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A Smelly S(t)imulation:

Stress Induction by a Multimodal Military Training

Simulation and the Added Value of Olfactory Stimuli

SUBMITTED IN PARTIAL FULLFILLMENT FOR THE DEGREE OF MASTER OF SCIENCE

by

ISABELLE LAMERS

10548033

MASTER INFORMATION STUDIES

GAME STUDIES

FACULTY OF SCIENCE

UNIVERSITY OF AMSTERDAM

August, 2015

18 ECTS

1 April – 21 August

1

st

Supervisor

MSc. Gillian

van

de Boer–Visschedijk

TNO

2

nd

Supervisor & 1

st

Assessor

PhD. Anja van der Hulst

UvA & TNO

3

rd

Supervisor & 2

nd

Assessor

PhD. Olaf Binsch

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2

A Smelly S(t)imulation:

Stress Induction by a Multimodal Military Training

Simulation and the Added Value of Olfactory Stimuli

Isabelle Lamers

Universiteit van Amsterdam Science Park 904 Amsterdam, Netherlands

isabelle.lamers@student.uva.nl

ABSTRACT

Real-life battlefield situations ban be reproduced with serious games and simulations. The military values stress-resiliency training through exposure to maintain performance. The level of fidelity of the virtual environment (VE) affects immersion and stress induction, in turn influencing experienced stress. Fidelity is strongly affected by sensory feedback. However, most VEs do not include olfactory information, and its significance with regards to fidelity, immersion, and stress induction is relatively unexplored compared to the traditional haptic audio-visual modalities. Here, the added value of contextually fitting odors to the fidelity of an immersive, stress-inducing audio-visual VE is assessed by means of physical and psychological measures. Results indicate that olfactory information generally has no direct effect on objective and subjective stress experience, although a trend is observed. Furthermore, odors have positive effects on immersion, suggesting an odor-mediated enhancement of stress experience. Follow-up studies with sufficient power are needed to further explore the present findings.

General Terms

Design, Documentation, Experimentation, Measurement, Standardization, Theory, Verification

Keywords

Military, stress, immersion, virtual environment, serious gaming, simulation-based training, VBS2, fidelity, multimodality, olfaction, olfactory display, olfactory information

1. INTRODUCTION

Serious games and simulation-based trainings are used in various fields, such as in the military, due to the presumed educational gains and practical advantages they have compared to traditional teaching and training methods[6, 21, 22, 28, 35]. One of the interests of the military is to train their soldiers to become more stress resilient in order to perform optimally under stressful conditions in the battlefield and to prevent the onset of post-traumatic stress disorder (PTSD)[5, 30, 31]. An important aspect of such virtually simulated trainings is the level of fidelity. This needs to be optimal in order to ensure desired virtual environment (VE) experiences, such as immersion, and subsequent training outcomes[42]. However, most VEs only make use of the traditionally implemented visual, auditory and haptic modalities[34]. Adding olfactory information to such VEs shows potential to optimize fidelity, but has received

significantly less attention[17, 34]. The aim of this paper is to explore the added value of the use of olfactory stimuli in traditionally designed VEs for the enhancement of the subjective feeling of immersion and stress. Before going into more detail on the present study, a theoretical background is provided that elaborates on (1) simulation-based trainings (SBTs) and their application in the military, (2) stress, immersion, fidelity and sensory modalities affecting it, (3) olfactory information and their presentation in VEs, and (4) limitations in applied olfactory research.

The term simulation-based trainings (SBTs), is often used to describe a simulation in which the context, aspects, and conditions of the real world are replicated in a virtual environment (VE)[6, 34]. VEs thus mimic real world situations and provide virtual training scenarios which would be too complicated, costly or risky to simulate and train in the operational world[34, 36]. Hence, SBTs are more flexible than live training since they are capable of incorporating elements that would be difficult or impossible to include in the latter. Furthermore, less material demands, increased training frequency and knowledge transfer (e.g. sensorimotor and cognitive) from the virtual environment to real-world tasks has been shown[34, 36].

SBTs have been put into practice by military organizations worldwide[22, 24, 35]. While real world military training places more emphasis on training motor skills, SBTs focus more on tactical decision making, situation awareness, communication and coordination skills[24, 28]. By providing trainees with the required knowledge and skills, they are aimed at preparing trainees for tasks in heated and stressful battlefield situations and preventing the development of PTSD[5, 24, 28, 30, 31]. Within that context, stress resiliency thus plays a key role. The military is therefore particularly interested the exposure to stressful battlefield stimuli before deployment by means of realistic SBTs to investigate the possibilities of training soldiers to cope with stress and keep performing optimally under stressful conditions[35, 41]. For example, a study in progress is the Stress Resilience In Virtual Environments (STRIVE) project, which aims at raising soldiers’ stress threshold. This is done by means of a set of battlefield simulations and accompanying cognitive behavioral techniques, during which stress responses are measured physiologically and hormonally[5, 30, 31]. Other examples of military SBTs, not focused on stress-resiliency training, are a close range weapons system trainer, AirBook (flight simulation), Steel Beasts (tank

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3 simulation), SubSafe (a submarine qualification course), and

Virtual Battlespace (VBS)[1, 4, 10, 13, 35]. VBS is a battlefield training simulation that is actually referred to by the military as a serious game for which a VE is used, but will be defined here as a SBT environment. VBS provides real-time and editable scenario management, variable environmental conditions, equipment customization, and the operation of customizable land, sea, and air vehicles[4, 10]. Furthermore, it allows teaching and training of tactics, techniques, and procedures during various operations within a realistic virtual environment (see Figure 1)[4, 10]. Logically, the level of fidelity of VEs to real world battlefield situations has to be optimal to increase immersion into the VE and ensure the desired knowledge transfer and training outcomes, such as increased stress resilience[42]. Research in which various levels of visual fidelity are compared suggests that high fidelity causes increased feeling of immersion and stress experience, both objectively as well as subjectively[18, 26]. Immersion thus acts as a mediator for stress provocation.

Figure 1. A screenshot of a possible military training scenario employing Virtual Battlespace version two[4].

The level of fidelity can be altered by incorporating and adjusting various elements of a simulation. Most virtual worlds include three sensory modalities: visual, auditory and haptic[17, 34]. Levels of fidelity are affected by e.g. the quality and intensity of the images, sounds, and haptic feedback that is presented. Furthermore, the methods used to present these sensory stimuli have an effect on fidelity, e.g. presenting visuals on a computer screen versus a head mounted display[2, 9, 34, 43]. Visuals, audio, and haptics however, only address three out of five traditionally recognized human senses[27].

Since the goal of trainings is to develop knowledge, behavior and skills to e.g. become more stress-resilient, a reason to incorporate olfactory cues in VEs and SBTs is the significant increase in immersion due to the tight coupling of odors with memory and emotion[17]. They are closely linked and bi-directionally influence each other[3, 17]. Regarding emotion, odors have a strong emotion-evoking capability in real world situations[14]. The vast majority of research demonstrates that VE accompanying odors positively affect the feeling of immersion, effectively elicit emotion, shift a person’s preference, influence motivation, and elicit affective responses in post-traumatic stress disorder (PTSD) sufferers[11, 15, 25, 29, 31]. However, other

research in which the effect of odors on emotions and affective feelings in a VE showing signs of public disorder was investigated, suggests that olfactory information does not influence subjective emotional responses and appraisals in this context. [38, 39]. However, more research is required and the strong association odors have with emotion and memory provides a valid argument in favor of including olfactory information in traditional VEs, therewith creating a rich environment that significantly increases immersion and potentially evokes stress.

In the military domain, exposure to battlefield-specific scents helps soldiers experience these scents in a controlled and neutral setting prior to deployment and exposure in the battlefield. The military has developed SBTs that, besides visual and auditory stimuli, include olfactory information. Examples of these are Warfighter, DarkCon, and the Infantry Immersion Trainer that are accompanied by contextual odors presented at specific (stressful) moments during the simulation. Results suggest that olfactory presentation increases immersion into the simulation and recollection of the environment[7, 17, 37, 40].

There are contextually pleasant odors that positively affect performance, but especially the pre-exposure to malodors has received special attention in the military field[17, 37]. Characteristic (alerting) unpleasant odors in the battlefield are e.g. gasoline, fire, poisonous gases, burnt flesh, and rotting corpses[16]. Such malodors can elicit a range of physical and mental reactions, such as nausea and stress[32]. Consequently, required human performance is impaired. Although more research is needed, it has been suggested that the trainee becomes more resilient to the negative effects of malodors when previously exposed to malodors during training events in a controlled VE, especially when the olfactory information is combined with contextual visual and auditory cues[17].

Research into the development of olfactory displays and interfaces has been advancing during the past few years, facilitating the use of odors and the sense of smell in VEs[17, 34]. There are various methods currently used to deliver scents with olfactory displays. One of these is an ambient and unobtrusive method which allows for odors to disperse in area (e.g. odor releasing vents or diffusers)[17]. This method is used amongst others in theme parks, theatres, and simulations[17, 38, 39, 44]. Other methods are more specific in odor presentation and localization (e.g. projection-based systems or inkjet printer trigger mechanisms in a scent collar or head-mounted display) [17, 23, 40]. Because of their small size and portability, localization, dissipation, and control of scents is made easier. However, such methods are often obtrusive since the olfactory display has to be worn by the user and realism is impaired by incorrect odor concentrations and sources. Although less precise, in order to ensure immersion, the unobtrusive ambient odor presentation is the preferred method. Odor presentation timing methods are also important factors in scent presentation. Timing methods can be categorized into static and dynamic presentation[17]. The static method encompasses constant odor presentation, whereas the dynamic variant involves irregularly timed bursts. The generally preferred method is the latter, because this technique maintains the perceived intensity and prevents habituation[8, 19]. Furthermore, dynamic presentation has shown

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4 to positively affect task performance and increase odor sensitivity

in individuals that were insensitive prior to exposure[45].

Even though research into the development of olfactory displays for VEs has been advancing, applied olfactory research is still relatively limited compared to the more frequently used sensory modalities of vision, audition and haptics. Especially with regards to the investigation of the use of olfactory information to increase fidelity, immersion, and stress (resiliency). This is due to a few factors. First, a standardized way of producing, presenting and reporting odors has to be developed in order to explain and support study results. Second, although there are connections between odor perception, accompanied input from other sensory modalities, emotion, and cognition, these complex relationships still need to be studied more extensively to gain a better understanding of the underlying mechanics and consequent behavioral output following odor perception. This is especially important due to differences in sensory perception between individuals caused by e.g. handedness, gender, and age, with optimal olfactory function and identification between 20 – 60 years old[17, 33]. Third, the types of scents and the range of appraisal needs to be expanded. Most of the conducted research focused on peppermint and (other) positively appraised odors[17]. Investigating negatively appraised and other types of odors thus need more attention. Lastly, the timing method of presenting odors in intermittent bursts needs to be validated and other methods need to be developed to leverage or avoid olfactory adaptation during scent presentation in VEs[17].

1.1.

Research Question & Current Research

The main research question in the current pilot study is:

What is the added value of olfactory stimuli to stress induction with a multimodal (visuals, audio, and odors) military VE?

A sub-focus is put on immersion and its mediating role between fidelity and stress induction. We hypothesize that outcomes of this study highlight the biological relevance and importance of the incorporation of odors in VEs to optimize fidelity, increase immersion, and to induce stress, which ultimately would lead to the use of olfactory information in military stress-resiliency SBTs. However, the main importance of this study is to validate and provide new insights into the methodology concerning olfactory presentation in virtual environments.

In order to investigate this, the VE simulation used in this exploratory pilot study is made with VBS version two (VBS2), in which stressful events occur that are presented to the user through visuals and audio in the control condition, and with added olfactory information (unobtrusively presented in intermittent bursts) in the experimental condition. A pre-pilot study, in which the goal was to decide on which odor(s) would be used in the pilot study, yielded a combination of a few odors that are relatively negatively appraised, considerably arousing, and are collectively labelled as smelling like fire, wood, ash, coals, smoke, barbeque, and chemicals. Acquiring a realistic measure of stress is challenging. Here, to increase the robustness of the measure of stress and allow for comparisons of

responses to specific stimuli exposed to during the experiment, stress experienced by the participant is estimated using multiple approaches. These include 1) quantitative (objective) physiological measures such as heart rate (HR), heart rate variability (HRV), and the galvanic skin response (GSR) measured with a physiological monitor device from Equivital[12], and 2) qualitative (subjective) data obtained through questionnaires gathering the demographics of the participant group, their subjective stress and immersion experience, and their evaluation of the odor. Because this is a pilot study and thus due to the small sample size, each participant conducts the experiment twice, following a repeated measures design. After the experimental phase, data analysis is performed both descriptively and statistically with appropriate tests. The results of this exploratory pilot study will hopefully indicate if and to what extend there is an added value of olfactory information to immersion enhancement and stress induction with VEs and determine the potential for its implementation in military SBTs.

2. MATERIALS AND METHODS

2.1.

Participants

For the purpose of this pilot study a maximum of eight participants (♂n = 4 and ♀n = 4) was included. They were aged between 18 and 31 with a mean age of 24.25±3.01 years. Due to the repeated measures design of this study, the group was split in two in order to counterbalance a possible interaction effect caused by the order of conditions exposed to. The group that conducted the experiment first under the experimental condition, then under the control condition, will be referred to as Group Odor-Control (O-C; n = 4,) and consisted of two males and two females with an average age of 24.50±4.36 years old. The second group, Group Control-Odor (C-O; n = 4) with an average age of 24.00±1.41 years also had an even gender distribution and performed the experimental trial the other way around. The respondents were recruited at the Dutch Organization for Applied-Scientific Research (TNO), the University of Amsterdam, and through personal recruiting. Due to practical reasons and schedules, no soldiers in training were recruited for this study. Other inclusion criteria besides age and gender were 1) having basic gaming experience, i.e. basic navigation with computer keyboard and mouse, 2) being sufficiently sensory sensitive, thus without significant impairments in seeing, hearing and smelling, 3) being physically and mentally healthy, e.g. no heart problems, flu/cold, or mental illnesses, 4) non-smoking and/or abnormally consuming alcoholic beverages, and 5) not having consumed alcohol or drugs during the 24h prior to the experiment.

2.2.

Scenario and Task Description

The background story (displayed in text on paper and on-screen) within the simulation is about an experienced soldier who has returned to his/her hometown after a long deployment to a warzone filled with many tough and dangerous missions. At the start of the simulation the soldier is outside of town and is returning home. The first task of the participant is to walk home. During this journey, an explosion occurs in a waste-treatment plant next to the home of the soldier, i.e. event one, the ‘Explosion’ (see Figure 2A). The plant

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5 catches fire and there is a risk of workers being trapped inside. The

second task for the participant is a search and rescue mission inside and on the terrain of the plant. Once the unconscious worker has been found (i.e. event two, ‘Survivor’), the third task for the participant is to carry him outside the factory to a safe place (see

Figure 2B). When the participant reaches the designated safe spot,

a final explosion occurs in the factory (i.e. event three, ‘Finale’; see

Figure 2C). This indicates the successful completion of the search

and rescue and ends the simulation. For more screenshots see

Appendix 7.1.

2.3.

Set-up

All experiments took place in the same controlled setting (see

Figure 3). This was a closed and well ventilated room with no

distractions from outside. The room was divided in two by a partition wall that was placed between the spot of the experiment leader and that of the participant. A chair and table with a computer screen, keyboard, mouse, and papers containing the briefing, debriefing, and list of controls were part of the set-up at the participant’s side. This computer screen was connected to the main laptop that was situated on the other side of the partitioning wall. Under guidance and supervision of the experiment leader, this laptop served to 1) play a video for baseline measures, 2) provide context generation in addition to the (de)briefing, and 3) run the simulation created with VBS2 in which task performance took place. A second laptop is included on this side and is used to monitor the physiological measurements. Lastly, three RS Scentvertisers (odor dispensers) containing cartridges with fire/chemical odors (chosen from the pre-pilot study) were made as soundproof as possible and hidden underneath the table of the experimental leader, but had hoses travelling to the other side of the wall that were discretely connected to the bottom and back of the participant’s table. Once activated, these dispensers asynchronously diffused the odors in intermittent bursts with a duration of 20 seconds and breaks of 10 seconds in between each burst.

2.4.

Measurement Instruments

Several instruments were used to measure objective and subjective stress, immersion into the VE, general information, and evaluate the presented odor (see Table 1 for an overview). Objective physiological data was gathered with Equivital measurement instruments. One of these instruments was an Equivital EQ02 LifeMonitor (SEM), which measured and stored data. The SEM was connected to an accessory chest belt containing three electrodes that touch the skin when worn. This belt obtained e.g. ECG, breathing, and body temperature data, but specific measures used for this study are HR (in beats per minute [bpm]) and HRV (Root Mean Square of the Successive Differences[RMSSD] in milliseconds [ms]) derived from ECG and breathing data. Additionally, GSR data (in microSiemens [µS]) was obtained through two GSR electrodes that on one side were connected to the SEM and chest belt, and on the other side to the top of the disinfected middle phalanges of the left index and middle fingers.

Figure 2. Screenshots of the created VBS2 scenario and its events. Figures (A), (B), and (C) illustrate the consecutive events

of the Explosion, Survivor detection, and Finale, respectively.

Figure 3. Experimental set-up. (A) The experimental leader’s

side with odor dispensers on the floor (hidden and made sound-proof during experiments), a laptop projecting to the computer screen of the participant, and a monitoring laptop for Equivital physiological measurements (not in image). A wall is situated in between the experimental leader’s side and (B) the participant's side, containing a chair, table, computer screen, keyboard, mouse, headphones, and (de)briefing and simulation controls on paper.

A

B

C

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6 Subjective data was obtained through various

questionnaires (see Appendix 7.2) that all contained a 7-point Likert scale ranging from 1 = ‘completely disagree’ to 7 = ‘completely agree’. A general form gathered general information of the user, e.g. age, gender, handedness, health, and sensory functionality. Two other questionnaires called the Emotional Stress Reaction Scale (ESRS) and the Challenge & Threat Questionnaire (CTQ) focused on measuring stress during baseline and task performance. The ESRS contained a list of emotions which required to be rated based on how much they matched the participant’s emotional stress state during either baseline or task performance. Although randomized in the questionnaire, these emotions can be categorized into ‘Irrelevant’ (e.g. indifferent), ‘Benign-Positive’ (e.g. pleased), ‘Challenge’ (e.g. focused), ‘Threat, harm or loss’ (e.g. angry) subgroups. Increased stress reaction intensities can be observed when the latter two categories are given high ratings as compared to the former two[20], therefore it was chosen to measure challenge and threat in more detail with the CTQ. The CTQ contained statements with regards to the amount of challenge and threat experienced. The iGroup Presence Questionnaire (IPQ) aimed at obtaining information on participants’ subjective immersion into VE and was done after task performance. It included statements and questions that are subdivided into ‘General’, ‘Spatial Presence’, ‘Involvement’, and ‘Realism’. The fifth and last questionnaire, the Odor Questionnaire (OQ), served as odor evaluation method after exposure to the presented olfactory information. It scored the ‘Valence’, ‘Arousal’, odor ‘Awareness’, its effect on ‘Immersion’, and the extent to which the odor fitted within the given ‘Context’.

2.5.

Procedure

Firstly, participants were asked to read an information letter containing details about the background, purpose, procedure, duration, compensation, data anonymization, and minor risks tied to the experiment. They were then asked to fill-in a general

questionnaire that documented information on the participants (e.g. age, gender, handedness, state of health and sensory function, and game-experience) after which they signed an informed consent to partake in the experiment.

Hereafter measurement preparations took place. These consisted of putting on all the Equivital measuring gear. A SEM was connected to a suitable chest belt, which were used for data storage and electrocardiography (ECG) measurements, respectively. These were then put on the participant, after which the index and middle fingers of their left hand were disinfected for GSR electrode attachment. The last step included checking the functionality of the measurement equipment with an Equivital program on the second laptop.

Once this was finished, the participant started the first of two experiment sessions. This consisted of a baseline measurement and subsequent task performance, accompanied by multiple questionnaires. For the baseline measure, a calming nature video was shown for about 9 minutes and 30 seconds, followed by the ESRS and CTQ questionnaires. A context video was then displayed (2 minutes 30 seconds), showing helmet cam video footage of a real-life ambush event in a battlefield. The participant then required to read the briefing, after which the simulation was started up. During task performance, the odor dispenser was switched on at the time of the plant explosion, but only if the participant was currently performing under the experimental condition. After completing the task, the participants read the debriefing and subsequently filled out the ESRS, CTQ, and IPQ questionnaires. When in the experimental condition, also the OQ was completed. A break then took place in order for the participant to rest and get ready for the next session, and optionally for the odor to leave the room. The second session consisted of the exact same previous steps: baseline – questionnaires – context – briefing – task (with or without odor) – debriefing – questionnaires. Lastly, in order to receive the promised compensation, the participant filled out a form.

Table 1.Measurement instruments overview.

Measure Instrument Function Item total Cronbach’s α

Objective Equivital SEM Receive and store physiological data n.a.* n.a. Equivital belt with electrodes Measure heart rate (bpm) and heart rate

variability (RMSSD in ms)

n.a. n.a. Equivital galvanic skin response electrodes

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Measure galvanic skin response (µS) n.a. n.a.

Subjective General Form Gather general participant information 17 n.a. Emotional Stress Reaction Scale Measure subjective stress during baseline

and task performance

14 0.773 Challenge & Threat Questionnaire Measure subjective stress during baseline

and task performance

12 0.696 iGroup Presence Questionnaire Measure subjective immersion into VE 14 0.767

Odor Questionnaire Evaluate presented odor 9 0.239

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2.6.

Data Analysis

Statistical analysis on data obtained from repeated measures is done with the Repeated Measures Analysis of Variance (rmANOVA) test. This is the case if the data meet the assumptions of this parametric test such as being normally distributed immediately or after transformation. If the data fail to meet the assumptions, then statistical testing is done with the Wilcoxon Signed-Rank (WSR) test. The same goes for data acquired from non-repeated measures. These are analyzed with an Independent Samples t-test (IST) and or the non-parametric Mann-Whitney U (MWU) test. Test results with a p-value below p = 0.05 were deemed significant.

3. RESULTS

3.1.

Subjective

The average score reactivity between baseline and task for the ESRS and CTQ are shown in Figure 4 and Figure 5, respectively. In these and following result-figures, the odor condition is referred to with a ‘+’ and the control condition with a ‘-‘. Descriptively, the ESRS item categories Irrelevant (IR) and Benign-Positive (BE) have a negative score reactivity. This means that the simulation caused the scores for these question categories to decrease compared to baseline. On the other hand, the Challenge (CH) and

Threat, harm or loss (TH) scores increase due to the simulation.

Slight differences can be seen between the conditions, but statistical analysis with an rmANOVA did not support this finding, F(1,7) = 0.126, p = 0.734, and no overall interaction effect caused by condition order (i.e. order effect) was detected, F(1,6) = 0.168, p = 0.696. In line with the ESRS results, the challenge and threat items in the CTQ also have a positive reactivity. Descriptively, differences between conditions are limited, and statistical analysis with an rmANOVA supports this, F(1,7) = 0.597, p = 0.465, with a significant order effect F(1,6) = 16.912, p = 0.006.

Figure 4. Emotional Stress Reaction Scale average score reactivity. The experimental and control conditions are indicated

by a '+' and '-', respectively. IR = 'Irrelevant', BE = ‘Benign-Positive’, CH = ‘Challenge’, and TH = ‘Threat, harm or loss’.

Figure 5. Challenge & Threat Questionnaire average score reactivity. The experimental and control conditions are indicated

by a '+' and '-', respectively. CH = 'Challenge', and TH = 'Threat'.

The average scores for each item category in the IPQ are depicted in Figure 6. The categories include General (GE), Spatial Presence (SP), Involvement (IN), and Realism (RE). This figure shows that, on average, the items were scored around neutral. Scores given under the odor condition are slightly higher than those of the control condition. These descriptive results are supported by statistical analysis with an rmANOVA yielding a significant main effect,

F(1,7) = 15.545, p = 0.006, with no significant order effect, F(1,6)

= 0.123, p = 0.738.

Figure 6. iGroup Presence Questionnaire average scores. The

experimental and control conditions are indicated by a '+' and '-', respectively. GE = 'General', SP = 'Spatial Presence', IN = 'Involvement', and RE = 'Realism'.

Average OQ scores for Valence (VA), Arousal (AR), Awareness (AW), Immersion (IM), and Context (CO) are illustrated in Figure

7A and B for both groups together and per group (O-C [odor 

control] and C-O [control  odor]), respectively. Both valence and arousal were rated relatively neutral, whereas awareness of the odor, its effect on immersion, and contextual fitting were rated with higher scores. When looking at Figure 7B, these latter three categories seem to have been rated somewhat higher by Group O-C. Since this data is non-repeatedly measured, a two-tailed Independent Samples t-Test was used to statistically compare Group O-C versus C-O. The test yielded no significant difference between the groups (see Table 2). Lastly, the last item of this questionnaire asked the participants to define the odor they smelled. Seven out of eight participants gave a description of the odor that can be linked to fire.

-5 -4 -3 -2 -1 0 1 2 3 4 5 Sco re rea ctiv ity

Emotional Stress Reaction Scale

-Average Score Reactivity

IR+ IR-BE+ BE-CH+ CH-TH+ TH--5 -4 -3 -2 -10 1 2 3 4 5 Sco re rea ctiv ity

Challenge & Threat Questionnaire

-Average Score Reactivity

CH+ CH-TH+ TH-1 2 3 4 5 6 7 A v er ag e sco re

iGroup Presence Questionnaire

-Average Scores

GE+ GE-SP+ SP-IN+ IN-RE+

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RE-8

Figure 7. Odor Questionnaire average scores for both groups together (A) and per group (B). In (B) the two groups are

indicated by CO and OC. VA = 'Valence', AR = 'Arousal', AW = 'Awareness', IM = 'Immersion', and CO = 'Context.

Table 2. Two-tailed Independent Samples t-Test results for the Odor Questionnaire categories.

Category Test results

Valence t(6) = 0.000, p = 1.000 Arousal t(6) = 0.000, p = 1.000 Awareness t(6) = 1.732, p = 0.134 Immersion t(6) = 1.028, p = 0.344 Context t(6) = 1.494, p = 0.186

3.2.

Physiology

Shown in Figure 8 is the average GSR reactivity for each condition in general as well as per event (Explosion [EX], Survivor [SU], and

Finale [FI]) in the simulation task. This data was obtained from raw

GSR data coming from six participants due to material failure of two GSR measurements. The overall average GSR reactivity and that of the events was positive for both conditions, with the reactivity for the control condition being slightly higher. There was no statistically significant main effect for condition, F(1,5) = 0.355,

p = 0.577, and a significant interaction, F(1,4) = 10.802, p = 0.030.

Neither significant differences between the conditions nor significant interactions were found for each event (see Table 3 for statistics).

Figure 8. Galvanic skin response average reactivity. The

experimental and control conditions are indicated by a '+' and '-', respectively. EX = ‘Explosion’, SU = ‘Survivor’, and FI = ‘Finale’.

Table 3. Repeated measures analysis of variance test results for main- and interaction effects for each of the events.

Event Effect Test results

EX Main F(1,5) = 0.051, p = 0.830 EX Interaction F(1,4) = 3.953, p = 0.118 VI Main F(1,5) = 0.361, p = 0.574 VI Interaction F(1,4) = 7.055, p = 0.057 FI Main F(1,5) = 0.008, p = 0.933 FI Interaction F(1,4) = 1.618, p = 0.272

Compared to the GSR data, the following HR and HRV results were not obtained from raw data. The data used here are means pre-calculated by the Equivital program. This means that no analyses concerning the separate simulation events are made. Figure 9 and

Figure 10 illustrate the average reactivities in HR and HRV (in

RMSSD), respectively. For the odor condition, the average HR (in beats per minute [bpm]) increases compared to baseline, whereas a decrease can be detected for the control condition. The opposite can be seen when looking at the HRV graph: a negative RMSSD reactivity (in milliseconds [ms]) for the odor condition versus a positive reactivity for control condition. Statistical analysis with an rmANOVA yielded no significant main effect for condition for HR,

F(1,7) = 0.593, p = 0.466, without interaction, F(1,6) = 0.556, p =

0.484, as well as for HRV, F(1,7) =3.102, p = 0.122 with a significant interaction effect for order, F(1,6) = 7.777, p = 0.032.

Figure 9. Heart rate average reactivity. The experimental and control conditions are indicated by a '+' and '-', respectively.

1 2 3 4 5 6 7 A v er ag e sco re

Odor Questionnaire

-Average Scores

Valence Arousal Awareness Immersion Context

A

1 2 3 4 5 6 7 A v er ag e sco re

Odor Questionnaire

-Average Scores per Group

VA - OC VA - CO AR - OC AR - CO AW - OC AW - CO IM - OC IM - CO CT - OC CT - CO

B

-1 0 1 2 3 4 G S R Re ac ti v it y (µ S)

Galvanic Skin Response

-Average Reactivity

+ -EX+ EX-SU+ SU-FI+ FI--9 -6 -3 0 3 6 9 12 Hea rt r ate rea ctiv ity (b p m )

Heart Rate

-Average Reactivity

+

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-9

Figure 10. Heart rate variability average reactivity. The experimental and control conditions are indicated by a '+' and '-', respectively.

4. CONCLUSION AND DISCUSSION

This pilot study was dedicated to investigating the added value of olfactory information to the induction of stress with a multimodal virtual environment training simulation. A condition in which visual and auditory stimuli were the only stressors was compared to an experimental condition containing visual- and auditory-accompanying olfactory information. Results showed that odors have a positive effect on subjective feelings of immersion, indicating that it does add to a more realistic training environment. A direct effect on stress induction was however not found, but a slight trend can be observed.

The simulation itself (i.e. without odor) causes a stress reaction. This can be concluded from most measures in the control condition, except for the descriptive results for HR and HRV reactivity. Most measures show a positive reactivity for values compared to baseline measures, meaning that the game increases stress experienced both subjectively and objectively. However, a decrease in HR and increase in HRV can be seen in the control condition, meaning that the game itself has a relatively calming effect compared to baseline.

Considering the comparison between the conditions for stress measures specifically, subjective data shows that the experienced stress did increase during task performance (i.e. ESRS positive scores went down and negative ESRS and CTQ scores went up), but statistically it did not make a difference if the game was with or without odors. These subjective stress measure results contradict the majority of the evidence, but are in line with results coming from Toet et al. (2013a & 2013b) which suggests that odors have no effect on emotional (stress) reactions and appraisal of signs of public disorder in a VE.

Objective stress measure results obtained from GSR, HR, and HRV data yield mixed conclusions. Interestingly, GSR results oppose what was expected by showing a higher reactivity in sweat production for controls versus the condition with odors, albeit not statistically supported. Furthermore, compared to the earlier mentioned relaxing effect derived from HR and HRV control data, the experimental condition yielded a HR increase and HRV decrease. Although this is not statistically supported, a trend can be seen in favor of suggesting that the task with odors had a stress-inducing effect on HR and HRV measures.

The investigation of subjective immersion with the IPQ shows that the added olfactory information significantly increases the feeling of presence and immersion in the VE. This is supported by the OQ: participants were considerably positive towards the effect the odor had on their immersion during task performance. Furthermore, the appraisal and arousal the odor caused was neutral, meaning that the odor had neither a positive nor negative valence and that the odor was moderately stimulating. Participants were also moderately aware of the odor and found that it fitted within the given context of the VE. The latter is supported by the fact that almost all of the participants gave the odor a fire-related description. Interestingly, although the odor descriptions given in pre-pilot collectively pointed towards a smell of fire and chemicals, a greater variation was seen in those descriptions versus the ones given in the pilot. Since the pre-pilot only contained olfactory information, this suggests that cross-modality between olfaction, vision, and audition must have played a role in creating a better context.

These findings support the suggestion that odors have no direct positive effect on stress induction but do have a positive effect on immersion, therewith creating a more realistic environment and likely acting as mediator for stress responses. However, there are a few factors that may have influenced the data of this pilot study. First, the small sample size obtained in this study means that any conclusions drawn from the current data have relatively litter power to back up claims. A repeated measures design was chosen, as such a design is relatively high in power. The downside of such a design – and the second factor of influence – is that participants are exposed to the contents of the experiment when they perform it the second time under a different condition, thus biasing the results. To counterbalance this effect, one half of the group did the complete experiment in reverse order, but significant interaction effects due to order were detected in the data coming from the CTQ, GSR and HRV measures, thus affecting experimental outcomes. Third, all results are based on averages, and not e.g. on data calculated from areas under the curve. This means that a considerable amount of information, such as insightful fluctuations over time, is lost due to averaging. Next, although the odor chosen in this study fitted within the given context and improved immersion, valence and arousal were neutrally rated. On the one hand this means that while having been detected, the odor was neither too pleasant or unpleasant, nor too calming or stimulating. It was detectable below threshold. On the other hand, when considering objective and subjective results, it might also suggest that the chosen combination of odors was not arousing enough or appraised ideally to be capable of inducing the desired increased stress reaction. After all, the smell of fire and chemicals might not be as alarming as hypothesized because some individuals may have a positive association with this smell. Linked to this is the simulation scenario itself. Considering the low stress-related reactivities due to odor, it is possible that the scenario and simulation themselves already elicit an enhanced stress reaction due to olfactory stimuli. The contextual video, (de)briefing, soldier’s thoughts, scenario, and all the other elements in the VE served to create an immersive background story and a realistic environment. In contrast, the given context may have been -60 -40 -20 0 20 40 60 80 R MSSD rea ctiv ity (m s)

Heart Rate Variability

-Average Reactivity

+

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-10 insufficient, therewith forming an incorrect basis for further stress

induction. In other words, the realism of and immersion into the VE could have been too low to be able to induce an enhanced stress response. Furthermore, with regards to the given context, it still could have been difficult for the participants to mentally put themselves in the position of the soldier and fully experience the simulation. Consequently, immersion into the VE and especially stress induction might have been reduced considerably. The VBS2 simulation and scenario also had a few bugs that possibly affected participants’ VE experience, such as misplaced objects, non-playable character behavior deviations, action performance errors (i.e. not being able to drag survivor to safe zone), and the sound of fire that had regular pauses and obvious loops. Sometimes minor interventions by the experimental leader were required in order to keep the experiment going. Also, even though each participant met the minimum gaming-experience requirement, there were expected differences in additional gaming skills. This might underlie variation between participants in game play style, the route taken, and overall task duration. Here, hints and minor interventions concerning gaming-experience were also required from time to time. The bugs, different gaming skills, and the occasional hint/intervention may have altered the participants’ experience of the VE, therewith possibly affecting immersion and stress induction.

In conclusion, this study provides insight into a less widely used dimension in virtual environments and simulation-based trainings: the inclusion of olfactory information in addition to the more commonly used sensory modalities of vision and audition to enhance immersion and induce stress. Together with this, the types of olfactory displays and odors used here provide additional theoretical and practical knowledge on the application of 1) an ambient, unobtrusive olfactory display consisting of three odor dispensers with each diffusing a different scent through obscure hoses into the air behind the user’s computer screen, and 2) a mix of odors that is generally moderately appraised and simulating, and is perceived as the smell of fire, contrasting the more frequently used positively appraised and considerably stimulating odors such as peppermint[17]. Because this study is an exploratory pilot study, it is of importance to emphasize the value of the practical insights of olfactory display use, odor characteristics, experimental setup, and simulation contents. The current experimental outcomes regarding the use of odors to enhance fidelity, immersion, and stress responses are also considerably valuable, but this experiment should be improved and repeated in order to infer conclusions with regards to that subject with more certainty.

Future studies with regards to the use of olfactory information in VE can be improved by taking into account findings of this study. One of these is a larger sample size so that e.g. a repeated measures design is not needed, consequently avoiding interaction effects due to order. Additionally, they should consider using data that are not averaged but e.g. calculated from areas under the curve to include otherwise lost information that could be valuable. Future studies could also experiment with various odors and their characteristics in order to obtain the hypothesized effects on stress. This can be done by e.g. increasing the diffusion strength,

length or concentrations of currently used odors, or consider using odors that are more negatively appraised and more arousing. Decreasing the intensity of visual and auditory stimuli to lower the threshold for additional effects caused by odor stimuli should be considered. Moreover, a better simulation scenario context could be created to serve as a better basis for stress responses and so that users can immerse more easily in the VE. The simulation itself can be improved in general by resolving the encountered bugs in this study. Lastly, more specific inclusion criteria considering gaming-experience could be applied to avoid interventions during the conduction of the experiment. Revising these elements and implementing them in follow-up studies that repeat the research at hand, may yield further insights regarding the methodology and obtained results, that either support or reject the current findings concerning the incorporation of odors and their added value to stress induction. Regarding the observed trends, it can be carefully said that the practical implication of odors in military SBTs can be deemed fruitful for stress-resiliency training.

5. ACKNOWLEDGEMENTS

I would like to thank the following people for the guidance, support, advice, feedback, realization of this study, and for the educative internship period at TNO:

 Anja van der Hulst

 Gillian van de Boer - Visschedijk

 Olaf Binsch

 Andrea Jetten

 Alexander Toet

 Martin van Schaik

 Marielle Weghorst

 Nicolien Berkers

 Ronald Jongen

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7. APPENDIX

7.1.

Screenshots VBS2 Search & Rescue Task

1. First in-simulation screen. 2. Task 1: ‘Go home. Follow the blue arrows.’ Home = brown apartment building on the right. Waste-treatment plant = white building in the middle.

3. Post-explosion in plant. Thoughts soldier on-screen. 4. Task 2: ‘Go to the plant. Search the plant's terrain and the building itself for survivors'.

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14 7. Inside the plant - ground floor. 8. Inside the plant - second floor.

9. On the roof of the plant. 10. Inside an office on the second floor of the plant.

11. Survivor detection on the terrain of the plant (exit through second floor).

12. Unconscious survivor on plant terrain. On-text screen (not visible here) shows Task 3: ‘Drag unconscious man to safety.’

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15 13. Dragging survivor to safety. 14. Post-finale explosion with survivor brought to safety.

7.2.

Questionnaires

7.2.1. General Questionnaire

1. PIN 2. Leeftijd 3. Geslacht M/V M/V M/V M/V M/V M/V M/V M/V 4. Handvoorkeur R/L R/L R/L R/L R/L R/L R/L R/L

5. Ik heb voldoende game-ervaring. J/N J/N J/N J/N J/N J/N J/N J/N

6. Ik draag een bril/lenzen. J/N J/N J/N J/N J/N J/N J/N J/N

7. Ik zie voldoende tot goed. J/N J/N J/N J/N J/N J/N J/N J/N

8. Ik draag een gehoorapparaat. J/N J/N J/N J/N J/N J/N J/N J/N

9. Ik hoor voldoende tot goed. J/N J/N J/N J/N J/N J/N J/N J/N

10. Ik heb momenteel geen verkoudheid/griep/hooikoorts. J/N J/N J/N J/N J/N J/N J/N J/N

11. Ik heb geen trauma opgelopen waardoor mijn reukvermogen significant en blijvend

verslechterd is.

J/N J/N J/N J/N J/N J/N J/N J/N

12. Ik ruik voldoende tot goed. J/N J/N J/N J/N J/N J/N J/N J/N

13. Ik heb geen hartaandoening. J/N J/N J/N J/N J/N J/N J/N J/N

14. Ik heb geen gediagnostiseerde psychische klachten. J/N J/N J/N J/N J/N J/N J/N J/N

15. Ik rook niet. J/N J/N J/N J/N J/N J/N J/N J/N

16. Mijn alcoholconsumptie valt binnen normale grenzen. J/N J/N J/N J/N J/N J/N J/N J/N

17. Ik heb geen alcohol en/of drugs geconsumeerd 24 uur voor aanvang van het

experiment.

J/N J/N J/N J/N J/N J/N J/N J/N

18. Paraaf

7.2.2. Emotional Stress Reaction Scale

Hel em a a l n ie t We in ig N o g a l Hel em a a l w el 1. Onverschillig 1 2 3 4 5 6 7 2. Tevreden 1 2 3 4 5 6 7 3. Geconcentreerd 1 2 3 4 5 6 7 4. Kwaad 1 2 3 4 5 6 7 5. Energiek 1 2 3 4 5 6 7 6. Bezorgd 1 2 3 4 5 6 7 7. Alert 1 2 3 4 5 6 7 8. Blij 1 2 3 4 5 6 7 9. Teleurgesteld 1 2 3 4 5 6 7 10. Opgewonden 1 2 3 4 5 6 7 11. Boos 1 2 3 4 5 6 7 12. Gefocust 1 2 3 4 5 6 7 13. Ontspannen 1 2 3 4 5 6 7 14. Onzeker 1 2 3 4 5 6 7

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16

7.2.3. Challenge & Threat Questionnaire

7.2.3.1. Challenge Z ee r me e o n ee n s N eu tr a a l Z ee r me e ee n s

1. Deze taak is een uitdaging voor mij. 1 2 3 4 5 6 7

2. Deze taak geeft mij de mogelijkheid om mijn cognitieve vaardigheden te laten zien. 1 2 3 4 5 6 7

3. Deze taak geeft mij de mogelijkheid om obstakels te pareren. 1 2 3 4 5 6 7

4. Deze taak geeft mij de mogelijkheid om mijn zelfvertrouwen te versterken. 1 2 3 4 5 6 7

5. Over het algemeen denk ik succesvol te zijn in de uitvoering van deze taak. 1 2 3 4 5 6 7

6. Ik denk dat ik de capaciteiten heb voor een succesvolle prestatie. 1 2 3 4 5 6 7

7.2.3.2. Threat Z ee r me e o n ee n s N eu tr a a l Z ee r me e ee n s

1. Deze taak is een dreiging voor mij. 1 2 3 4 5 6 7

2. Ik ben bezorgd dat deze taak mogelijk mijn zwakke plek bloot legt. 1 2 3 4 5 6 7

3. Deze taak lijkt me lang en saai. 1 2 3 4 5 6 7

4. Ik ben bezorgd dat deze taak mogelijk mijn zelfvertrouwen aantast. 1 2 3 4 5 6 7

5. In het algemeen denk ik dat ik niet succesvol kan zijn in deze taak. 1 2 3 4 5 6 7

6. Ik ben bezorgd dat ik de capaciteiten niet heb om deze taak succesvol uit te voeren. 1 2 3 4 5 6 7

7.2.4. iGroup Presence Questionnaire

Hel em a a l n ie t N eu tr a a l Hel em a a l w el

1. Ik had het gevoel aanwezig te zijn in de computerwereld. 1 2 3 4 5 6 7

2. Ik had het gevoel omgeven te zijn door de virtuele wereld. 1 2 3 4 5 6 7

3. Ik had het gevoel slechts plaatjes te aanschouwen. 1 2 3 4 5 6 7

4. Ik had niet het gevoel in de virtuele ruimte aanwezig te zijn. 1 2 3 4 5 6 7

5. Ik had meer het gevoel bezig te zijn in de virtuele ruimte, dan dat ik het gevoel had iets van buitenaf te bedienen. 1 2 3 4 5 6 7

6. Ik voelde me aanwezig in de virtuele ruimte. 1 2 3 4 5 6 7

7. Hoe bewust was u zich van de echte omgeving (bv. geluiden van buiten, kamertemperatuur), terwijl u

zich bevond in de virtuele ruimte? 1 2 3 4 5 6 7

8. Ik was me niet bewust van mijn echte omgeving. 1 2 3 4 5 6 7

9. Ik lette nog op de echte omgeving. 1 2 3 4 5 6 7

10. Ik ging volledig op in de virtuele wereld. 1 2 3 4 5 6 7

11. Hoe echt kwam de virtuele omgeving op u over. 1 2 3 4 5 6 7

12. In hoeverre kwam uw ervaring in de virtuele omgeving overeen met uw ervaringen in de echte wereld? 1 2 3 4 5 6 7

13. Hoe werkelijk kwam de virtuele wereld op u over? 1 2 3 4 5 6 7

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17

7.2.5. Odor Questionnaire

Z ee r me e o n ee n s N eu tr a a l Z ee r me e ee n s

1. De geur paste in de game. 1 2 3 4 5 6 7

2. De geur paste niet bij de gepresenteerde situatie/scenario. 1 2 3 4 5 6 7

3. De geur droeg positief bij aan de immersie. 1 2 3 4 5 6 7

4. De geur had een afleidende werking waardoor ik mij meer in de echte wereld

dan in de virtuele wereld bevond. 1 2 3 4 5 6 7

5. De geur was te sterk om mij nog te kunnen concentreren op de game. 1 2 3 4 5 6 7

6. De geur was nauwelijks waarneembaar. 1 2 3 4 5 6 7

7. De geur was aangenaam om te ruiken. 1 2 3 4 5 6 7

8. De geur werkte opwekkend/stimulerend 1 2 3 4 5 6 7

9. Ik zou de geur omschrijven als…

(Noteer hieronder uw antwoord. Gelieve specifieke woorden te gebruiken.)

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