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Social interaction is one of the most popular use cases of virtual reality (VR). Virtual worlds accessed through VR headsets can immerse people in diverse places and present its users however they wish to be represented. The affordances of this technology allow people to connect with themselves, others, and their surroundings in unique ways. Research has shown that social norms found in the physical world transfer over to virtual worlds. People respond to virtual people in a manner similar to how they would treat people in the physical world. Although virtual worlds and the physical world share similarities, they have many differences. Virtual reality is not—and does not necessarily need to be—a veridical representation of the physical world. Virtual reality has the ability to transform everything, such as what people look like, how they behave, where they are, and how they see things. Cues related to people, such as their visual appearance and nonverbal behavior, or place, such as the surrounding environment and perspective, can be augmented, filtered, or suppressed. These transformations also lead to significant psychological and behavioral effects, affecting how people build trust, engage with others, or communicate nonverbally. Whereas some of these transformations may be unintentional, such as technological by-products, other transformations can be intentional. As a result, it is critical to understand how social interactions occur differently in these transformed environments.

Immersive virtual environments (IVEs) are systems comprised of digital devices that simulate multiple layers of sensory information so that users experience sight, sound, and even touch like they do in the physical world. Users are typically represented in these environments in the form of virtual humans and may interact with other virtual representations such as health-care providers, coaches, future selves, or treatment stimuli (e.g., phobia triggers, such as crowds of people or spiders). These virtual representations can be controlled by humans (avatars) or computers algorithms (agents). Embodying avatars and interacting with agents, patients can experience sensory-rich simulations in the virtual world that may be difficult or even impossible to experience in the physical world but are sufficiently real to influence health attitudes and behaviors. Avatars and agents are infinitely customizable to tailor virtual experiences at the individual level, and IVEs are able to transcend the spatial and temporal boundaries of the physical world. Although still preliminary, a growing number of studies demonstrate IVEs’ potential as a health promotion and therapy tool, complementing and enhancing current treatment regimens. Attempts to incorporate IVEs into treatments and intervention programs have been made in a number of areas, including physical activity, nutrition, rehabilitation, exposure therapy, and autism spectrum disorders. Although further development and research is necessary, the increasing availability of consumer-grade IVE systems may allow clinicians and patients to consider IVE treatment as a routine part of their regimen in the near future.

Fear is a basic human emotion important for survival and for staying alert to potential danger. In psychology, fear is defined as a discrete emotion to help humans adapt to the environment and serves as a signal for potential danger to help humans avoid or prepare for such threats. While fear is typically experienced through real-world threats as a natural response for survival, modern society also exposes us to fear through mediated content like movies and news. Interactive media, such as video games and virtual reality (VR), have emerged as new ways to experience fear because of their immersive environments. Researchers have discovered that people have similar reactions to both real-life and mediated threats. Previous studies have explored the reasons and methods behind how people experience fear through media. With advancements in technology, researchers have also examined the emotional impact of interactive media, such as video games and VR. This article examines fear elements, fear reactions, and coping reactions in video games and VR. Results indicate that horror games are the most likely to elicit fear responses in video games, and participants often experience greater cognitive than physical reactions. In VR, research has shown that elements that make players feel realistic inside the games, termed plausibility illusion elements, are most effective in eliciting fear. Players’ reactions toward the VR horror games include active approach strategies, or a constant reminder that the VR events are not real; directly disengaging physically and mentally; and other self-help coping strategies. In addition to immediate fear during VR-horror gameplay, some players showed residual fear on the day after they finished playing the game, indicating that the Tetris effect is strong in VR-horror games. Overall, the empirical evidence in existing gaming literature show that emotional responses are greater in VR than in non-VR video games. The literature also explores the appeal of horror games, and their mechanisms are reviewed. By understanding the fear responses of audiences in video games and VR, researchers and the industry can design effective intervention and training materials. Media-elicited fear, mediated fright, is reviewed, followed by the appeal of horror games. Game elements from the design perspective to discuss various elements in horror games that may elicit fear are also reviewed. Fear reactions, negative emotions experienced in horror games and other game-related elements such as music and soundtrack, virtual environment, game characters’ appearance, and their facial expressions, all contributed to the fear emotion among players. The discussion of unique affordances and traits of VR and its implications conclude the article.