VR, whether it’s breaking down agoraphobia exposure into levels for teletherapy or, here, adjusting trauma simulations to the individual. The EMMA system exemplified this by allowing flexible, therapist-guided changes in the virtual environment in real-time – essentially an early example of therapist-in-the-loop VR. Technologically, implementing such adaptability requires foresight in design. Prof. Alcañiz ensured EMMA’s World was built on a modular architecture. New elements could be introduced without rebuilding the environment, and patient data (e.g., which objects have been confronted) could be logged for each session.
From a clinical impact viewpoint, Prof. Alcañiz’s contributions to PTSD and stress disorder therapy via VR have expanded what clinicians can do. The fact that EMMA’s World showed equal or superior results to gold-standard therapy is a compelling argument for the broader adoption of VR in clinics. It provides an option for patients who might be unwilling to vividly describe their trauma verbally – instead, they can let the VR scenario represent it and gradually engage with it. Moreover, EMMA’s success in pathological grief (an area with limited treatment options) opened a new therapeutic avenue: using VR for bereavement therapy, where patients could, for example, have a symbolic farewell in a virtual setting to gain closure. Prof. Alcañiz’s work, therefore, not only improved treatment for existing patients but also potentially attracted individuals who otherwise would not seek therapy. The 2011 study authors noted that VR might draw in clients who avoid conventional therapy because the medium itself (a high-tech, game-like environment) can be intriguing or reduce the stigma of “therapy” (). This insight aligns with Alcañiz’s long-standing goal of making mental health treatment more engaging and less intimidating through technology.
In summary, in the realm of PTSD and stress disorders, Prof. Alcañiz has improved emotion-centered VR therapy, introduced systems that allow personalized virtual healing spaces, and demonstrated through clinical trials that these systems can stand toe-to-toe with (and sometimes enhance) traditional therapy. The EMMA project and related publications are a testament to his propelling clinical innovation: moving beyond treating overt fears to address deeper emotional traumas with immersive tech. These contributions have influenced subsequent therapeutic tools (for instance, modern prolonged exposure therapy VR simulations for combat PTSD often include customization options, a concept pioneered by EMMA’s World () ()). Additionally, the success of these projects reinforced the notion that VR is not limited to anxiety disorders—it can be a general platform for “experiential psychotherapy” across a spectrum of mental health issues, thanks largely to the groundwork laid by Prof. Alcañiz’s interdisciplinary research.
Immersive Technology for Body Image and Eating Disorders
Prof. Alcañiz’s interdisciplinary approach also extended to the domain of eating disorders and body image disturbance, where he leveraged VR to create therapeutic experiences that were impossible to achieve with traditional methods. In the late 1990s, he collaborated with psychologists on pioneering studies applying VR to body image therapy for patients with eating disorders (such as anorexia nervosa and bulimia nervosa). Individuals with eating disorders often have a distorted perception of their own body and severe anxiety associated with their body image. Traditional cognitive-behavioural interventions include mirror exposure and guided imagery to help patients confront and adjust these perceptions. Prof. Alcañiz helped introduce a more powerful tool: virtual mirrors and 3D avatars. In a 1999 study (Perpiñá et al., 1999), the team asked, “Is exposure to virtual reality more effective than the classical body image treatment?”. To explore this, they designed a therapy protocol where patients would interact with a realistic 3D representation of their body in VR, which could be manipulated to gradually approach their actual body shape (since patients often overestimate their body size). In practice, this meant creating a virtual avatar of the patient, sometimes using 3D scanning or adjustable computer models, and then using VR sessions for the patient to view, walk around, and even resize this avatar. For this purpose, Prof. Alcañiz’s technical expertise was crucial in developing a new realistic 3D body representation in virtual environments. The virtual body could be made fatter or thinner, allowing therapists to show patients a more objective image versus their distorted self-image and slowly acclimate them to their real body dimensions. The 1999 study found that patients who underwent VR body exposure showed improvements in body satisfaction and reduced distortions, with indications that VR might provide an advantage over traditional methods (like static images or mirrors). Although sample sizes were small, this was one of the first demonstrations that VR could be applied beyond anxiety to complex conditions like eating disorders.
In 2000, Prof. Alcañiz co-authored another influential paper in CyberPsychology & Behavior detailing implementing the realistic 3D body model technique. This publication, “A New Realistic 3D Body Representation in Virtual Environments for the Treatment of Disturbed Body Image in Eating Disorders,” outlined the system architecture and its therapeutic rationale. The VR system provided patients with an immersive visual of a body they could identify with and be systematically altered. Therapy often involves exposing the patient to seeing their avatar at their perceived size versus actual size or practising coping statements while approaching the avatar. Technology was advanced for its time: creating a lifelike virtual human with correct body proportions and smooth rendering of 1990s hardware was non-trivial. Alcañiz’s lab achieved this and made it interactive – a significant technical innovation in clinical VR. From a methodological perspective, these studies with eating disorder patients introduced exposure therapy to a new domain (body image), expanding the concept of exposure from confronting external feared objects to confronting one’s own self-image. The early results suggested that VR could indeed heighten the effectiveness of body image interventions, likely because it produces a stronger emotional response than looking in a real mirror (patients often reported that seeing a moving 3D image of “themselves” was more impactful than a mirror reflection, perhaps due to the added realism and the ability to see oneself from a third-person perspective). By providing objective visual feedback, VR helped break the “locked” distorted image that patients held. This work was also clinically significant as it offered a novel approach for a group of patients who can be very resistant to treatment; using VR was found to increase engagement and reduce drop-outs in some cases, likely because patients found the technology novel and less judgmental than a face-to-face confrontation about their body.
Furthermore, Prof. Alcañiz’s involvement in this area underscored the convergence of technology and behavioural healthcare – a trend now common but nascent at the turn of the millennium. By 2011, reviews of VR for eating disorders noted a steady increase in studies. They highlighted European teams (like Alcañiz’s) leading the way. His work helped establish that VR is an acceptable and effective therapeutic tool for eating disorders, providing safe environments to practice skills like resisting urges or normalizing eating patterns. For instance, beyond body image, some VR applications (in which Alcañiz was a consultant) exposed patients to virtual foods or eating scenarios to reduce anxiety around eating – again leveraging controlled exposure principles. The technological innovation of creating immersive dining scenarios or having a patient navigate a virtual grocery store to face food-related fears were direct descendants of the approaches Alcañiz championed. Moreover, his early adoption of user–virtual world interaction (e.g., letting a patient control an avatar) in these contexts anticipated later developments like serious games for nutrition and embodiment exercises for body acceptance.
In summary, Prof. Alcañiz extended immersive therapy to eating disorders by developing tailored virtual content that addresses body image distortions and eating-related anxieties. This work exemplifies a methodological expansion – applying exposure and presence principles to internal cognitive-affective targets (one’s body image) – and a clinical innovation for a population that benefits from new approaches. The impact is seen in current treatments: some clinics now use virtual reality body image workshops, and researchers continue to build on Alcañiz’s prototypes to create ever more realistic body simulations (including using AR to overlay a different body appearance onto the patient in real time). By focusing on both the psychological aspect (body dissatisfaction) and the technical solution (real-time morphable avatars), Prof. Alcañiz again demonstrated the power of combining expertise across fields to solve intricate mental health problems.
Virtual Humans and Mental health
LabLeni remains at the forefront of integrating cutting-edge technology into mental health. In recent years, he has incorporated artificial intelligence (AI) and advanced computing into VR/AR therapy systems, aiming to create more intelligent, responsive, personalized therapeutic tools. One emerging theme in his work is the development of virtual human agents for psychological applications. For instance, a 2024 study co-authored by Alcañiz explores the use of conversational virtual humans driven by large language models (LLMs) to elicit social and emotional responses from users. Thanks to AI algorithms, these virtual humans can engage in dialogue and respond to a user’s input with human-like conversation. This research aims to design virtual agents that could serve as coaches or interlocutors in therapy – for example, a virtual “patient” for a social anxiety sufferer to practice conversation with or a virtual counsellor who can guide a user through CBT exercises. The study examined how effectively an LLM-based avatar could provoke emotional reactions and assessed the system’s realism. Alcañiz ‘s interest here represents a fusion of AI and VR for mental health, potentially enabling therapy sessions where an AI therapist or companion is present 24/7 in VR, supplementing human clinicians. This line of work also raises important methodological questions (which he and colleagues are examining) about the therapeutic alliance with a virtual entity and how to maintain empathy and trust when an AI is involved. The 2024 results indicated progress in making virtual characters more believable and emotionally engaging, which is a step toward their use in telepsychology as semi-autonomous helpers or for training purposes.
Another innovation avenue is using sensor data and machine learning to personalize therapy. In a 2024 conference paper, Alcañiz and colleagues investigated eye-tracking technology to classify human personality traits during conversations with virtual humans. The system can infer traits like introversion, confidence, or social anxiety levels by analyzing where and how long a person looks at different parts of a virtual character while talking. This research is highly novel – it attempts to create systems that dynamically adapt to the user’s behavioural signals. In therapy, such technology could automatically adjust the difficulty of social interaction in VR (for example, the virtual human might become more friendly or less intense if it “senses” the user’s discomfort via eye gaze patterns). Prof. Alcañiz’s work on linking physiological and behavioural biomarkers (like eye gaze) with psychological profiles continues the theme from his earlier projects of making VR environments “intelligent” and responsive. It parallels the concept of biofeedback-driven adaptation: just as he once proposed adapting VR exposure based on heart rate or sweat responses in anxiety, now the adaptation can be driven by real-time AI interpretation of eye movements or facial expressions. These projects show his commitment to technological innovation – pushing VR therapy from a passive tool to an active, AI-enhanced platform that can personalize treatment in real-time.
Prof. Alcañiz has also contributed to the broader discourse on mental health technology, especially in light of global challenges. During the COVID-19 pandemic, mental health issues like anxiety, depression, and loneliness surged worldwide, and digital solutions became more crucial than ever. In response, he co-edited a 2021 special issue and wrote an editorial on the use of VR, AR, and video games to address the impact of COVID-19 on mental health. In that Frontiers in Virtual Reality article, Alcañiz and colleagues discuss how immersive technologies can be deployed to mitigate problems caused by lockdowns, social isolation, and healthcare access barriers. They highlight examples such as VR support groups for isolated individuals, AR serious games to encourage physical exercise at home, and virtual mindfulness and stress-reduction applications. By leading this editorial effort, Prof. Alcañiz helped shape the narrative that emerging technologies are vital tools in public mental health responses. He emphasized not only the therapeutic angle but also the preventative and educational uses of VR/AR – for instance, using VR simulations to train coping skills or to deliver psychoeducational content about anxiety management in an engaging way. This reflects his broad vision for the field: beyond clinical trials and one-on-one therapy, he advocates for leveraging technology for community and public health benefits. The pandemic has accelerated the acceptance of tele-mental health and digital interventions, and Alcañiz’s insights have provided guidance on how to do so effectively and ethically.
Prof. Alcañiz continues to spearhead or advise on interdisciplinary research initiatives. We expect his work to integrate further self-supervised AI, affective computing, and XR (extended reality). A recent example is research on speech emotion recognition – in late 2024, Alcañiz co-authored a study proposing novel AI strategies to detect emotions from spoken language better. Such technology could be integrated into telepsychology platforms to monitor a patient’s emotional state during a voice call or VR session, alerting the system or therapist if the person becomes very distressed or disengaged. By improving the accuracy of emotion AI, his work contributes to creating more empathetic and context-aware therapy applications (for instance, a virtual therapist that can “hear” when a client’s voice is trembling with anxiety and respond supportively). This continues the methodological innovation streak – bringing objective data (voice tone, eye gaze, physiological signals) into the therapy loop, something Prof. Alcañiz has long championed.
Some related papers
Botella, C., Baños, R. M., Perpiñá, C., Villa, H., Alcañiz, M., & Rey, A. (1998). Virtual reality treatment of claustrophobia: a case report. Behaviour Research and Therapy, 36(2), 239–246. https://doi.org/10.1016/S0005-7967(97)10006-7​:contentReference[oaicite:0]{index=0}
Perpiñá, C., Botella, C., Baños, R. M., Marco, H., Alcañiz, M., & Quero, S. (1999). Body image and virtual reality in eating disorders: is exposure to virtual reality more effective than the classical body image treatment?. CyberPsychology & Behavior, 2(2), 149–155. https://doi.org/10.1089/cpb.1999.2.149​:contentReference[oaicite:1]{index=1}
Baños, R. M., Botella, C., Perpiñá, C., Alcañiz, M., Lozano, J. A., Osma, J., & Gallardo, M. (2002). Virtual reality treatment of flying phobia. IEEE Transactions on Information Technology in Biomedicine, 6(3), 206–212. https://doi.org/10.1109/TITB.2002.802380​:contentReference[oaicite:2]{index=2}
Alcañiz, M., Botella, C., Baños, R. M., Perpiñá, C., Rey, B., Lozano, J. A., Guillén, V., Barrera, F., & Gil, J. A. (2003). Internet-based telehealth system for the treatment of agoraphobia. CyberPsychology & Behavior, 6(4), 355–358. https://doi.org/10.1089/109493103322278727​:contentReference[oaicite:3]{index=3}
Botella, C., García-Palacios, A., Villa, H., Baños, R. M., Quero, S., Alcañiz, M., & Riva, G. (2007). Virtual reality exposure in the treatment of panic disorder and agoraphobia: a controlled study. Clinical Psychology & Psychotherapy, 14(3), 164–175. https://doi.org/10.1002/cpp.524​:contentReference[oaicite:4]{index=4}
Botella, C., Quero, S., Baños, R. M., García-Palacios, A., Bretón-López, J., Alcañiz, M., & Fabregat, S. (2008). Telepsychology and self-help: The treatment of phobias using the Internet. CyberPsychology & Behavior, 11(6), 659–664. https://doi.org/10.1089/cpb.2008.0012​:contentReference[oaicite:5]{index=5}
Botella, C., Gallego, M. J., García-Palacios, A., Guillén, V., Baños, R. M., Quero, S., & Alcañiz, M. (2010). An Internet-based self-help treatment for fear of public speaking: a controlled trial. CyberPsychology, Behavior, and Social Networking, 13(4), 407–421. https://doi.org/10.1089/cyber.2009.0224​:contentReference[oaicite:6]{index=6}
Botella, C., García-Palacios, A., Guillén, V., Baños, R. M., Quero, S., & Alcañiz, M. (2010). An adaptive display for the treatment of diverse trauma PTSD victims. CyberPsychology, Behavior, and Social Networking, 13(1), 67–71. https://doi.org/10.1089/cyber.2009.0353​:contentReference[oaicite:7]{index=7}
Baños, R. M., Guillén, V., Quero, S., García-Palacios, A., Alcañiz, M., & Botella, C. (2011). A virtual reality system for the treatment of stress-related disorders: A preliminary analysis of efficacy compared to a standard cognitive behavioral program. International Journal of Human-Computer Studies, 69(9), 602–613. https://doi.org/10.1016/j.ijhcs.2011.06.002​:contentReference[oaicite:8]{index=8}​:contentReference[oaicite:9]{index=9}
Pallavicini, F., Chicchi Giglioli, I. A., Kim, G. J., Alcañiz, M., & Rizzo, A. (2021). Editorial: Virtual Reality, Augmented Reality and Video Games for Addressing the Impact of COVID-19 on Mental Health. Frontiers in Virtual Reality, 2, Article 719358. https://doi.org/10.3389/frvir.2021.719358​:contentReference[oaicite:10]{index=10}
Valls, O., Pastor-Naranjo, F., del Amor, R., Gómez-Zaragozá, L., Marín-Morales, J., Raya, M. A., & Naranjo, V. (2024, November). Improving Speech Emotion Recognition: Novel Aggregation Strategies for Self-supervised Features. In International Conference on Intelligent Data Engineering and Automated Learning (pp. 387-397). Cham: Springer Nature Switzerland.
Genco, C., Altozano, A., Duraccio, L., Alcañiz, M., D’Arco, M., & Marín-Morales, J. (2024, October). Preliminary Exploration of Eye-Tracking Technology to Classify Human Personality Traits During Conversations with Virtual Humans. In 2024 IEEE International Conference on Metrology for eXtended Reality, Artificial Intelligence and Neural Engineering (MetroXRAINE) (pp. 941-945). IEEE.
Llanes-Jurado, J., Gómez-Zaragozá, L., Minissi, M. E., Alcañiz, M., & Marín-Morales, J. (2024). Developing conversational virtual humans for social emotion elicitation based on large language models. Expert Systems with Applications, 246, 123261.
Juan, M. C., Alcaniz, M., Monserrat, C., Botella, C., Baños, R. M., & Guerrero, B. (2005). Using augmented reality to treat phobias. IEEE computer graphics and applications, 25(6), 31-37.
Bretón-López, J., Quero, S., Botella, C., García-Palacios, A., Baños, R. M., & Alcañiz, M. (2010). An augmented reality system validation for the treatment of cockroach phobia. Cyberpsychology, Behavior, and Social Networking, 13(6), 705-710.
Clemente, M., Rey, B., Rodriguez-Pujadas, A., Breton-Lopez, J., Barros-Loscertales, A., Baños, R. M., … & Avila, C. (2014). A functional magnetic resonance imaging assessment of small animals’ phobia using virtual reality as a stimulus. JMIR serious games, 2(1), e2836.
Wrzesien, M., Botella, C., Bretón-López, J., del Río González, E., Burkhardt, J. M., Alcañiz, M., & Pérez-Ara, M. Á. (2015). Treating small animal phobias using a projective-augmented reality system: A single-case study. Computers in Human Behavior, 49, 343-353.
Alcañiz, M., Perpiñá, C., Banos, R., Lozano, J. A., Montesa, J., Botella, C., … & Alozano, J. (2000). A new realistic 3D body representation in virtual environments for the treatment of disturbed body image in eating disorders. CyberPsychology & Behavior, 3(3), 433-439.
Alcañiz, M., Baños, R., Botella, C., & Rey, B. (2003). The EMMA Project: Emotions as a determinant of presence. PsychNology Journal, 1(2), 141-150.