Phobias are one of the most common psychological issues people face today. 10% of the US population are reported to experience or have experienced a specific phobia in their lifetimes, however it is thought that between 60 and 80% of sufferers do not actively seek treatment for their phobias. Treatment for the affliction normally involves “exposure therapy” where the patient, under the guidance of a professional psychologist, will gradually be exposed to the subject of their phobia and over time, it is hoped their fear will dilute. Repeated exposure to the subject can lessen feelings of anxiety and fear over time through a process of desensitisation. This treatment method is normally referred to as “in vivo therapy” and has demonstrated long term positive results. Despite demonstrated effectiveness, up to 25% of phobia sufferers refuse exposure therapy. In vivo treatment can seem intense and avoidant behaviour, common in phobia sufferers, may result in patients not seeking help for their issue. Treatment cost is no doubt another major factor as therapy must be overseen by a licensed professional. Phobias, such as fear of driving, or fear of crowds can be debilitating and have major effects on quality of life. Many patients may now be looking to technology as a possible solution.
Virtual reality has become a powerful tool in psychological treatment and has already registered success in the treatment of fear of flying, driving, spiders and heights. Virtual reality systems harness high-tech visuals and graphics, sensory input devices and body tracking software to create a realistic virtual environment in which users can immerse themselves. The VR environment is multi-sensory and through a series of tools and visuals, patients can feel entirely immersed in their virtual surroundings. Feelings of presence can attune patients to the stimuli contained in the VR environment. As a new technology, VR may spark curiosity and this could be a considerable advantage over traditional methods of therapy, reducing any stigma typically attached to psychiatric treatment and prompting patients to sample the treatment. VR therapy can also be viewed as a safer option for patients as they will not have to expose themselves to real life situations.
VR technology is particularly useful for the treatment of phobias as it allows therapists to recreate phobic stimuli and have complete control over environmental variables to facilitate exposure therapy. Arachnophobia, or the fear of spiders is a very common disorder and arachnophobes have been found to show preference towards VR exposure therapy over in vivo. Through VR simulations, stimuli can be programmed to move a certain way, physical characteristics of the subject can be altered and environments manipulated for optimal effect. This has been shown to greatly benefit arachnophobes, as patients who are exposed to simulated spider in various different VR environments and contexts were less likely to report a return of fear than those treated with video recordings of spiders, in situ.
Many treatments for arachnophobia also integrate physical models that can be felt by the patient. Tactile augmentation is a process whereby virtual objects can be experienced physically. This is referred to as “cyberheft”. This allows patients to experience the weight and texture of a subject, while remaining in the virtual environment. Haptic communication is becoming a vital component of VR programmes and can be incorporated into phobia treatment. Haptics allows users to experience “touch” and interact with objects in their virtual environments. This added dimension gives more depth to online simulations, creating a more realistic and engaging experience for users.
Despite the many advantages of these treatments, there have been some reported health and safety concerns surrounding VR. Nausea and eye-strain have been reported as potential side effects of VR therapy. Cybersickness, or motion sickness brought about by a virtual environment, is another potential adverse effect of the treatment. This could potentially be distressing for a patient already suffering from anxiety and this is a concern for ethics boards when proposing treatment in this field. Warnings have been issued advising against the use of VR technology in the treatment of claustrophobia and schizophrenia as the adverse effects may outweigh the benefits.
VR is becoming increasingly more affordable with major companies such as Google, Samsung and Oculus now producing headsets at a reasonable cost. The most useful emerging technology on the horizon is the VR mobile app, where users can access a virtual environment directly from their mobile device. The more widespread and immersive these apps become, VR will become more universally accessible. In turn, this seachange will help to make therapy more accessible to the average person. Google Cardboard, a cardboard viewer allowing users to insert a mobile phone into a cardboard headset to experience VR immersion via mobile apps, is now being sold for $30 and will surely lead to more widespread adoption of VR treatments. With sufficient training and guidance, and if the participant meets the appropriate criteria, VRET (virtual reality exposure therapy) treatments may be used in patients homes through a mobile device.
The prevalence of VR is on the up, with a 12 fold increase in VR traffic expected before 2022. With increasing advances in VR technology, the opportunity for low cost mental health support is clear. VR therapy has been shown to be an effective tool for the treatment of phobias. Despite massive gains in VR technology, it is important that future research is centred around individual cognitive factors such as susceptibility to cybersickness and immersion, to assess whether someone is a good candidate for VR treatment. It is also important that therapists receive adequate training and guidance around how best to support VR therapy to harness the best possible results for participants. VR treatments for social anxiety and PTSD are also being developed and it is clear that we are only beginning to scratch the surface in how VR can support ongoing mental health therapies.
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