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OKANA has always endeavoured to combine the roles of national coordinator and services and programmes provider in the fields of prevention, treatment and reintegration. To hammer out and coordinate national drug policies, OKANA works together with national ministries, treatment programmes, local government authorities, universities etc. When it comes to prevention, OKANA has liaised with local government authorities in order to create an extended network of Prevention Centres all over Greece alongside several treatment and social reintegration programmes meeting the different needs of addicted persons. The post of General Director is published by means of a vacancy notice. The General Director is in charge of the Organisation's services and units. OKANA provides an ever-increasing network of services in order to meet the multifaceted prevention, treatment, social and professional reintegration, and harm reduction needs in the best possible way. Working together with other bodies and organisations inside and outside Greece is a for OKANA sine qua non, and a valuable input to the effort of coordinating a coherent philosophy with a strategy complying with current needs so as to avoid overlaps and to optimise resources. As a contributor to the national coordination and planning in regard to drug demand reduction, OKANA is constantly in close cooperation with the National Coordinator Service and the co-competent following Ministries of:. In line with the national pluralistic and holistic approach towards treatment of addictions OKANA cooperates with other treatment agencies, i. Its constituent instrument stipulates that OKANA shall: plan, promote, coordinate and implement a national policy on prevention, treatment and rehabilitation of drug addicts address the drug problem at a national level, provide valid and documented information, and raise public awareness establish and effectively manage prevention centres, treatment units and social and professional reintegration centres OKANA has always endeavoured to combine the roles of national coordinator and services and programmes provider in the fields of prevention, treatment and reintegration. The administration. The Organisation's network of services consists in the following: Prevention 73 Prevention Centres in 50 out of 51 Geographical Departments which are run in cooperation with the respective local government authorities. Inter-Ministerial Coordination and Partnerships.

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Perspective taking techniques have been used to transport people into imaginary situations and the lives of others. Virtual Reality provides an immersive way to virtually experience the lives of stigmatized by society members. Through the support of sensorimotor contingencies, people can use natural movements to view and interact with the virtual world around them. In this study, we compared a perspective-taking immersive Virtual Reality system which supports a number of sensorimotor contingencies SC group with a perspective-taking desktop system of the same application but without support of any sensorimotor contingencies NSC group , to investigate the effect of the supported sensorimotor contingencies in promoting empathy and positive attitudes toward drug users. Results demonstrate a strong correlation between closeness to the drug user and empathy in the SC group. In both groups there were a within group significant change in their reported attitudes before and after their exposure. Finally, participants in the SC condition reported significantly higher levels of Place Illusion PI , body ownership, agency and plausibility of people. Further research is needed to investigate how sensorimotor contingencies can be exploited to the fullest to be used as an effective method to induce empathy and change attitudes toward stigmatized by society people. Members of stigmatized groups are often discriminated against in their workplace, educational settings, health care, and the criminal justice system Sidanius and Pratto, Furthermore, extensive research by Dan Batson has shown that perspective taking can lead to an increase of empathy, and this can lead to prosocial behaviors toward not only members of stigmatized groups, but toward stigmatized groups as a whole Batson et al. Empathy can be defined as the ability to connect emotionally with another individual and understand his point of view Davis, ; Galinsky et al. The field of Virtual Reality VR offers new ways to induce empathy into people. We can create experiences that genuinely show people how it is to take the place of somebody else and create a narrative that unfolds around them and therefore people can focus on the events that are happening around them and how they make them feel and go through a more genuine experience of what is like to be that person. In VR, we can also elicit presence, the illusion of being in the virtual world Place Illusion, PI , and the extent to which the situation and events seemed to be really happening Plausibility Illusion, Psi Slater, Bertrand et al. Their strategies included the Body ownership illusion through multisensory and motor perspective taking, which if induced, could modulate bias, mimicry, similarity and emotion after the experience. Another strategy was place and plausibility illusion through sensorimotor stimuli and a highly credible environment, which could result for the users to behave and feel as if they are in the VR environment. It has been shown that the Proteus effect is mediated by the level of embodiment felt by users in relation to their avatar Ash, suggesting that EVR can enhance this effect. They suggested the embodiment of a digital avatar of an outgroup member that presents traits that contradict stereotypes, which we have done in our study. The use of immersive virtual environments to have an individual take on the perspective of another individual is known as Virtual Reality Perspective-Taking VRPT van Loon et al. Ahn et al. Penn et al. Results indicated that the virtual reality experience resulted in greater engagement and a higher level of empathy for the refugee girl compared to the control condition. Chowdhury et al. Hamilton-Giachritsis et al. Results showed that experiencing negative maternal behavior increased levels of empathy and participants reported a strong body ownership illusion for the child body that led to cognitive, emotional and physical reactions. Herrera et al. Seinfeld et al. It has been showed by several studies Groom et al. Finally, a study Christofi et al. A survey regarding VR interventions for stigmatized groups has been made by Christofi and Michael-Grigoriou , with additional emphasis on the measurements used for prejudice and empathy. The studies reviewed were grouped according to the social stigma form that the group investigated belonged to, as defined by Goffman , which are; i overt or external deformations, ii deviation in personal traits, and iii tribal stigmas. The survey reviewed the measurements used in these studies for empathy and prejudice. It concluded that the majority of the studies focused on the third form of social stigma, and most specifically on reducing implicit racial bias against dark-skinned people. As far as the measurements used for empathy and prejudice, it was observed that in the reviewed studies they tended to use self-report instruments more and rarely used behavioral observational and neuroscientific methods which could be more accurate than self-reports from the participants. In this study, we compared a VRPT system that supports a number of sensorimotor contingencies SC condition and a less immersive perspective-taking system using a desktop computer with a minimum support of sensorimotor contingencies NSC condition , to investigate their effect in promoting empathy and creating positive attitudes toward drug users. Following the strategies and suggestions of Bertrand et al. An application was designed and developed in which participants were able to virtually experience some scenes of the life of a person who became a drug user, through his point of view, in order to debunk stereotypes surrounding drug users. In total, the participants viewed nine scenes from the life of the drug user. The scenario and scenes they virtually experienced are described in more detail in the following sections. A number of the scenes, have a mirror on one of the walls including the first one for familiarization with the VR equipment and the suit , so that the participants could see the avatar they were embodying and progressively see some of the physical changes, the drug consumed by their avatar which in this scenario is cocaine, does to people, which include dilated pupils, increased heart rate, extreme weight loss, bloody nose and cocaine powder running through the nose. These changes were visible to their avatar from the scene after he consumed cocaine in one of the starting scenes Scene 5 as described below. The scenario put the participants in the shoes of a man named Mark, a year old man, who recently lost his mother due to cancer, and is living with his wife Amanda. It is said in the narrative, that he is stressed due to his workplace, where his boss assigns him many duties. A video illustrating the application can be found in the Supplementary Video S1. Scene 1 — Bathroom: You are in the bathroom, standing in front of the sink. There is a mirror in front of you, where you can look at your avatar. Scene 2 — Dinner : You are in the dinner, and your friends are discussing sports on the table. Then one of your friends, Lisa, mentions that you are quiet tonight, followed by Amanda explaining that it is because of the work stress, among other stuff. In this scene, there is a mirror on the left side of the room, where participants can view their avatar. Scene 3 — Work 1 : You are in your office, and your boss is telling you to prepare some files for him before lunch time because important clients are waiting for them. Your boss leaves and your coworker turns to you and invites you to a party in a few days to release all your stress. Scene 4 — Party 1 : You are in that party, loud music is playing, people dancing, drinking around you. Your coworker is telling you to enjoy yourself, and then a man notices how stressed and serious your character is and tells you to follow him. Scene 5 — Party 2 : You are in the toilets of the house that the party takes place in. In front of you there are two sinks with needles, cocaine powder divided in straight lines and razors. The man stands in front of the second sink, and sniffs cocaine and urges you to do the same Figure 1 , top right. Figure 1. Workplace scene top-left , party scene top-right , bathroom scene, illustrating the physical effects of cocaine use bottom-left , consequences on the relationship bottom right. Scene 6 — Drug dealer: You stand in front of your drug dealer who is sitting relaxed at a table where you can see cocaine in lines, razors and a bag and money laying around in packs. The dealer wonders how you can afford all this cocaine, implying that you are a regular and warns you that demand is getting bigger and the prices are getting higher and next time you should bring more money. Starting from this scene, participants can view the physical changes cocaine had done to their character, which include weight loss in the starting scenes Mark appears to have a belly so that the change is more noticeable , so in this scene he looks really thin, his eyes are red, he has blood running from his nose, and cocaine power visible on the nose as well. Scene 7 — Work 2 : Your boss yells at you for not showing up to an important meeting the day before Figure 1 , top left and then your coworker tells you to look at yourself in a mirror and that he worries about you. Scene 8 — Bathroom 2 : You locked yourself in the bathroom of your house the same one you see in the first scene , and standing in front of the mirror, on the sink you can see cocaine powder and a razor Figure 1 , bottom left. You can listen to your wife, who is outside the room, wondering why you locked the door and informing you that the food is ready. Scene 9 — Dining area: You stand in the dining area, your wife is standing by the table and you see your bag opened and cocaine on the table as well as money found by your wife, who is disappointed in you and says she noticed a big withdrawal of money from your shared account and it explains all the symptoms you have been showing lately Figure 1 , bottom right. She wonders what your mother would say about all this and urges you to seek some help or she is going to leave you. The goal of showing the participants the whole journey of this man was to reverse the fundamental attribution error, that people tend to do. In this case and with our narrative, we wanted to show the participants, that in most cases situations drive people to drug use. According to the self-medication hypothesis Khantzian, , , addictive drugs have appeal because during the short term they relieve painful feelings and psychological distress. There is a tendency in society to stigmatize drug users, as people think they use drugs for their enjoyment only. The character in the scenario is seen using drugs as a coping mechanism for the death of his mother and the stress from his work. Additionally, we followed the suggestion of Bertrand et al. Additional screenshots from the scenes can be found in the Supplementary Table S1. For the recruitment of the participants we used convenience sampling. Ages of participants varied from 18 to 59 with the majority A table with the frequencies of the demographics across the two groups can be found in Supplementary Table S2. A between-groups design was used to conduct the study. The majority 11 of the participants in the NSC group were aged between 18—24 , and for the SC group the majority 8 aged between 25 and 29 years old. Regarding occupation, in the NSC group the majority 12 were students and in the SC group 7 were working in the private sector. All participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individuals for the publication of any potentially identifiable images or data included in this article. This condition supports several sensorimotor contingencies for the user. It required the participants to put on a VR HMD allowing stereo viewing in degrees of the surrounding environment and supporting head tracking allowing displacement of the viewing scene in a physical way. That was achieved by having the participants fitted with a wireless full body motion capture suit and VR data gloves. Wearing both, the participants were virtually embodying the drug user. They were viewing the virtual world in first-person view and could rotate their head to change their point of view. There was no other stimulation than the first-person perspective view over the body. The participants could not interact with the application in any way or with the other avatars or virtual items in the virtual world. The participants were required to be standing up and could move their body and head around to change their point of view and watch their avatar in the virtual world, which was the drug user, move simultaneously to their real time movements. The application of the NSC version was identical with the SC version with the difference being that the participants did not wear any of the equipment mentioned above thus no sensorimotor contingencies were supported. Instead, they were sitting on a chair in front of a desktop computer, viewing the same application, this time, through a flat computer screen and could only turn their point of view with the use of the mouse. The application used for both groups was developed in the Unity software. These recordings were then edited in the Adobe Audition CS6 software. The participants in this group had to wear the Xsens MVN Awinda wireless motion capture trackers for real time body movement tracking which was mapped to their avatar in the virtual world through the Xsens software and the Manus VR — Xsens Edition gloves which offered finger tracking see Figure 2. Figure 2. A computer mouse was used for the interaction with the application and headphones for the sound see Figure 3. Upon arriving at the laboratory, the participants were randomly assigned to one of the two groups, NSC or SC and were asked to read and sign the consent form. Then they were given the pre-questionnaire. Once this process was completed, participants in the SC group were asked to put on the VR HMD, Xsens Awinda trackers and VR gloves and participants in the NSC group were asked to sit in front of the computer screen and wear the headphones for the sound. They were then briefed about the way they could interact with the application. Then, both groups viewed the application. The intervention lasted approximately 10 min for both groups. Participants completed the same post-intervention questionnaire immediately after viewing the application. Two questionnaires were given to the participants in total, which were the same for both groups, NSC and SC. The pre-questionnaire was given to the participant before their exposure to the virtual world. Using this questionnaire, we gathered demographic data such as age, gender, occupation, hours spent playing video games, experience in using VR environments and computer programming knowledge. The four subscales are: a Perspective-Taking scale PT : the ability to shift perspectives when dealing with other people. It is important to note, that in the pre-questionnaire, the fantasy scale was not measured, as the participants would experience through an application the life of the drug user, not imagine it. It was adapted from the questionnaire used by Batson et al. Higher scores indicate more positive attitudes toward drug users. This questionnaire was given to the participants before and after their exposure, in order to see if their exposure to the application, can change their attitudes toward drug users. The questionnaire given to all participants, regardless of their group, after their exposure included questionnaires measuring their level of empathy and personal distress, the Inclusion of the Other in the Self scale, the same questions regarding their attitudes toward drug users as the pre-questionnaire. The results of these four questions were used to create an index of empathic concern. This measure was adapted from Batson et al. The results of these four questions were used to create an index of personal distress. This measure was also adapted from Batson et al. Developed by Aron et al. The pictures are coded from 1 to 7 with the larger numbers indicating a closer relationship with the drug user. The Plausibility of the situation Psi is the illusion that what is apparently happening is really happening even though you know that it is not. In the questionnaires, Psi was divided into two aspects; the Psi, and plausibility of the virtual human characters, which is if the participants felt that the virtual people were behaving, moving, reacting as if they were real. According to Tsakiris et al. All datasets generated for this study are included in the Supplementary Data Sheet S1. Table 1. Means and standard deviations for all outcome variables for both groups. An independent-samples t -test was conducted to compare the level of empathy of the participants before their exposure in the two groups. This suggests that the two conditions were balanced in terms of pre-intervention empathy and they were successfully randomly assigned into these two groups. This suggests that females in the SC group had significantly higher levels of empathy than the males in the SC group before their exposure. This aligns with the findings of Davis , where women displayed higher scores than men for each of the four subscales or IRI. A Pearson product-moment correlation coefficient was computed to estimate the relationship between the IRI total score of the participants that was measured before their exposure and their attitudes toward drug users before and after their exposure. Results indicate significant positive correlation between these variables. Both groups showed a significant difference in their reported attitudes toward drug users before and after their exposure. Gender differences were found in the NSC group regarding both pre-attitudes and post-attitudes. Both these results suggest that females in the NSC group had more positive attitudes toward drug users both before and after their exposure than the males in the NSC group. Which means that participants in the SC group who reported being emotionally closer to the drug user, also reported more positive attitudes toward drug users after their exposure, and more empathetic. Figure 4. Strong correlation between closeness to the drug user and empathy in the SC group. Which means that participants in the NSC group who reported being emotionally closer to the drug user, also reported higher levels of BOA. Participants empathy was measured after their exposure. This means that the more empathetic they reported they felt after their exposure, the more distressed they were and reported higher levels of body ownership, agency and plausibility of the virtual people. Participants personal distress was measured after their exposure. This means that the more distressed they felt, the higher the levels of PI, Psi, and the virtual people. For the questionnaire data regarding the participants experience, factor analysis was carried out to reduce the number of questionnaire variables, which also has the advantage of transforming ordinal variables to continuous ones. Corresponding factor scores were used, and the interpretation of each factor was identified. Subsequent analysis on the derived variables was done using independent samples t -test. Figure 5. Factor analysis in the questionnaire on the participants reported PI has resulted in a single factor. The factor loadings of the scoring variable PI are shown in Table 2. Participants in the SC condition reported higher levels of presence 0. Table 2. Factor analysis for Place Illusion, resulting in a single factor F1 and the corresponding scoring coefficients of the factor score yp1. Factor analysis in the questionnaire on the participants reported BOA has resulted in a single factor. The factor loadings of the scoring variable BOA are shown in Table 3. Table 3. Factor analysis for Body Ownership and Agency, resulting in a single factor F1 and the corresponding scoring coefficients of the factor score yboa1. Factor analysis in the questionnaire on the participants reported Psi has resulted in a single factor. The factor loadings of the scoring variable PSI are shown in Table 4. Table 4. Factor analysis for Plausibility of the situation, resulting in a single factor F1 and the corresponding scoring coefficients of the factor score ypsi1. Factor analysis in the questionnaire on the participants reported PVP has resulted in a single factor. The factor loadings of the scoring variable PVP are shown in Table 5. Table 5. Factor analysis for Plausibility of the virtual people, resulting in a single factor F1 and the corresponding scoring coefficients of the factor score ypvp1. Although the SC group had higher means in all the measures, as seen in Table 1 , they were not significantly different to those of the NSC group. This aligns with the results of Herrera et al. Both groups showed a significant difference in their reported attitudes toward drug users before and after their exposure which means that both interventions succeeded in eliciting more positive attitudes toward drug users to the participants. This is in line with the study by Maister et al. Additionally, the experience lasted approximately 6 min, and this perhaps was not enough time for the participants to truly experience what it is like to be a drug user. Considering that, the scenes and scenario created, wanted to reflect the journey a person goes in, before drug use and after, and the consequences it has in his health, life, family and workspace. Future studies should focus more on the negative aspects that drug use has on drug users and their life. Future studies should also investigate the role of agency and interactivity plays in empathy and attitudes toward stigmatized people. Interactivity has been found to increase empathy Vorderer et al. As many companies are releasing VR headsets every year with way more features and needing less extra equipment to allow hands and even body tracking, it would be interesting to compare in future studies, the difference between low vs. The findings of this study provide more evidence that show that VRPT, can be used for to induce empathy and prosocial behavior of the participants toward members of stigmatized groups. Further research is needed to investigate how perception through sensorimotor contingencies can be exploited to the fullest to be used as an effective method to induce empathy and change attitudes toward stigmatized by society people. The participants provided their written informed consent to participate in this study. MC made substantial contribution in the conception and design of the study, development of the VR application, data collection, analysis and interpretation of the data, and drafting the article. DM-G contributed in the design and conception of the study, interpretation of the data, revising critically the manuscript, and supervised and coordinated all the steps of the study. CK contributed partially in the development of the VR application and substantially in data analysis. The 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. We would like to thank Dr. Domna Banakou for the discussion and exchanging ideas on the experimental design and methods. Ahn, S. The effect of embodied experiences on self-other merging, attitude, and helping behavior. Media Psychol. Aron, A. Inclusion of other in the self scale and the structure of interpersonal closeness. Ash, E. Priming or proteus effect? Examining the effects of avatar race on in-game behavior and post-play aggressive cognition and affect in video games. Games Cult. Banakou, D. Virtual embodiment of white people in a black virtual body leads to a sustained reduction in their implicit racial bias. PubMed Abstract Google Scholar. Batson, C. Perspective taking: imagining how another feels versus imaging how you would feel. Behm-Morawitz, E. The effects of virtual racial embodiment in a gaming app on reducing prejudice. Bertrand, P. Learning empathy through virtual reality: multiple strategies for training empathy-related abilities using body ownership illusions in embodied virtual reality. AI Chowdhury, T. VR disability simulation reduces implicit bias towards persons with disabilities. IEEE Trans. Christofi, M. Davis, M. Individual differences in empathy: a multidimensional approach. Google Scholar. Measuring individual differences in empathy: evidence for a multidimensional approach. Farmer, H. Beyond the colour of my skin: how skin colour affects the sense of body-ownership. Conscious Cogn. Galinsky, A. Why it pays to get inside the head of your opponent. Gallagher, S. Philosophical conceptions of the self: implications for cognitive science. Trends Cogn. Goffman, E. Stigma: Notes on the Management of Spoiled Identity. Groom, V. The influence of racial embodiment on racial bias in immersive virtual environments. Influence 4, — Hamilton-Giachritsis, C. Reducing risk and improving maternal perspective-taking and empathy using virtual embodiment. Harris, L. Dehumanizing the lowest of the low: neuroimaging responses to extreme out-groups. Hasler, B. Virtual race transformation reverses racial in-group bias. PLoS One e Herrera, F. Building long-term empathy: a large-scale comparison of traditional and virtual reality perspective-taking. Khantzian, E. The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Psychiatry 4, — The self-medication hypothesis revisited: the dually diagnosed patient. Psychiatry 10, 47— Lamm, C. The neural substrate of human empathy: effects of perspective-taking and cognitive appraisal. Maister, L. Experiencing ownership over a dark-skinned body reduces implicit racial bias. Cognition , — Myers, D. Psychology , 9th Edn. New York, NY: Worth. Peck, T. Putting yourself in the skin of a black avatar reduces implicit racial bias. Penn, D. The virtual doppelganger: effects of a virtual reality simulator on perceptions of schizophrenia. Perdue, C. Evidence for the automaticity of ageism. Ross, L. Schutte, N. Facilitating empathy through virtual reality. Seinfeld, S. Offenders become the victim in virtual reality: impact of changing perspective in domestic violence. Shechtman, Z. Counseling groups for Arab adolescents in an intergroup conflict in Israel: report of an outcome study. Peace Conflict 12, — Sidanius, J. Cambridge: Cambridge University Press, doi: Slater, M. Place illusion and plausibility can lead to realistic behaviour in immersive virtual environments. B , — Enhancing our lives with immersive virtual reality. Stavroulia, K. Assessing the emotional impact of virtual reality-based teacher training. Tomasello, M. The Cultural Origins of Human Cognition. Cambridge, MA: Harvard university press. Tsakiris, M. Having a body versus moving your body: how agency structures body-ownership. Virtual reality perspective-taking increases cognitive empathy for specific others. Vorderer, P. Does entertainment suffer from interactivity? Yee, N. The Proteus effect: the effect of transformed self-representation on behavior. The Proteus effect: implications of transformed digital self-representation on online and offline behavior. Zaki, J. The neuroscience of empathy: progress, pitfalls and promise. Keywords : virtual reality, sensorimotor contingencies, perspective-taking, empathy, attitudes. 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Introduction Members of stigmatized groups are often discriminated against in their workplace, educational settings, health care, and the criminal justice system Sidanius and Pratto, Materials and Methods Application An application was designed and developed in which participants were able to virtually experience some scenes of the life of a person who became a drug user, through his point of view, in order to debunk stereotypes surrounding drug users. Scenes Scene 1 — Bathroom: You are in the bathroom, standing in front of the sink. Figure 3. One of the participants of the NSC group.

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