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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Virtual Real.</journal-id>
<journal-title>Frontiers in Virtual Reality</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Virtual Real.</abbrev-journal-title>
<issn pub-type="epub">2673-4192</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">788820</article-id>
<article-id pub-id-type="doi">10.3389/frvir.2022.788820</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Virtual Reality</subject>
<subj-group>
<subject>Review</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Because I&#x2019;m Happy&#x2014;An Overview on Fostering Positive Emotions Through Virtual Reality</article-title>
<alt-title alt-title-type="left-running-head">Pavic&#x2009; et&#x20;al.</alt-title>
<alt-title alt-title-type="right-running-head">Fostering Positive Emotions through VR</alt-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Pavic&#x2009;</surname>
<given-names>Katarina</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<xref ref-type="corresp" rid="c001">&#x2a;</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1151659/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Vergilino-Perez&#x2009;</surname>
<given-names>Dorine</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1485772/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Gricourt</surname>
<given-names>Thierry</given-names>
</name>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1685280/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Chaby</surname>
<given-names>Laurence</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/203765/overview"/>
</contrib>
</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>Universit&#xe9; de Paris</institution>, <institution>Vision Action Cognition</institution>, <addr-line>Paris</addr-line>, <country>France</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>Sorbonne Universit&#x00E9;</institution>, <institution>CNRS</institution>, <institution>Institut des Syst&#xe8;mes Intelligents et de Robotique</institution>, <institution>ISIR</institution>, <addr-line>Paris</addr-line>, <country>France</country>
</aff>
<aff id="aff3">
<sup>3</sup>
<institution>SocialDream</institution>, <institution>Research and Development Department</institution>, <addr-line>Bourg-de-P&#xe9;age</addr-line>, <country>France</country>
</aff>
<aff id="aff4">
<sup>4</sup>
<institution>Universit&#xe9; de Paris</institution>, <institution>UFR de Psychologie</institution>, <addr-line>Boulogne-Billancourt</addr-line>, <country>France</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>
<bold>Edited by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1013760/overview">Florian Pecune</ext-link>, University of Glasgow, United&#x20;Kingdom</p>
</fn>
<fn fn-type="edited-by">
<p>
<bold>Reviewed by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1064590/overview">Thomas Schubert</ext-link>, University of Oslo, Norway</p>
<p>
<ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1214644/overview">Cedric Buche</ext-link>, CNRS, Australia</p>
</fn>
<corresp id="c001">&#x2a;Correspondence: Katarina Pavic&#x2009;, <email>katarina.pavic@u-paris.fr</email>
</corresp>
<fn fn-type="other">
<p>This article was submitted to Virtual Reality and Human Behaviour, a section of the journal Frontiers in Virtual Reality</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>01</day>
<month>03</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="collection">
<year>2022</year>
</pub-date>
<volume>3</volume>
<elocation-id>788820</elocation-id>
<history>
<date date-type="received">
<day>03</day>
<month>10</month>
<year>2021</year>
</date>
<date date-type="accepted">
<day>09</day>
<month>02</month>
<year>2022</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2022 Pavic&#x2009;, Vergilino-Perez&#x2009;, Gricourt and Chaby.</copyright-statement>
<copyright-year>2022</copyright-year>
<copyright-holder>Pavic&#x2009;, Vergilino-Perez&#x2009;, Gricourt and Chaby</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these&#x20;terms.</p>
</license>
</permissions>
<abstract>
<p>In recent years, an increased demand for improving mental health and well-being led to developing procedures capable of enhancing positive experiences. One highly attractive candidate for evoking positive experiences is Virtual Reality (VR), as VR enables users to experience various situations in controlled and safe environments. This overview first investigates how positive emotions, well-being and VR are interconnected. Then, an overview about how and why to induce positive emotions in adult users is provided. Methodological and ethical considerations about VR technology, measurements of VR&#x2019;s efficacy and user characteristics are reviewed. It emerges that VR is efficient in inducing positive emotions across the adult lifespan and in various settings. Levels of immersion, interactivity, Virtual environment contents, sensory modalities involved and users&#x2019; characteristics emerged as key determinants for successfully inducing positive emotions with VR. The main applications of positive VR experiences consist in using VR for relaxation, stress and pain management, motivation for physical activities, and gives promising results for apathy treatment in elderly users. Although VR is efficient in eliciting positive emotions and experiences, the underlying operating mechanisms remain unclear and are yet to be further investigated. Finally, the need for a user-centered approach when designing positive VR experiences, clear guidelines for the use of VR, and a better documentation of its potential adverse effects are addressed.</p>
</abstract>
<kwd-group>
<kwd>virtual reality</kwd>
<kwd>well-being</kwd>
<kwd>aging</kwd>
<kwd>mood induction</kwd>
<kwd>emotion</kwd>
<kwd>physiological measure</kwd>
<kwd>positive technologies</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<sec id="s1">
<title>1 Introduction</title>
<sec id="s1-1">
<title>1.1 From Positive Emotions to Well-Being</title>
<p>Taking a stroll in nature, sharing pleasant moments with relatives or friends, traveling and discovering new places. While all these experiences may seem trivial, they are beneficial for our well-being, thanks to the positive emotions that can emanate from them. A large body of literature showed that positive emotions are the founding stone of human fulfillment and well-being (<xref ref-type="bibr" rid="B55">Fredrickson and Joiner, 2002</xref>; <xref ref-type="bibr" rid="B56">Fredrickson, 2004</xref>; <xref ref-type="bibr" rid="B57">Fredrickson, 2006</xref>; <xref ref-type="bibr" rid="B62">Garland et&#x20;al., 2010</xref>). In addition, positive emotions are closely associated with quality of life (<xref ref-type="bibr" rid="B90">Kuppens et&#x20;al., 2008</xref>), life success (<xref ref-type="bibr" rid="B101">Lyubomirsky et&#x20;al., 2005</xref>), better health and longevity (<xref ref-type="bibr" rid="B41">Diener and Chan, 2011</xref>) and cognitive functioning (<xref ref-type="bibr" rid="B44">Dolan, 2002</xref>; <xref ref-type="bibr" rid="B17">Blair et&#x20;al., 2007</xref>). Therefore, there are clear benefits in promoting positive experiences and emotions among healthy, vulnerable and/or isolated adults. Despite the high benefits of positive emotions emanating from the above-mentioned experiences, not everyone has regular access to nature walks, social interactions or travel. Moreover, access has become even more restricted due to the current COVID-19 crisis, leading to heightened mental health issues (<xref ref-type="bibr" rid="B61">Ganesan et&#x20;al., 2021</xref>), increased loneliness and isolation (<xref ref-type="bibr" rid="B86">Killgore et&#x20;al., 2020</xref>). A critical concern that needs to be addressed is how people can have access to positive experiences for enhancing well-being and mental health. One innovative answer for bringing nature, people and places together may be virtual reality (VR). VR has the advantage of enabling users to safely experience various real-life or imaginary situations, while allowing tight control over the stimuli used (<xref ref-type="bibr" rid="B10">Ba&#xf1;os et&#x20;al., 2017</xref>; <xref ref-type="bibr" rid="B59">Freeman et&#x20;al., 2017</xref>). VR is therefore a suitable candidate for promoting positive experiences.</p>
<p>Historically, research has focused on understanding negative emotions and pathology, while positive emotions, well-being and the links between them have been understudied (<xref ref-type="bibr" rid="B2">Alexander et&#x20;al., 2020</xref>). In recent years, considerable efforts have been made to delimit and describe the diversity of positive emotions, revealing that positive emotions are more than the mere concepts of &#x201c;joy&#x201d; and &#x201c;happiness&#x201d; (see <xref ref-type="bibr" rid="B39">Desmet, 2012</xref>; <xref ref-type="bibr" rid="B2">Alexander et&#x20;al., 2020</xref>). In this context, the broaden-and-build theory provides a framework for understanding the links between positive emotions, cognition and well-being (<xref ref-type="bibr" rid="B56">Fredrickson, 2004</xref>; <xref ref-type="bibr" rid="B57">Fredrickson, 2006</xref>). According to this theory, positive emotions broaden one&#x2019;s mind, unlike negative emotions that lead to narrowing one&#x2019;s mind (<xref ref-type="bibr" rid="B62">Garland et&#x20;al., 2010</xref>; <xref ref-type="bibr" rid="B35">Cohen et&#x20;al., 2016</xref>). This has been supported by studies reporting attentional capture and broadening following positive emotion induction (<xref ref-type="bibr" rid="B54">Fredrickson and Branigan, 2005</xref>; <xref ref-type="bibr" rid="B66">Gupta, 2019</xref>). In return, the mind broadening resulting from positive emotions helps build long-lasting resources, such as social connections, opportunities and knowledge, resulting in well-being (<xref ref-type="bibr" rid="B56">Fredrickson, 2004</xref>; <xref ref-type="bibr" rid="B57">Fredrickson, 2006</xref>; <xref ref-type="bibr" rid="B62">Garland et&#x20;al., 2010</xref>). Enhancing positive emotion and accumulating long-lasting resources may be of great interest in vulnerable and/or isolated populations such as elderly people (<xref ref-type="bibr" rid="B118">Ong, 2010</xref>). Additionally, it has been argued that positive emotions are linked to better health outcomes and longevity (<xref ref-type="bibr" rid="B41">Diener and Chan, 2011</xref>). Therefore, gaining a better understanding of positive emotions appears as crucial as understanding and relieving negative&#x20;ones.</p>
<p>Growing interest in positive emotions and their potential links to individuals&#x2019; well-being began with the development of positive psychology, a scientific field that investigates well-being at the individual, organizational and societal levels (<xref ref-type="bibr" rid="B136">Seligman and Csikszentmihalyi, 2000</xref>). This has led to a paradigm shift where well-being is no longer seen as the absence of health issues, but also as the presence of positive emotions, resources, and strengths (<xref ref-type="bibr" rid="B136">Seligman and Csikszentmihalyi, 2000</xref>; <xref ref-type="bibr" rid="B18">Bos et&#x20;al., 2016</xref>). Defining the notion of well-being is not straightforward, since in the existing literature, the terms &#x201c;well-being,&#x201d; &#x201c;happiness&#x201d; and &#x201c;life satisfaction&#x201d; are often used interchangeably (<xref ref-type="bibr" rid="B147">Suardi et&#x20;al., 2016</xref>). However, two main approaches can be identified in the literature: 1) subjective and 2) psychological well-being. Subjective well-being, or &#x201c;hedonia,&#x201d; consists in life satisfaction, with a focus on positive, pleasant experiences and quality of life (<xref ref-type="bibr" rid="B42">Diener et&#x20;al., 1999</xref>). Psychological well-being, also called &#x201c;eudaimonia,&#x201d; focuses on long-term fulfillment, encompassing the idea of constant improvement towards fulfilling life-goals and optimal functioning (<xref ref-type="bibr" rid="B131">Ryff, 1989</xref>; <xref ref-type="bibr" rid="B95">Lent, 2004</xref>). As these two major approaches have overlapping goals and are not fully exclusive, integrative theories of well-being have developed (e.g., see <xref ref-type="bibr" rid="B68">Henderson and Knight, 2012</xref>) in parallel to critics suggesting they are two sides of the same coin (e.g., see <xref ref-type="bibr" rid="B80">Kashdan et&#x20;al., 2008</xref>).</p>
</sec>
<sec id="s1-2">
<title>1.2 Fostering Positive Emotions Through Technology</title>
<p>Recently, technologies have become believable candidates for enhancing individuals&#x2019; health and well-being, leading to the emergence of &#x201c;positive technologies&#x201d;. Derived from positive psychology, the positive technologies framework investigates the use of technology to improve users&#x2019; well-being, quality of life and experiences (<xref ref-type="bibr" rid="B19">Botella et&#x20;al., 2012</xref>; <xref ref-type="bibr" rid="B122">Riva et&#x20;al., 2012</xref>; <xref ref-type="bibr" rid="B10">Ba&#xf1;os et&#x20;al., 2017</xref>). It has been suggested that positive technologies can enhance subjective (&#x201c;hedonia&#x201d;), psychological (&#x201c;eudaimonia&#x201d;) or social well-being (<xref ref-type="bibr" rid="B19">Botella et&#x20;al., 2012</xref>; <xref ref-type="bibr" rid="B122">Riva et&#x20;al., 2012</xref>; <xref ref-type="bibr" rid="B10">Ba&#xf1;os et&#x20;al., 2017</xref>). VR belongs to the technologies cited within the framework of positive technologies, especially as a &#x201c;hedonic&#x201d; technology enabling positive and pleasant experiences in the present (<xref ref-type="bibr" rid="B19">Botella et&#x20;al., 2012</xref>; <xref ref-type="bibr" rid="B122">Riva et&#x20;al., 2012</xref>). What makes VR a suitable candidate for fostering positive experiences are its immersive power and the sense of presence that VR experiences generate. Historically, sense of presence has been defined as the feeling of &#x201c;being physically there&#x201d; (i.e.,&#x20;spatial presence, <xref ref-type="bibr" rid="B142">Slater, 1999</xref>; <xref ref-type="bibr" rid="B146">Steuer, 1992</xref>) to which can be added the feeling of &#x201c;being with others&#x201d; (i.e.,&#x20;social presence, <xref ref-type="bibr" rid="B15">Biocca et&#x20;al., 2001</xref>).</p>
<p>Recent research has established that VR is arousing (<xref ref-type="bibr" rid="B52">Felnhofer et&#x20;al., 2015</xref>; <xref ref-type="bibr" rid="B103">Mar&#xed;n-Morales et&#x20;al., 2018</xref>) and is an effective tool for inducing emotions in laboratory settings (<xref ref-type="bibr" rid="B43">Bernardo et&#x20;al., 2021</xref>). More precisely, VR has proven effective in inducing various positive emotions, such as joy, relaxation (e.g., see <xref ref-type="bibr" rid="B3">Anderson et&#x20;al., 2017</xref>; <xref ref-type="bibr" rid="B138">Serrano et&#x20;al., 2016</xref>) and more complex emotions such as awe (i.e.,&#x20;feeling of wonder when confronted with vast and transcending stimuli, <xref ref-type="bibr" rid="B30">Chirico et&#x20;al., 2017</xref>; <xref ref-type="bibr" rid="B32">Chirico et&#x20;al., 2018</xref>) and the sublime (i.e.,&#x20;feeling of &#x201c;amazement tinged with fear&#x201d; in response to vast or powerful stimuli, <xref ref-type="bibr" rid="B31">Chirico et&#x20;al., 2021</xref>). However, significant divergences can be observed about recruited users and the material used for inducing positive emotions with VR. As these methodological choices can greatly influence the emotions induced, they will be further examined in the present article.</p>
</sec>
<sec id="s1-3">
<title>1.3 Aim of the Overview</title>
<p>There are already reviews about VR, emotion induction, well-being and their links to mental health. A recent systematic review confirmed that VR technology is efficient for inducing both positive and negative emotions in lab-settings (<xref ref-type="bibr" rid="B43">Bernardo et&#x20;al., 2021</xref>). Other reviews highlighted VR&#x2019;s potential for improving mental health (<xref ref-type="bibr" rid="B59">Freeman et&#x20;al., 2017</xref>; <xref ref-type="bibr" rid="B77">Jerdan et&#x20;al., 2018</xref>), and elder&#x2019;s quality of life and emotions (<xref ref-type="bibr" rid="B38">D&#x2019;Cunha et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B87">Kim et&#x20;al., 2019</xref>). However, the aim of these reviews was not about understanding key aspects that need to be considered when inducing positive emotions with VR across the adult-life span. Additionally, VR interventions for mental health mostly relied on exposing participants to negative stimuli, for example in the context of exposure therapies, craving induction, or better understanding paranoia among else (<xref ref-type="bibr" rid="B59">Freeman et&#x20;al., 2017</xref>; <xref ref-type="bibr" rid="B77">Jerdan et&#x20;al., 2018</xref>).</p>
<p>Thus, the goal of the present article is to provide an overview and reflect on key determinants for inducing efficiently and safely positive emotions with VR technology. We specifically aim to survey the methodology used for inducing positive emotions, as well as address theoretical and ethical considerations that need to be taken into account. The following topics will be covered in the subsequent sections:<list list-type="simple">
<list-item>
<p>&#x2022; How and why to induce positive emotions in healthy adult users;</p>
</list-item>
<list-item>
<p>&#x2022; Can positive emotion induction through VR be beneficial for elderly users;</p>
</list-item>
<list-item>
<p>&#x2022; What are the potential underlying cognitive mechanisms involved during positive emotion induction with&#x20;VR.</p>
</list-item>
</list>
</p>
</sec>
<sec id="s1-4">
<title>1.4 Scope and Limitations</title>
<p>There are several definitions of VR in the literature, focusing rather on its immersive (e.g., <xref ref-type="bibr" rid="B143">Slater and Wilbur, 1997</xref>) or interactive (e.g., <xref ref-type="bibr" rid="B146">Steuer, 1992</xref>) proprieties. For present purposes, VR will be defined as &#x201c;inducing targeted behavior in an organism by using artificial sensory stimulation, while the organism has little or no awareness of the interference&#x201d; (<xref ref-type="bibr" rid="B93">LaValle, 2016</xref>). While this is a broad definition, it has the advantage of including varying levels of immersion (<xref ref-type="bibr" rid="B93">LaValle, 2016</xref>), ranging from low immersive and more affordable devices such as screens, to highly immersive Cave Automated Virtual Environments, whereby users enter a room with graphical projections onto surrounding walls (<xref ref-type="bibr" rid="B37">Cruz-Neira et&#x20;al., 1993</xref>), and Head-Mounted Displays (HMDs). We decided to include a broad range of devices in order to investigate the degree of immersion and/or interactivity needed for an optimal emotion induction through VR, therefore not limiting the present survey to highly immersive devices such as CAVEs and HMDs. However, as VR technology has been in constant development the last few years it is more than possible that methodological, theoretical and ethical aspects discussed in this paper are prone to change in the future (<xref ref-type="bibr" rid="B47">Elor and Kurniawan, 2020</xref>).</p>
<p>Inducing positive emotions through VR implies using it as a Mood Induction Procedure (MIP). MIPs are well-established experimental procedures for inducing temporary emotional states, considered similar to the ones experienced in everyday life (<xref ref-type="bibr" rid="B105">Martin, 1990</xref>; <xref ref-type="bibr" rid="B12">Ba&#xf1;os et&#x20;al., 2012</xref>). MIPs relies traditionally on presenting arousing pictures (<xref ref-type="bibr" rid="B92">Lang et&#x20;al., 1997</xref>), film sequences (<xref ref-type="bibr" rid="B64">Gross and Levenson, 1995</xref>), music (<xref ref-type="bibr" rid="B153">V&#xe4;stfj&#xe4;ll, 2001</xref>) or sentences (<xref ref-type="bibr" rid="B154">Velten, 1968</xref>). However, a caveat about MIPs must be addressed, as &#x201c;emotion&#x201d; and &#x201c;mood&#x201d; are often used interchangeably, making it unclear what is truly induced via these procedures. For the sake of clarity and to ensure consistency throughout this overview, &#x201c;emotions&#x201d; will be defined as states elicited by precise events or stimuli, and of short duration (<xref ref-type="bibr" rid="B134">Scherer, 2005</xref>). Following <xref ref-type="bibr" rid="B132">Sander et&#x20;al. (2005)</xref>, emotions will be considered to consist of the following five components: subjective feeling, stimulus evaluation, motivation, motor expression and physiological responses. In contrast, &#x201c;mood&#x201d; consists of broader and more diffuse states, and does not necessarily need a contextual stimulus (<xref ref-type="bibr" rid="B46">Ekkekakis, 2012</xref>).</p>
<p>We believe that this work will be of interest to researchers in affective cognitive sciences, psychologists, and healthcare providers wondering which material and content to use, and why it is relevant to induce positive emotions in adults users. For a broad picture of this overview, we have presented a Sankey Diagram (<xref ref-type="fig" rid="F1">Figure&#x20;1</xref>) based on studies included in this overview. The Sankey Diagram allows a quantitative visualization and understanding of the links between recruited populations, employed VR devices, VE contents, affective measures and study aims. The details about each study included in the diagram can be found in <xref ref-type="sec" rid="s8">Supplementary Material</xref>.</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption>
<p>Sankey diagram illustrating links in the literature between recruited populations, VR devices, VE contents, emotional measures and study aims in the field of fostering positive emotions through VR. For instance, the majority of the studies recruited young adults in their study, and the majority of studies that recruited participants in RACFs used a Samsung Gear HMD. Stroke breadths indicate the number of experiments for a given category going from left to right. Abbreviations: RACF, Residential Aged Care Facility; HMD, Head-Mounted Display, obj, objective; UX, User Experience (in this case acceptability and/or feasibility studies).</p>
</caption>
<graphic xlink:href="frvir-03-788820-g001.tif"/>
</fig>
</sec>
<sec id="s1-5">
<title>2 Fostering Positive Emotions Among Healthy Young Users</title>
<sec id="s1-5-1">
<title>2.1 How to Induce Positive Emotions Through VR?</title>
<p>Pivotal studies in the field of positive emotion induction through VR have been conducted on healthy young adults, usually students, to confirm whether it is possible to induce positive emotions with VR (<xref ref-type="bibr" rid="B123">Riva et&#x20;al., 2007</xref>; <xref ref-type="bibr" rid="B11">Ba&#xf1;os et&#x20;al., 2008</xref>) and whether the technology employed is acceptable and useful (<xref ref-type="bibr" rid="B13">Ba&#xf1;os et&#x20;al., 2014</xref>). Since then, a large body of literature explored which methodological aspects can greatly influence users&#x2019; experience (see <xref ref-type="sec" rid="s8">Supplementary Table S1</xref>). It appears that the level of immersion, interactivity, VE contents, and sensory modalities involved are key determinants for fostering positive emotions. As there are discrepancies in the affective measures used to assess VR&#x2019;s efficacy for inducing positive emotions, they will also be covered in the present section.</p>
<p>Ensuring that VR technology is adequately tolerated by healthy young users is the prerequisite before aiming to induce positive emotion. Cybersickness corresponds to adverse effects during and after VR exposure, and is characterized mainly by symptoms such as eye strain, headaches, sweating, disorientation, and nausea (<xref ref-type="bibr" rid="B94">LaViola, 2000</xref>). It is usually assessed by the Simulator Sickness Questionnaire (SSQ) (<xref ref-type="bibr" rid="B83">Kennedy et&#x20;al., 1993</xref>). Intriguingly, only three studies inducing positive emotions with HMDs have explicitly assessed cybersickness symptoms (<xref ref-type="bibr" rid="B16">Bittner et&#x20;al., 2018</xref>; <xref ref-type="bibr" rid="B99">Liszio and Masuch, 2019</xref>; <xref ref-type="bibr" rid="B135">Seabrook et&#x20;al., 2020</xref>). However, the results of these studies corroborate good tolerance of HMDs in the context of positive emotion induction (<xref ref-type="bibr" rid="B16">Bittner et&#x20;al., 2018</xref>; <xref ref-type="bibr" rid="B99">Liszio and Masuch, 2019</xref>; <xref ref-type="bibr" rid="B135">Seabrook et&#x20;al., 2020</xref>).</p>
<p>The first aspect that needs to be taken into account when inducing positive emotions with VR is the level of immersion. There is a heterogeneity of devices included under the umbrella term VR in the literature, and with varying levels of immersion that can lead to low or more intense emotional states (<xref ref-type="bibr" rid="B156">Visch et&#x20;al., 2010</xref>; <xref ref-type="bibr" rid="B40">Diemer et&#x20;al., 2015</xref>). Surprisingly, a limited number of studies have compared immersion levels needed for positive emotion induction. One study compared the effectiveness of inducing positive emotions using an HMD, a tablet, or reading neutral text (control condition) (<xref ref-type="bibr" rid="B16">Bittner et&#x20;al., 2018</xref>). Although VR was most effective in improving positive emotions and mild depressive symptoms, the superiority of the HMD over a less immersive tablet was slight (<xref ref-type="bibr" rid="B16">Bittner et&#x20;al., 2018</xref>). A second study showed a superiority of HMD compared to a screen for inducing awe (<xref ref-type="bibr" rid="B30">Chirico et&#x20;al., 2017</xref>), however, as awe is a complex emotion, it is difficult to conclude if this is true for basic positive emotions.</p>
<p>The second aspect that needs to be considered is the level of interactivity and user engagement within the VEs. Interactive VR experiences under a HMD appear to enhance positive emotions (<xref ref-type="bibr" rid="B158">Yeo et&#x20;al., 2020</xref>), and reduce stress (subjective and physiological) (<xref ref-type="bibr" rid="B99">Liszio and Masuch, 2019</xref>) better than non-interactive VR experiences. Authors suggest that these results can be explained by the ability of interactive experiences to capture and hold users&#x2019; attention over time (<xref ref-type="bibr" rid="B158">Yeo et&#x20;al., 2020</xref>). Nevertheless, a consensus about what falls under the term of &#x201c;interactive&#x201d; is required, as it sometimes means accomplishing a task in the VE (<xref ref-type="bibr" rid="B99">Liszio and Masuch, 2019</xref>), or navigating freely in the VE (<xref ref-type="bibr" rid="B158">Yeo et&#x20;al., 2020</xref>).</p>
<p>Third, contents of the VEs have to be considered, as they can greatly influence induced emotions (<xref ref-type="bibr" rid="B64">Gross and Levenson, 1995</xref>). Most of the studies involved natural settings featuring either vegetation or water (see <xref ref-type="fig" rid="F1">Figure&#x20;1</xref>). This is in line with well known and documented benefits of natural environments on emotions (for a review see <xref ref-type="bibr" rid="B107">McMahan and Estes, 2015</xref>). Several studies confirmed that exposure to virtual nature increases positive emotions and/or perceived restoration (<xref ref-type="bibr" rid="B123">Riva et&#x20;al., 2007</xref>; <xref ref-type="bibr" rid="B25">Browning et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B106">Mattila et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B135">Seabrook et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B158">Yeo et&#x20;al., 2020</xref>) while also significantly reducing negative ones (<xref ref-type="bibr" rid="B155">Villani and Riva, 2012</xref>; <xref ref-type="bibr" rid="B3">Anderson et&#x20;al., 2017</xref>; <xref ref-type="bibr" rid="B158">Yeo et&#x20;al., 2020</xref>). Additionally, virtual nature has a positive impact on physiological arousal, further confirming its relaxing and restorative properties (<xref ref-type="bibr" rid="B4">Annerstedt et&#x20;al., 2013</xref>; <xref ref-type="bibr" rid="B3">Anderson et&#x20;al., 2017</xref>; <xref ref-type="bibr" rid="B25">Browning et&#x20;al., 2020</xref>). Similar benefits of real and virtual nature have been observed when using highly-immersive HMDs (<xref ref-type="bibr" rid="B33">Chirico and Gaggioli, 2019</xref>; <xref ref-type="bibr" rid="B25">Browning et&#x20;al., 2020</xref>). There are however discrepancies on the best way to deliver virtual nature experiences, as it has been reported similar benefits of computer-generated and 360&#xb0;natural videos (<xref ref-type="bibr" rid="B23">Brivio et&#x20;al., 2021</xref>), or greater efficacy of computer-generated VEs (<xref ref-type="bibr" rid="B158">Yeo et&#x20;al., 2020</xref>) in inducing positive emotions.</p>
<p>Fewer studies have investigated the effect of other types of VE contents such as art (<xref ref-type="bibr" rid="B152">Valtchanov et&#x20;al., 2010</xref>; <xref ref-type="bibr" rid="B31">Chirico et&#x20;al., 2021</xref>), crowded urban environments (<xref ref-type="bibr" rid="B160">Yu et&#x20;al., 2018</xref>), or personalized VE contents (<xref ref-type="bibr" rid="B49">Evans et&#x20;al., 2020</xref>). Art and urban-based contents have usually been compared to virtual nature&#x2019;s efficacy for inducing positive emotions. It emerged a superiority of natural VE contents for inducing the sublime (<xref ref-type="bibr" rid="B31">Chirico et&#x20;al., 2021</xref>), as well as heightened positive emotions and resource restoration compared to virtual art (<xref ref-type="bibr" rid="B152">Valtchanov et&#x20;al., 2010</xref>). Furthermore, compared to crowded urban environments, natural environments again induced greater positive emotions and vigor in young adults (<xref ref-type="bibr" rid="B160">Yu et&#x20;al., 2018</xref>). However, studies comparing urban and natural environments in VR did not manage to show physiological changes or differences between natural and urban environments. Finally, personalized 360&#xb0; videos also appeared as efficient for inducing positive emotions (<xref ref-type="bibr" rid="B49">Evans et&#x20;al., 2020</xref>), although their efficacy has not been compared to other VE contents.</p>
<p>The fourth key determinant that needs to be considered is the sensory modality involved in positive VR experiences. Only one study investigated the influence stereoscopy, i.e.,&#x20;the presentation of a different image to each eye in order to give an impression of depth, revealing that it does not impact the valence or intensity of induced emotions (<xref ref-type="bibr" rid="B11">Ba&#xf1;os et&#x20;al., 2008</xref>). Furthermore, it is preferable to include auditory stimuli, rather than relying solely on visual stimuli (<xref ref-type="bibr" rid="B4">Annerstedt et&#x20;al., 2013</xref>; <xref ref-type="bibr" rid="B85">Kern et&#x20;al., 2020</xref>). Auditory stimuli mostly consisted in music and/or ambient environmental sounds (e.g., birds chirping, waves, etc.), and on fewer occasions on positive narratives (e.g., <xref ref-type="bibr" rid="B123">Riva et&#x20;al., 2007</xref>; <xref ref-type="bibr" rid="B135">Seabrook et&#x20;al., 2020</xref>). The added value of olfactory and tactile stimulation have been explored in one study, concluding that auditory and visual information were sufficient in VR for relaxing participants (<xref ref-type="bibr" rid="B138">Serrano et&#x20;al., 2016</xref>).</p>
<p>Finally, VR&#x2019;s efficacy for inducing targeted emotions has mainly been investigated with questionnaires, the most widely used ones being the Positive and Negative Affect Schedule (<xref ref-type="bibr" rid="B157">Watson et&#x20;al., 1988</xref>) and Visual Analogical Scales (VAS, see <xref ref-type="bibr" rid="B12">Ba&#xf1;os et&#x20;al., 2012</xref>). More recently, physiological measures have started to be collected in addition to questionnaires, confirming VR&#x2019;s capacity for arousal (<xref ref-type="bibr" rid="B52">Felnhofer et&#x20;al., 2015</xref>). Commonly collected physiological measures are skin conductance, and cardiac measures such as Heart Rate (HR) or Heart Rate Variability (HRV) (see <xref ref-type="fig" rid="F1">Figure&#x20;1</xref>). In a limited number of studies, electromyography (<xref ref-type="bibr" rid="B30">Chirico et&#x20;al., 2017</xref>), cortisol (<xref ref-type="bibr" rid="B4">Annerstedt et&#x20;al., 2013</xref>; <xref ref-type="bibr" rid="B98">Liszio et&#x20;al., 2018</xref>) or electroencephalography (<xref ref-type="bibr" rid="B103">Mar&#xed;n-Morales et&#x20;al., 2018</xref>) have been used to explore VR&#x2019;s potential for inducing emotions.</p>
</sec>
</sec>
<sec id="s1-6">
<title>2.2 Why Induce Positive Emotions in Healthy Users?</title>
<p>Positive emotions coupled with VR can have great benefits on healthy users&#x2019; physical activity. For instance, when combined with stationary cycling, a virtual park inducing joy efficiently motivated users (<xref ref-type="bibr" rid="B109">Miragall et&#x20;al., 2021</xref>). However, authors pointed out that inducing joy was not sufficient to increase user&#x2019;s motivation without an appropriate body posture (e.g., leaning forward posture while pedaling) (<xref ref-type="bibr" rid="B109">Miragall et&#x20;al., 2021</xref>). It emerges that coupling VR, positive emotion induction and exercise can have great benefits on users&#x2019; motivation, although VR and positive emotions by themselves are not sufficient for that goals. It should be noted that the present studies used large screens, possibly because using HMDs for exercise may be challenging and increase cybersickness symptoms.</p>
<p>There is also compelling evidence that VR experiences are efficient for relaxation when combined with VE contents showing natural settings. On numerous occasions, virtual nature (both vegetation and water features) has proven to be efficient for inducing relaxed states in healthy young adults (<xref ref-type="bibr" rid="B123">Riva et&#x20;al., 2007</xref>; <xref ref-type="bibr" rid="B4">Annerstedt et&#x20;al., 2013</xref>; <xref ref-type="bibr" rid="B3">Anderson et&#x20;al., 2017</xref>; <xref ref-type="bibr" rid="B25">Browning et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B106">Mattila et&#x20;al., 2020</xref>) and supporting mindfulness practice (<xref ref-type="bibr" rid="B135">Seabrook et&#x20;al., 2020</xref>). Furthermore, it has been verified that the novelty and attractiveness of VR did not distract participants from accessing a relaxed yet focused state needed for biofeedback (<xref ref-type="bibr" rid="B127">Rockstroh et&#x20;al., 2019</xref>) or hypnosis (<xref ref-type="bibr" rid="B149">Thompson et&#x20;al., 2010</xref>). A recent study revealed that VR relaxation applications are overall positively perceived by users (<xref ref-type="bibr" rid="B50">Fagern&#xe4;s et&#x20;al., 2021</xref>), further confirming their usefulness.</p>
<p>One last application of positive emotions induced through VR among healthy young adults is stress and pain management. Inducing positive emotions with VR appears efficient at recovering from acute stress, with subjective outcomes such as improved self-report emotions, and objective outcomes such as an increased HRV (<xref ref-type="bibr" rid="B155">Villani and Riva, 2012</xref>; <xref ref-type="bibr" rid="B4">Annerstedt et&#x20;al., 2013</xref>; <xref ref-type="bibr" rid="B99">Liszio and Masuch, 2019</xref>). Additionally, playing a game in an aquatic environment under an HMD has proven efficient in reducing experimentally induced pain (<xref ref-type="bibr" rid="B63">Gordon et&#x20;al., 2011</xref>). However, VR was efficient in reducing only high intensity pain, and both HMDs and CAVE were efficient for accomplishing it (<xref ref-type="bibr" rid="B63">Gordon et&#x20;al., 2011</xref>).</p>
<p>It should be noted that the vast majority of the above-mentioned studies used natural contents. This demonstrates the virtues of nature, while again confirming the need for investigating the potential benefits of social contents, notably for physical activity and motivation. For instance, it could be relevant to compare exercising in natural virtual environments and exercising with a virtual coach in order to better understand the influence of the contents on positive VR applications. Additionally, as the previously cited studies about positive emotion induction through VR and their applications were conducted on healthy young adults, their generalization to more vulnerable users needs to be addressed separately.</p>
</sec>
<sec id="s1-7">
<title>3 Towards Successful Aging With VR</title>
<p>Although the majority of VR studies on positive emotion induction have been conducted on young adults, a growing number of studies have investigated the use of VR for elderly users (see <xref ref-type="sec" rid="s8">Supplementary Table S2</xref>). Fostering positive experiences can be particularly beneficial to elderly adults, given the previously discussed benefits of positive emotions on health and quality of life (<xref ref-type="bibr" rid="B90">Kuppens et&#x20;al., 2008</xref>; <xref ref-type="bibr" rid="B41">Diener and Chan, 2011</xref>). Moreover, it is generally admitted that positive emotions and happiness follow a U-shaped pattern throughout the life-span, with an improvement from early to advanced adulthood (although see <xref ref-type="bibr" rid="B145">Steptoe et&#x20;al., 2015</xref>). However, advancing in age is often described as a developmental process characterized by social, physical and cognitive losses (<xref ref-type="bibr" rid="B9">Baltes and Baltes, 1990</xref>; <xref ref-type="bibr" rid="B8">Baltes and Carstensen, 2003</xref>). In contrast, the concept of &#x201c;successful aging&#x201d; has emerged, consisting in aging with well-functioning physical and cognitive abilities, and minimized risks of developing diseases and disabilities (<xref ref-type="bibr" rid="B129">Rowe and Kahn, 1987</xref>; <xref ref-type="bibr" rid="B130">Rowe and Kahn, 2015</xref>). Thus, exploring positive VR experiences for elderly users has a twofold advantage, as it may enable a better understanding of why some people are considered to age successfully while also potentially alleviating age-related health issues and decline.</p>
<p>Providing elderly users with VR experiences requires ensuring that the VR devices and high levels of immersion are adapted to them. Elderly users seem to prefer devices with lower levels of immersion, such as smartphones, to highly-immersive HMDs, while the opposite holds for younger adults (<xref ref-type="bibr" rid="B100">Liu et&#x20;al., 2020</xref>). On a similar note, hospitalized patients who were not interested in testing an HMD were older than those who were interested (<xref ref-type="bibr" rid="B110">Mosadeghi et&#x20;al., 2016</xref>). This does not mean that older adults do not appreciate HMDs, as they usually find highly immersive VR experiences enjoyable, and have a rather positive attitude towards HMDs once they have tested them (<xref ref-type="bibr" rid="B76">Huygelier et&#x20;al., 2019</xref>). Furthermore, high levels of acceptance and satisfaction have been reported towards HMDs and CAVE for VR, which can be safely used with elderly users considered &#x201c;in good health&#x201d; (<xref ref-type="bibr" rid="B14">Benoit et&#x20;al., 2015</xref>; <xref ref-type="bibr" rid="B76">Huygelier et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B28">Chan et&#x20;al., 2020</xref>) or having cognitive and/or physical impairments (<xref ref-type="bibr" rid="B126">Roberts et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B5">Appel et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B21">Brimelow et&#x20;al., 2020</xref>). The duration of immersion under an HMD may last up to 20&#xa0;minutes, with little to no adverse side effects (<xref ref-type="bibr" rid="B5">Appel et&#x20;al., 2020</xref>).</p>
<p>In line with these results, several studies confirm VR&#x2019;s efficacy for inducing positive emotions (such as joy and relaxation) in healthy middle-aged (<xref ref-type="bibr" rid="B159">Yu et&#x20;al., 2020</xref>), elderly users (<xref ref-type="bibr" rid="B48">Etchemendy et&#x20;al., 2011</xref>; <xref ref-type="bibr" rid="B12">Ba&#xf1;os et&#x20;al., 2012</xref>; <xref ref-type="bibr" rid="B100">Liu et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B159">Yu et&#x20;al., 2020</xref>), or among more vulnerable and/or dependent users (e.g., residents of Residential Aged Care Facilities, RACF) (<xref ref-type="bibr" rid="B113">Moyle et&#x20;al., 2018</xref>; <xref ref-type="bibr" rid="B126">Roberts et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B5">Appel et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B21">Brimelow et&#x20;al., 2020</xref>). As for younger users, most of the studies relied on natural-based VE contents (<xref ref-type="bibr" rid="B12">Ba&#xf1;os et&#x20;al., 2012</xref>; <xref ref-type="bibr" rid="B113">Moyle et&#x20;al., 2018</xref>; <xref ref-type="bibr" rid="B76">Huygelier et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B5">Appel et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B21">Brimelow et&#x20;al., 2020</xref>), mainly because of their well-known benefits and safety of use (<xref ref-type="bibr" rid="B5">Appel et&#x20;al., 2020</xref>). Additionally, it has been showed that nature contents lead to lower feelings of tiredness and depression in middle-aged and older adults (<xref ref-type="bibr" rid="B159">Yu et&#x20;al., 2020</xref>). Several studies used other VE contents such as interactive applications (<xref ref-type="bibr" rid="B48">Etchemendy et&#x20;al., 2011</xref>; <xref ref-type="bibr" rid="B7">Baker et&#x20;al., 2020</xref>) or personalized contents (<xref ref-type="bibr" rid="B14">Benoit et&#x20;al., 2015</xref>), mainly in order to investigate elderly users&#x2019; acceptability and satisfaction of these contents (see <xref ref-type="sec" rid="s8">Supplementary Material</xref>).</p>
<p>Positive emotions induced through VR have proven to be useful in improving cognitive and physical outcomes in people with mild cognitive impairment (<xref ref-type="bibr" rid="B87">Kim et&#x20;al., 2019</xref>) and people living with dementia (<xref ref-type="bibr" rid="B38">D&#x2019;Cunha et&#x20;al., 2019</xref>). A growing demand for using VR to reduce apathy in RACFs has also sprung up in recent years. Although current evidence is limited to exploratory and preliminary research, VR has potential for reducing apathy in addition to improving overall emotions (<xref ref-type="bibr" rid="B21">Brimelow et&#x20;al., 2020</xref>). This observation is further supported by residents&#x2019; families and by staff members (<xref ref-type="bibr" rid="B113">Moyle et&#x20;al., 2018</xref>). However, one limitation is the lack of control groups in order to understand to what extent VR by itself is efficient in reducing apathy compared to traditional treatments. A research project aims at answering this limitation by including an active and passive control group for comparison with the VR group (<xref ref-type="bibr" rid="B133">Saredakis et&#x20;al., 2020</xref>).</p>
<p>As a side note, despite high levels of satisfaction and an efficient induction of positive emotions, it has been reported on several occasions that VR also induces negative emotions in elderly users (<xref ref-type="bibr" rid="B5">Appel et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B21">Brimelow et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B28">Chan et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B100">Liu et&#x20;al., 2020</xref>), especially feelings of anxiety or fear (<xref ref-type="bibr" rid="B113">Moyle et&#x20;al., 2018</xref>). These mixed feelings about VR experiences can be explained by characteristics of the users and of the devices. It is plausible that VR experiences, especially those involving HMDs, are less appropriate for users with cognitive deficits, who may experience VR as confusing or even intrusive (<xref ref-type="bibr" rid="B126">Roberts et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B7">Baker et&#x20;al., 2020</xref>). Elderly users have reported the following drawbacks of VR experiences: physical discomfort and blurred vision due to inadequate devices, issues for executing required movements in VE, worries about using the equipment without assistance, and personal preference for less immersive experiences (<xref ref-type="bibr" rid="B126">Roberts et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B7">Baker et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B100">Liu et&#x20;al., 2020</xref>).</p>
</sec>
</sec>
<sec id="s2">
<title>4 Discussion</title>
<sec id="s2-1">
<title>4.1 Strengths and Weaknesses of Positive Emotion Induction Through VR</title>
<p>In recent years increased interest in using technology to enhance health and well-being has sprung up (<xref ref-type="bibr" rid="B88">Kitson et&#x20;al., 2018</xref>). The present review aimed specifically at investigating VR&#x2019;s potential for eliciting and fostering positive emotional states. This investigation was conducted on studies that recruited adult users, most of them conducted on young healthy users. It emerged that VR is a safe and potent technology for inducing positive emotions in young and elderly users. The results of the present overview support the claim that the positive emotions induced through VR provide effective leverage for physical activity (<xref ref-type="bibr" rid="B109">Miragall et&#x20;al., 2021</xref>), alleviating induced stress (<xref ref-type="bibr" rid="B4">Annerstedt et&#x20;al., 2013</xref>; <xref ref-type="bibr" rid="B99">Liszio and Masuch, 2019</xref>) or pain (<xref ref-type="bibr" rid="B63">Gordon et&#x20;al., 2011</xref>) in healthy young adults, as well as a promising tool for reducing apathy in elderly users (<xref ref-type="bibr" rid="B113">Moyle et&#x20;al., 2018</xref>; <xref ref-type="bibr" rid="B21">Brimelow et&#x20;al., 2020</xref>).</p>
<p>High levels of acceptability, satisfaction and perceived usefulness of positive VR experiences have been reported by young adults, and elderly users. However, a limited number of studies assessed explicitly VR tolerance and cybersickness symptoms when inducing positive emotions. As variable levels of cybersickness symptoms have been reported in the literature, with usually women (<xref ref-type="bibr" rid="B144">Stanney et&#x20;al., 2020</xref>), and elderly users (<xref ref-type="bibr" rid="B6">Arns and Cerney, 2005</xref>; <xref ref-type="bibr" rid="B76">Huygelier et&#x20;al., 2019</xref>) being more prone to it, generalizing explicit measures of cybersickness symptoms appears relevant, especially when aiming to induce positive emotions. Employing objective measures in addition to self-reported measures of cybersickness could also be relevant for a better detection of cybersickness symptoms (see <xref ref-type="bibr" rid="B29">Chang et&#x20;al., 2020</xref>).</p>
<p>There are no clear answers about the levels of immersion and interactivity required for inducing positive emotions. Although highly immersive HMDs and CAVE are particularly efficient for inducing positive emotions (<xref ref-type="bibr" rid="B30">Chirico et&#x20;al., 2017</xref>; <xref ref-type="bibr" rid="B32">Chirico et&#x20;al., 2018</xref>; <xref ref-type="bibr" rid="B25">Browning et&#x20;al., 2020</xref>), alleviating negative emotions (<xref ref-type="bibr" rid="B16">Bittner et&#x20;al., 2018</xref>) and sensations (<xref ref-type="bibr" rid="B63">Gordon et&#x20;al., 2011</xref>), their superiority to screens remains to be validated. Moreover, interactivity appears beneficial for inducing positive emotions (<xref ref-type="bibr" rid="B155">Villani and Riva, 2012</xref>; <xref ref-type="bibr" rid="B99">Liszio and Masuch, 2019</xref>) and preventing users&#x2019; boredom (<xref ref-type="bibr" rid="B158">Yeo et&#x20;al., 2020</xref>), yet the majority of the studies relied on non-interactive VR experiences. Additionally, low immersive devices and non-interactive VR experiences appeared efficient at conveying positive emotions, especially in elderly users. Further studies are needed to disentangle the optimal levels of immersion and interactivity required based on users&#x2019; characteristics for fostering positive emotions.</p>
<p>Regarding VE contents employed for inducing positive emotions, it emerged that VEs of nature, i.e.,&#x20;vegetation and aquatic contents are widespread. This is mainly due to nature&#x2019;s health benefits (<xref ref-type="bibr" rid="B150">Twohig-Bennett and Jones, 2018</xref>), positive emotion improvement (<xref ref-type="bibr" rid="B107">McMahan and Estes, 2015</xref>) and ability to restore resources (<xref ref-type="bibr" rid="B79">Kaplan and Kaplan, 1989</xref>; <xref ref-type="bibr" rid="B151">Ulrich et&#x20;al., 1991</xref>). However, several points need to be addressed about natural VE contents. Firstly, a neutral VE has not been systematically used for comparison, therefore making it difficult to fully state natural VE superiority for conveying positive emotions over other types of VE. Furthermore, a new research field consisting in using natural VE for promoting climate change awareness has started developing (<xref ref-type="bibr" rid="B51">Fauville et&#x20;al., 2020</xref>). Natural VE are therefore employed for encouraging conservation behavior (<xref ref-type="bibr" rid="B73">Hsu et&#x20;al., 2018</xref>; <xref ref-type="bibr" rid="B114">Nelson et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B71">Hofman et&#x20;al., 2021</xref>), learning about ocean acidification (<xref ref-type="bibr" rid="B104">Markowitz et&#x20;al., 2018</xref>) or visualizing a forest under climate changes (<xref ref-type="bibr" rid="B74">Huang et&#x20;al., 2021</xref>). These natural VE do not necessarily aim at inducing positive emotions, but rather raising awareness which can lead to negative emotion induction (<xref ref-type="bibr" rid="B73">Hsu et&#x20;al., 2018</xref>; <xref ref-type="bibr" rid="B114">Nelson et&#x20;al., 2020</xref>). This means that natural VE are not intrinsically positive (or negative), but rather that their emotional valence relies heavily on the context and the meaning users are willing to give&#x20;them.</p>
<p>Social contents may also present advantages for fostering positive emotions, yet they have been understudied. This is intriguing given that their use in VR could help to enhance social well-being, as argued within the positive technologies&#x2019; framework (<xref ref-type="bibr" rid="B19">Botella et&#x20;al., 2012</xref>; <xref ref-type="bibr" rid="B122">Riva et&#x20;al., 2012</xref>; <xref ref-type="bibr" rid="B10">Ba&#xf1;os et&#x20;al., 2017</xref>). A research asking participants to record their personalized 360&#xb0; video revealed that more than half of the participants&#x2019; videos included family members, friends or loved ones, and that the majority of videos involved the presence of at least one person (<xref ref-type="bibr" rid="B49">Evans et&#x20;al., 2020</xref>). Moreover, it emerged from studies investigating elderly users&#x2019; preferences that they are particularly willing in using VR for social purposes and interactions (<xref ref-type="bibr" rid="B126">Roberts et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B7">Baker et&#x20;al., 2020</xref>). This is in line with researches showing that social contents (i.e.,&#x20;with people present in the pictures/videos) induce greater subjective feelings of positive emotions (<xref ref-type="bibr" rid="B36">Colden et&#x20;al., 2008</xref>), and different physiological responses to non-social contents (<xref ref-type="bibr" rid="B22">Britton et&#x20;al., 2006</xref>). This may for instance explain why studies comparing &#x201c;natural&#x201d; and &#x201c;urban&#x201d; (therefore social) VE contents (<xref ref-type="bibr" rid="B160">Yu et&#x20;al., 2018</xref>; <xref ref-type="bibr" rid="B159">Yu et&#x20;al., 2020</xref>) failed to reveal clear physiological differences between the two types of content. Developing a database of various VE contents for emotion induction thus appears necessary, and there have been attempts for developing one (e.g., see <xref ref-type="bibr" rid="B96">Li et&#x20;al., 2017</xref>).</p>
<p>VR&#x2019;s efficacy has mostly been investigated with questionnaires reporting &#x201c;subjective&#x201d; feelings, although in recent years they started being coupled to more &#x201c;objective&#x201d; measures, mainly skin conductance and various cardiac measures. As a matter of fact, it has been argued by various authors that combining questionnaires with &#x201c;objective&#x201d; measures helps better understand to what extent VR interventions are effective, and ensuring that participants do not simply experience social desirability-bias (<xref ref-type="bibr" rid="B5">Appel et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B38">D&#x2019;Cunha et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B52">Felnhofer et&#x20;al., 2015</xref>; <xref ref-type="bibr" rid="B123">Riva et&#x20;al., 2007</xref>; <xref ref-type="bibr" rid="B43">Bernardo et&#x20;al., 2021</xref>). However, a consensus about the relevant measures and the best way to collect them is needed since considerable heterogeneity was observed regarding the selected measures, the moment and duration of their collection.</p>
<p>More recently, there has been a growing interest in providing VR experiences, especially positive ones, to older users. When proposing positive VR experiences to elderly users, one should have the following considerations in mind. Depending on users&#x2019; characteristics and preferences, lower immersive devices may be more suitable, especially when setting up VR interventions for users with cognitive and/or physical impairments, and the benefits of interactivity has yet to be investigated among elderly users. Nevertheless, it has been argued on several occasions that elderly users can find highly immersive CAVEs and HMDs enjoyable and draw benefits from them (<xref ref-type="bibr" rid="B14">Benoit et&#x20;al., 2015</xref>; <xref ref-type="bibr" rid="B76">Huygelier et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B5">Appel et&#x20;al., 2020</xref>). Constructors of positive VR experiences under HMDs could consider that their use may be compromised when users rely on hearing and/or visual aid devices (<xref ref-type="bibr" rid="B126">Roberts et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B100">Liu et&#x20;al., 2020</xref>); should consider adapting the movements and inputs to be controller-free (<xref ref-type="bibr" rid="B121">Pimentel et&#x20;al., 2021</xref>) and simplify the equipment and interfaces for novice and less autonomous users (<xref ref-type="bibr" rid="B126">Roberts et&#x20;al., 2019</xref>). Lastly, further studies are necessary on middle-aged users, as so far only one study recruited these users (<xref ref-type="bibr" rid="B159">Yu et&#x20;al., 2020</xref>), therefore it is not possible to conclude on VR&#x2019;s efficacy in these&#x20;users.</p>
<p>Finally, several limitations must be addressed regarding studies that attempt to induce positive emotions through VR. Studies&#x2019; sample sizes can range from 5 to over a thousand participants per study and experimental condition (see <xref ref-type="sec" rid="s8">Supplementary Material</xref>). Smaller sample sizes have been observed in studies recruiting elderly users in RACFs and impairments, which implies lower statistical power (<xref ref-type="bibr" rid="B1">Akobeng, 2016</xref>). Additionally, effect sizes have not been consistently reported in presently selected studies, making it complex to fully conclude on VR&#x2019;s capacity for inducing positive emotions. However, a considerable number of studies with young adults reported medium to large effect sizes (see <xref ref-type="sec" rid="s8">Supplementary Material</xref>) suggesting that VR is at least to some extent efficient for inducing emotions in younger users. More robust studies reporting effect sizes of positive VR interventions are needed to support its efficacy in middle-aged and elderly users. One should have also in mind the possibility of <italic>p</italic>-hacking, which consists in a set of questionable practices forcing results to be significant even in under-powered studies (<xref ref-type="bibr" rid="B115">Nelson et&#x20;al., 2018</xref>; <xref ref-type="bibr" rid="B20">Botella and Suero, 2020</xref>). Lastly, a potential publication bias should be addressed, as the majority of the studies reported significant positive outcomes, while null or negative effects are a minority or non-existing so far in the literature. These statistical and publishing biases can be overcome by carefully reporting sample size measurements (<xref ref-type="bibr" rid="B115">Nelson et&#x20;al., 2018</xref>), significant and non-significant results (<xref ref-type="bibr" rid="B91">Lakens and Etz, 2017</xref>), and studies pre-registration and/or replication (<xref ref-type="bibr" rid="B117">Nosek and Lakens, 2014</xref>).</p>
</sec>
<sec id="s2-2">
<title>4.2 Potential Cognitive Mechanisms Involved</title>
<p>While there is no clear explanation of why VR is so efficient in inducing positive emotions nor what its short and long term benefits are (<xref ref-type="bibr" rid="B84">Kenwright, 2018</xref>; <xref ref-type="bibr" rid="B43">Bernardo et&#x20;al., 2021</xref>), findings allow us to speculate on the possible operating mechanisms. The <xref ref-type="fig" rid="F2">Figure&#x20;2</xref> provides a visual illustration of the cognitive mechanisms covered in the present section, which investigates the links behind VR technology, positive emotions and users&#x2019; characteristics.</p>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption>
<p>A schematic illustration of potential cognitive mechanisms linking positive emotions, VR and users. Concepts written on the arrows describe the link between two instances, and the theoretical models explaining the existing link are written below in italics.</p>
</caption>
<graphic xlink:href="frvir-03-788820-g002.tif"/>
</fig>
<p>It has been argued that highly immersive VR is arousing (<xref ref-type="bibr" rid="B156">Visch et&#x20;al., 2010</xref>; <xref ref-type="bibr" rid="B30">Chirico et&#x20;al., 2017</xref>), able to capture and hold users&#x2019; attention (<xref ref-type="bibr" rid="B34">Cho et&#x20;al., 2002</xref>; <xref ref-type="bibr" rid="B97">Li et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B135">Seabrook et&#x20;al., 2020</xref>), trick their senses (<xref ref-type="bibr" rid="B60">Gallace et&#x20;al., 2012</xref>; <xref ref-type="bibr" rid="B137">Serino et&#x20;al., 2016</xref>; <xref ref-type="bibr" rid="B45">Droit-Volet et&#x20;al., 2020</xref>), as well as distract from negative affects and sensations (<xref ref-type="bibr" rid="B102">Malloy and Milling, 2010</xref>; <xref ref-type="bibr" rid="B139">Sharar et&#x20;al., 2016</xref>). However, a neurological perspective on VR&#x2019;s benefits and adverse effects is highly needed. Recently, it has been suggested that VR and the brain may share similarities, i.e. embodied simulations (<xref ref-type="bibr" rid="B124">Riva et&#x20;al., 2018</xref>). For the brain, embodied simulations imply the existence of a &#x201c;body matrix,&#x201d; involved in coding visual, tactile and proprioceptive information which allows an individual to maintain a mental model of the body and the space around it (<xref ref-type="bibr" rid="B111">Moseley et&#x20;al., 2012</xref>; <xref ref-type="bibr" rid="B124">Riva et&#x20;al., 2018</xref>). Through the integration of several sensory stimuli, the body matrix is able to provide predictions about future actions (<xref ref-type="bibr" rid="B124">Riva et&#x20;al., 2018</xref>). As VR shares the same characteristics of integrating several sensory inputs and predicting future user actions for optimal VR experiences, it has been suggested that VR can be considered as an &#x201c;embodied technology&#x201d; (<xref ref-type="bibr" rid="B124">Riva et&#x20;al., 2018</xref>; <xref ref-type="bibr" rid="B159">Yu et&#x20;al., 2020</xref>). Currently, VR is highly efficient at simulating the external world and body, but simulating internal simulations is more complex (although see <xref ref-type="bibr" rid="B125">Riva et&#x20;al., 2019</xref>). When combined, these features may at least partially explain what makes VR suitable for positive emotion induction.</p>
<p>The operating mechanisms behind positive emotions and their influence are better documented, and interestingly, they have complementary benefits to VR. As already discussed, positive emotions present health benefits (<xref ref-type="bibr" rid="B41">Diener and Chan, 2011</xref>), can lead to happiness (<xref ref-type="bibr" rid="B42">Diener et&#x20;al., 1999</xref>) and influence cognition and stimuli processing (<xref ref-type="bibr" rid="B120">Phillips et&#x20;al., 2002</xref>; <xref ref-type="bibr" rid="B56">Fredrickson, 2004</xref>; <xref ref-type="bibr" rid="B128">Rowe et&#x20;al., 2007</xref>; <xref ref-type="bibr" rid="B72">Holland and Kensinger, 2010</xref>). Although there are discrepancies in the literature concerning the physiological markers of positive emotions (<xref ref-type="bibr" rid="B58">Fredrickson, 2003</xref>; <xref ref-type="bibr" rid="B89">Kreibig, 2010</xref>), they have undoubtedly effects on the cardiac, vascular and electrodermal systems (<xref ref-type="bibr" rid="B140">Shiota et&#x20;al., 2011</xref>). The recent development of a neuroscience of well-being suggests the implication of a broad neural system, involving several neurotransmitters and brain regions traditionally known to be involved in emotion processing (for a review see <xref ref-type="bibr" rid="B2">Alexander et&#x20;al., 2020</xref>).</p>
<p>Beyond complementary added values of VR and emotions for fostering well-being, a user-centered approach is highly needed to elicit optimal user experiences. Fostering positive emotions by means of technology implies taking into account users&#x2019; age (<xref ref-type="bibr" rid="B100">Liu et&#x20;al., 2020</xref>), gender (<xref ref-type="bibr" rid="B141">Siess and W&#xf6;lfel, 2019</xref>), and physical and cognitive impairments (<xref ref-type="bibr" rid="B126">Roberts et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B7">Baker et&#x20;al., 2020</xref>) as all these characteristics may potentially influence users&#x2019; VR experience (<xref ref-type="bibr" rid="B84">Kenwright, 2018</xref>). Personal relevance is another key aspect that may play a major role when opting for preferred VE contents, but has been understudied. Finally, cognitive reappraisal may come into play, as depending on users&#x2019; goals and regulation strategies employed they will drawn different benefits from emotional experiences (<xref ref-type="bibr" rid="B108">McRae et&#x20;al., 2012</xref>; <xref ref-type="bibr" rid="B24">Brockman et&#x20;al., 2017</xref>). It has also been argued in this overview that VE contents are not intrinsically &#x201c;positive&#x201d; or &#x201c;negative,&#x201d; as their emotional valence depends greatly on the meaning users are willing to give&#x20;them.</p>
</sec>
<sec id="s2-3">
<title>4.3 Ethical Considerations and Limitations</title>
<p>Several ethical considerations need to be discussed about positive VR and fostering well-being. Firstly, the devices and material used as VR should be reported clearly, as several devices, with variable levels of immersion, are grouped under the umbrella term of VR. VR material has been reported in the majority of the studies investigated for the present overview (see <xref ref-type="fig" rid="F1">Figure&#x20;1</xref>). Nevertheless, authors should consistently report the VR material used in their studies.</p>
<p>Although the studies discussed in the present review aimed specifically at inducing positive emotions in users, mixed feelings and negative emotions among elderly users (<xref ref-type="bibr" rid="B38">D&#x2019;Cunha et&#x20;al., 2019</xref>; <xref ref-type="bibr" rid="B100">Liu et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B113">Moyle et&#x20;al., 2018</xref>) and barriers for using HMDs outside lab-settings (<xref ref-type="bibr" rid="B121">Pimentel et&#x20;al., 2021</xref>) have been reported. This raises several concerns, starting with the need to involve elderly users in every feature design, from the early stages of development of a technology to its application (<xref ref-type="bibr" rid="B26">Castilla et&#x20;al., 2013</xref>). Before setting up positive VR experiences for elderly users, some design guidelines that should be considered are simplifying the technology to be accessible to novice users (<xref ref-type="bibr" rid="B84">Kenwright, 2018</xref>; <xref ref-type="bibr" rid="B121">Pimentel et&#x20;al., 2021</xref>), limiting the number of choices for a given action in the VE (<xref ref-type="bibr" rid="B26">Castilla et&#x20;al., 2013</xref>), enabling different levels of complexity in order to match users&#x2019; skills (<xref ref-type="bibr" rid="B27">Castilla et&#x20;al., 2020</xref>), and slow down speech narratives to avoid the double-tasks resulting from such situations (<xref ref-type="bibr" rid="B27">Castilla et&#x20;al., 2020</xref>).</p>
<p>A thorough reflection about which users can benefit from VR interventions, and those for whom it may be detrimental is necessary (<xref ref-type="bibr" rid="B82">Kellmeyer, 2018</xref>; <xref ref-type="bibr" rid="B81">Kellmeyer et&#x20;al., 2019</xref>). As literature about VR and emotion induction is nascent, it is normal to start investigating its effects on healthy users before proposing it to more fragile ones. It appears necessary to investigate the benefits, as well as the negative side-effects that may arouse from using VR. For instance, there is to our knowledge no literature about addiction to VR experiences, yet it needs to be investigated, especially when setting positive VR interventions. In line with this observation, it is intriguing that no clear guidelines about the VR exposure duration required and necessary for inducing positive emotions has been reported. For instance, the exposure duration in the cited studies ranges from 90&#xa0;s (<xref ref-type="bibr" rid="B103">Mar&#xed;n-Morales et&#x20;al., 2018</xref>) to 20&#xa0;min (<xref ref-type="bibr" rid="B12">Ba&#xf1;os et&#x20;al., 2012</xref>; <xref ref-type="bibr" rid="B5">Appel et&#x20;al., 2020</xref>; <xref ref-type="bibr" rid="B109">Miragall et&#x20;al., 2021</xref>) without breaks, and over 45&#xa0;min with breaks (<xref ref-type="bibr" rid="B3">Anderson et&#x20;al., 2017</xref>). As exposure duration requires to be long enough to elicit positive emotions, but not too lengthy to cause tiredness, confusion or boredom, its thresholds need to be further investigated.</p>
<p>Positive emotions are not valued and expressed in the same way in different cultures (<xref ref-type="bibr" rid="B78">Joshanloo and Weijers, 2014</xref>). Research into positive emotions and well-being should take cultural differences into account, which is still rarely the case (<xref ref-type="bibr" rid="B2">Alexander et&#x20;al., 2020</xref>). For instance, the majority of the cited studies has been on conducted on so-called Western, Educated, Industrialized, Rich and Democratic (WEIRD) populations (<xref ref-type="bibr" rid="B69">Henrich et&#x20;al., 2010a</xref>,<xref ref-type="bibr" rid="B70">b</xref>). While it does bring some insights on users&#x2019; opinions and reactions to positive VR interventions, it remains not generalizable to all potential users because of this&#x20;bias.</p>
<p>Finally, fostering positive emotions should not in any case become an injunction towards constant well-being and the repression of negative emotions. Several limitations have been raised about the broaden-and-build based literature, which supports the idea that positive emotions, cognition and well-being are tightly linked (<xref ref-type="bibr" rid="B56">Fredrickson, 2004</xref>; <xref ref-type="bibr" rid="B54">Fredrickson and Branigan, 2005</xref>; <xref ref-type="bibr" rid="B57">Fredrickson, 2006</xref>). Firstly, the dichotomy between positive and negative emotions have been criticized (<xref ref-type="bibr" rid="B67">Held, 2018</xref>). Thus, positive emotions do not always lead to well-being, and can even become detrimental (<xref ref-type="bibr" rid="B65">Gruber et&#x20;al., 2008</xref>; <xref ref-type="bibr" rid="B53">Ford and Mauss, 2014</xref>). In addition, negative emotions can also motivate the construction of useful resources (<xref ref-type="bibr" rid="B112">Moss and Wilson, 2015</xref>; <xref ref-type="bibr" rid="B119">P&#xe9;rez- &#xc1;lvarez, 2016</xref>). Methodological weaknesses of the broaden-and-build literature has also been reviewed, pointing mainly at the experimental methodologies employed for supporting the theory (<xref ref-type="bibr" rid="B116">Nickerson, 2007</xref>; <xref ref-type="bibr" rid="B119">P&#xe9;rez- &#xc1;lvarez, 2016</xref>). For instance, the supposed broadening of attention following positive emotions is not consistently found, as the links between emotions and cognition appear to be more flexible than originally conceptualized (e.g., see <xref ref-type="bibr" rid="B75">Huntsinger, 2012</xref>; <xref ref-type="bibr" rid="B148">Taylor et&#x20;al., 2017</xref>). Going further, it has been suggested that rather than purchasing constantly positive experiences and happiness, perhaps it is more relevant to pursue a valuable and meaningful life with its ups and downs (<xref ref-type="bibr" rid="B119">P&#xe9;rez-&#xc1;lvarez, 2016</xref>).</p>
</sec>
</sec>
<sec id="s3">
<title>5 Conclusion</title>
<p>In conclusion, the studies presented in this overview reveal the great potential and future that positive VR has for fostering positive emotions in young and adult users. These positive emotions may in return motivate users towards achieving their goals, or help relaxing and managing negative affects and pain. Key aspects that need to be reflected on before setting up positive VR interventions are users&#x2019; characteristics and needs, levels of immersion, interactivity, VE contents, sensory modalities involved, and exposure duration required for optimal positive emotion induction. In any cases, fostering well-being through VR should be driven by users&#x2019; characteristics and needs in the first place rather than by technological progresses, about which there is still a lot of gray area on their long-term benefits and side-effects. Overall, fostering positive emotions through VR should remain a proposition, and should not in any case become an injunction towards constant well-being and happiness.</p>
</sec>
</body>
<back>
<sec id="s4">
<title>Author Contributions</title>
<p>KP, DV-P, TG, and LC contributed to the conception and planning of the review. KP identified articles relevant to the topic and wrote the first draft of the manuscript. All authors contributed to manuscript revision, read and approved the submitted version.</p>
</sec>
<sec id="s5">
<title>Funding</title>
<p>This work was supported by the French Research and Technology Association (ANRT, Association Nationale de la Recherche et de la Technologie) exclusively for a doctorate scholarship and program between Universit&#xe9; de Paris, Sorbonne Universit&#xe9; and SocialDream from 2020 to 2023 (Grant Number 2019/0715). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</p>
</sec>
<sec sec-type="COI-statement" id="s6">
<title>Conflict of Interest</title>
<p>Authors KP and TG were employed at SocialDream</p>
<p>The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec sec-type="disclaimer" id="s7">
<title>Publisher&#x2019;s Note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<sec id="s8">
<title>Supplementary Material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/frvir.2022.788820/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/frvir.2022.788820/full&#x23;supplementary-material</ext-link>
</p>
<supplementary-material xlink:href="DataSheet1.PDF" id="SM1" mimetype="application/PDF" xmlns:xlink="http://www.w3.org/1999/xlink"/>
</sec>
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