How feelings of unpleasantness develop during the progression of motion sickness symptoms

To mitigate motion sickness in self-driving cars and virtual reality, one should be able to quantify its progression unambiguously. Self-report rating scales either focus on general feelings of unpleasantness or specific symptomatology. Although one generally feels worse as symptoms progress, there is anecdotal evidence suggesting a non-monotonic relationship between unpleasantness and symptomatology. This implies that individuals could (temporarily) feel better as symptoms progress, which could trouble an unambiguous measurement of motion sickness progression. Here we explicitly investigated the temporal development of both unpleasantness and symptomatology using subjective reports, as well as their mutual dependence using psychophysical scaling techniques. We found symptoms to manifest in a fixed order, while unpleasantness increased non-monotonically. Later manifesting symptoms were generally judged as more unpleasant, except for a reduction at the onset of nausea, which corresponded to feeling better. Although we cannot explicate the origin of this reduction, its existence is of importance to the quantification of motion sickness. Specifically, the reduction at nausea onset implies that rating how bad someone feels does not give you an answer to the question of how close someone is to the point of vomiting. We conclude that unpleasantness can unambiguously be inferred from symptomatology, but an ambiguity exists when inferring symptomatology from unpleasantness. These results speak in favor of rating symptomatology when prioritizing an unambiguous quantification of motion sickness progression. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00221-021-06226-1.