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Virtual Reality Exposure Therapy

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This is one therapy you will not be able to do on your own. You will have to find a place that offers this treatment since it requires a virtual reality setup. However, we can touch on the basics of what it can do and how it works.



Virtual Reality (VR) is a type of exposure therapy in a virtual setting that is safer, less embarrassing, and less costly than reproducing the real world situations. Besides situations can be created that are difficult to find in real life and it's more realistic than imagining the danger.

Already some experiments have proven VR to be a useful tool in treating specific phobias such as fear of heights, fear of spiders, fear of flying and claustrophobia, as well as agoraphobia. However most research that is done on VR exposure consists of single case studies and controlled group studies are necessary to support the conclusions of case studies. Research in this area is still in its infancy, but is progressing rapidly.

The therapy consists of a few sessions with a psychologist to determine the origin of the fear. The VRT portion of the therapy begins after there is a sufficient understanding of the phobia. Using a platform and a headset, a patient is immersed in a computer-generated environment designed to reproduce a real-world setting. Real digital video is incorporated into the virtual environment to promote a sense of reality. A process known as habituation is used to help patients manage their anxiety.

Habituation occurs with exposure over time. The therapy might begin with exposure to the virtual room only. Then the stimulus (spider) is introduced far away and gradually gets closer. It's sort of like taking baby steps. As the patient becomes more and more comfortable in the room, the body's anxiety reaction will become less and less severe.

The headset is attached to a desktop computer and sensors pick up any head movement so when the user turns his head, he can look around. The earphones will simulate the sounds of the environment. The platform also moves to simulate the physical nature of the situation.

The process is started in a hierarchical way beginning with the less intimidating scenario and gradually making it more difficult. The patient is kept in the environment until their anxiety begins to lessen (habituation).

Overall the experience is convincing but still cartoon-like; there's no mistaking this for the real situation. But, for most people with phobias that doesn't matter--it's real enough to elicit their fears. The advantages of virtual reality are becoming very evident. First, the therapist can carefully control the amount of exposure in each session. For fear of flying, for example, they can slowly take clients through the steps of a flight--from takeoff to landing--over many sessions, waiting at each step and working with them until they feel comfortable and habituated.

Also there is the convenience and confidentiality factor: One therapist explains, "I could take someone with a fear of elevators onto a real elevator, but this way they don't have to worry about running into people and explaining who this guy with them is."

Finally, it's easier to get people with phobias to agree to exposure therapy when it's begun virtually, rather than in vivo. In vivo [exposure therapy] is very effective, but you have to convince people to try it. By definition, someone with a phobia wants to avoid what they're afraid of.

Of course, virtual reality has some disadvantages as well. First, there is the cost: A Virtually Better VR system sells for more than $6,000 and requires a monthly licensing fee. That price tag doesn't put it out of reach for most therapists, but it is a significant investment.

For the patient, it can be expensive as well. The treatment costs between $100 and $300 an hour. Typical treatments are completed in eight one-hour sessions. Also, the therapy does not work for everyone--and it works better for some people than for others. Some studies have found, for example, that people who are more hypnotizable or more easily able to block out distraction and be absorbed in an activity like reading are also more likely to benefit from virtual reality exposure therapy. There are people who try it and it doesn't work, but that's not true for most people.

The goal, of course, is to eventually move all clients from the virtual to the real world.

When it comes to arachnophobia, virtual reality appears to work very, very well. On the screen, the phobic will see a 3-D virtual spider in what appears to be a normal setting like the kitchen. The subject will be encouraged to "walk" closer to the spider while their anxiety level is monitored.

Eventually, they will be asked to touch a realistic larger version of a spider while virtually touching the one in the setting. Again, habituation is used to minimize the body's fear response and the patient will eventually become less stressed to touch the spider - both virtually and in reality.

While not everyone is able to do this, they are able to make great strides towards reducing their anxiety level and better deal with the spider in real life.
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