Avatars are graphical representations of users in mediated environments such as the metaverse.1 While the avatar is clearly a digital representation, the psychological boundary between the user and the digital symbol can become progressively dissolved as the avatar follows the user's instructions.

If the user wants the avatar to walk, the avatar will. If the avatar speaks to another avatar using the user's words, the avatar moves another step closer to becoming the user. Over time, the avatar and the user could become inseparable, and this merger offers many exciting opportunities to optimize health.

In a sense, the body is a display device for the mind, but the mind can also see the avatar’s body and personality as that same display device. Neurologist Antonio Damasio once said, “a most curious physiological arrangement … has turned the brain into the body's captive audience.”2 When the body becomes the avatar, the brain will listen to that avatar.

Four theories explain how we may learn from avatars. Social-cognitive theory teaches us that we can observe and imitate avatars. The Proteus effect explains that our self-perception may be more in accordance with the avatar. Self-discrimination theory teaches us that we all have actual, ideal (the best version), and ought selves (what we believe we are duty-bound to be). Avatars can help us anchor to ideal or ought selves. Social learning theory teaches us that avatars are a powerful environmental stimulus when they become part of our exposome.

Avatar factors that promote positive outcomes include similarity to the user, normal body size, ideal avatars, the ability to customize an avatar, avatar transformations, and avatar behaviors.

There are many specific instances where avatar embodiment led to improved health outcomes. In one study, normal avatar participants had better exercise attitudes, exercise motivation, motivation to use the Nintendo Wii to exercise, and game performance compared to the obese avatar group.4 In another study, the avatar group showed increased exercise efficacy and weight loss than the no-avatar group.5 And other studies demonstrated increased physical activity,6 greater intention to play sports,7 eating less ice cream, and choosing drinks with less sugar.8

Also, one study showed that female older adults who embodied young avatars reported greater self-efficacy for future exercise and greater physical activity during the exercise phase than those who embodied older avatars.9 Also, compared to elderly individuals who embodied adult avatars, elderly individuals who embodied avatars who appeared to be four years old perceived themselves to be younger.10

Avatar use for neurorehabilitation takes advantage of the fact that the image or schema of the body in the brain is not fixed. As a result, the brain can be tricked into believing that a fake body part outside of itself is its body part.

After a stroke, a person’s posture can become asymmetrical, and avatars can restore symmetry11 or improve coordination while walking.12 In children with cerebral palsy, avatars can help them train to improve arm function in real life.13

In autism, the user takes on a first-person perspective while interacting with other avatars, thereby affording the autistic person the ability to interact with others and improve facial and emotional recognition.14 People with autism have an even better grasp of mental states when they see cartoons than neurotypical people.15

The metaverse may help improve mental health by affording control (over an avatar and its virtual environment), cognitive activation, physical activity, social connections, and a sense of autonomy and competence.16 When people feel like they’ve hit a wall in life, the avatar may afford creative solutions through metaphoric embodiment because of its ability to walk through walls.17

Avatars may also be used to facilitate social communities or augment face-to-face treatment. They may provide advantages by facilitating the development of a virtual therapeutic alliance, reducing communication barriers, promoting treatment-seeking through anonymity, and promoting expression and exploration of client identity.18 In addition, they may help with role modeling.

The greater sense of agency and overcoming barriers to social connection to form a community will likely impact our minds and bodies, too.19 Avatars are future health heroes in the metaverse.

References

(1) Biocca, F. The Cyborg’s Dilemma: Progressive Embodiment in Virtual Environments [1]. Journal of Computer-Mediated Communication 1997, 3 (2), JCMC324. https://doi.org/10.1111/j.1083-6101.1997.tb00070.x.

(2) Descartes’ Error: Emotion, Reason, and the Human Brain: Damasio, Antonio: 9780143036227: Amazon.com: Books. https://www.amazon.com/Descartes-Error-Emotion-Reason-Human/dp/01430362… (accessed 2023-03-26).

(3) Rheu, M. M.; Jang, Y.; Peng, W. Enhancing Healthy Behaviors Through Virtual Self: A Systematic Review of Health Interventions Using Avatars. Games Health J 2020, 9 (2), 85–94. https://doi.org/10.1089/g4h.2018.0134.

(4) Li, B. J.; Lwin, M. O.; Jung, Y. Wii, Myself, and Size: The Influence of Proteus Effect and Stereotype Threat on Overweight Children’s Exercise Motivation and Behavior in Exergames. Games Health J 2014, 3 (1), 40–48. https://doi.org/10.1089/g4h.2013.0081.

(5) Behm-Morawitz, E.; Lewallen, J.; Choi, G. A Second Chance at Health: How a 3D Virtual World Can Improve Health Self-Efficacy for Weight Loss Management Among Adults. Cyberpsychol Behav Soc Netw 2016, 19 (2), 74–79. https://doi.org/10.1089/cyber.2015.0317.

(6) Fox, J.; Bailenson, J. N. Virtual Self-Modeling: The Effects of Vicarious Reinforcement and Identification on Exercise Behaviors. Media Psychology 2009, 12 (1), 1–25. https://doi.org/10.1080/15213260802669474.

(7) Kastenmüller, A.; Greitemeyer, T.; Fairclough, S.; Waite, D.; Fischer, P. Playing Exergames and Sporting Activity.Social Psychology 2013, 44 (4), 264–270. https://doi.org/10.1027/1864-9335/a000111.

(8) Kuo, H.-C.; Lee, C.-C.; Chiou, W.-B. The Power of the Virtual Ideal Self in Weight Control: Weight-Reduced Avatars Can Enhance the Tendency to Delay Gratification and Regulate Dietary Practices. Cyberpsychol Behav Soc Netw2016, 19 (2), 80–85. https://doi.org/10.1089/cyber.2015.0203.

(9) Tammy Lin, J.-H.; Wu, D.-Y. Exercising With Embodied Young Avatars: How Young vs. Older Avatars in Virtual Reality Affect Perceived Exertion and Physical Activity Among Male and Female Elderly Individuals. Front Psychol2021, 12, 693545. https://doi.org/10.3389/fpsyg.2021.693545.

(10) Tajadura-Jiménez, A.; Banakou, D.; Bianchi-Berthouze, N.; Slater, M. Embodiment in a Child-Like Talking Virtual Body Influences Object Size Perception, Self-Identification, and Subsequent Real Speaking. Sci Rep 2017, 7 (1), 9637. https://doi.org/10.1038/s41598-017-09497-3.

(11) Liu, L. Y.; Sangani, S.; Patterson, K. K.; Fung, J.; Lamontagne, A. Real-Time Avatar-Based Feedback to Enhance the Symmetry of Spatiotemporal Parameters After Stroke: Instantaneous Effects of Different Avatar Views. IEEE Trans Neural Syst Rehabil Eng 2020, 28 (4), 878–887. https://doi.org/10.1109/TNSRE.2020.2979830.

(12) Liu, L. Y.; Sangani, S.; Patterson, K. K.; Fung, J.; Lamontagne, A. Instantaneous Effect of Real-Time Avatar Visual Feedback on Interlimb Coordination during Walking Post-Stroke. Clin Biomech (Bristol, Avon) 2022, 100, 105821. https://doi.org/10.1016/j.clinbiomech.2022.105821.

(13) Martins, F. P. A.; Massetti, T.; Crocetta, T. B.; Lopes, P. B.; da Silva, A. A.; Figueiredo, E. F.; de Abreu, L. C.; da Silva, T. D.; Monteiro, C. B. de M. Analysis of Motor Performance in Individuals with Cerebral Palsy Using a Non-Immersive Virtual Reality Task – a Pilot Study. Neuropsychiatr Dis Treat 2019, 15, 417–428. https://doi.org/10.2147/NDT.S184510.

(14) Hopkins, I. M.; Gower, M. W.; Perez, T. A.; Smith, D. S.; Amthor, F. R.; Wimsatt, F. C.; Biasini, F. J. Avatar Assistant: Improving Social Skills in Students with an ASD through a Computer-Based Intervention. J Autism Dev Disord2011, 41 (11), 1543–1555. https://doi.org/10.1007/s10803-011-1179-z.

(15) Cross, L.; Piovesan, A.; Atherton, G. Autistic People Outperform Neurotypicals in a Cartoon Version of the Reading the Mind in the Eyes. Autism Res 2022, 15 (9), 1603–1608. https://doi.org/10.1002/aur.2782.

(16) Paquin, V.; Ferrari, M.; Sekhon, H.; Rej, S. Time to Think “Meta”: A Critical Viewpoint on the Risks and Benefits of Virtual Worlds for Mental Health. JMIR Serious Games 2023, 11, e43388. https://doi.org/10.2196/43388.

(17) Wang, X.; Lu, K.; Runco, M. A.; Hao, N. Break the “Wall” and Become Creative: Enacting Embodied Metaphors in Virtual Reality. Conscious Cogn 2018, 62, 102–109. https://doi.org/10.1016/j.concog.2018.03.004.

(18) Rehm, I. C.; Foenander, E.; Wallace, K.; Abbott, J.-A. M.; Kyrios, M.; Thomas, N. What Role Can Avatars Play in E-Mental Health Interventions? Exploring New Models of Client–Therapist Interaction. Front Psychiatry 2016, 7, 186. https://doi.org/10.3389/fpsyt.2016.00186.

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