Psychologist uses virtual reality to treat fear

Dr. Elizabeth McMahon uses virtual reality to treat fear of flying. Graphic design by Nani Walker, courtesy of Felisberto Piazza and Alberto Hernandez (Noun Project).

About eight years ago, psychologist Dr. Elizabeth McMahon discovered virtual reality (VR) while researching its nascent use in behavioral therapy research studies. It dawned on her that her clinical practice could be improved by the budding technology.

She contacted the only therapist in Northern California with a VR set-up at the time and arranged for a meeting. Although some of the simulations were cartoonish due to limited graphics, people who had never been on an airplane were getting on an airplane after the therapy, McMahon said.

“Patients responded with things like ‘Wow!’ or ‘It’s so real!’” said McMahon. “They responded emotionally and physically, and they got better.”

McMahon specializes in helping people overcome anxieties and phobias. According to the National Institute of Mental Health, anxiety disorders are the most common mental illness in the United States, affecting 18 percent of the population.

During her three decades of clinical work, she has embraced a myriad of approaches, including hypnosis and guided imagery. She had patients imagine that they were coping with fear successfully by guiding them into a meditative state. She had people write out scenarios of things that scared them, so they could reevaluate the situation.

“Those are all useful tools,” she said. “Virtually reality is just a little more vivid, and more controllable than real life.”

Her private practice is located inside a gray Victorian with red trim in San Francisco’s Pacific Heights neighborhood. The office is cozy and bright. The restrained decor of white walls, lavender trim, and monochromatic prints of canyons on the walls creates a tranquil ambience. Across from a loveseat lies a head mounted display, the virtual reality goggles her patients wear.

McMahon said the average virtual reality exposure treatment for fear of flying is three to five sessions. A person with a fear of flying may walk in with the desire to go see his family on the East Coast. McMahon starts by talking to the patient about his life and past experiences. She learns about his strengths and asks him how he talks to himself. She determines if anxiety runs in the family. If he has no other disorders, McMahon delves into the heart of the problem. What is it about the plane that causes him dread?

Once the trigger is assessed, she teaches her patient how to deal with his anxieties through strategies like deep breathing. Finally, she confronts the patient’s fears by pitting them against the facts. For example, if someone is afraid of the plane crashing, she’ll ask about the likelihood of that possibility.

McMahon hands off a virtual reality headset.

The patient then slips the VR goggles over his head and finds himself in an airplane full of agitated people, taxiing down the runway. McMahon talks to her patient while he’s in the environment, asking him what his fear is saying to him.

Growing up, McMahon had wanted to go into music or writing because of their ability to touch people emotionally. After some soul-searching, however, she realized that psychology was another way to do that. It also made sense because she comes from a long line of physicians; her father, grandfather and great-grandfather were all doctors.

“I’ve always loved puzzles, trying to figure out why something is not working, and what you can do to help break the log jam and make things work,” McMahon said.

She explained that growing up Catholic, she was especially moved by a prayer ascribed to Saint Francis of Assisi:

Lord, make me an instrument of your peace.
Where there is hatred, let me so love.

She realized at an early age that if something could increase someone’s capacity to give and receive love, it had intrinsic value and meaning. More than three decades later, she still finds that in her practice. Tools like virtual reality just aid in the process.

McMahon spent more than 30 years at Kaiser Permanente, where she first began incorporating VR therapy after a grant provided funds to purchase the equipment. At the time, treatments for fear of flying, fear of heights and fear of public speaking were the only options. She started her private practice in 2013.

As an early adopter, McMahon said she has seen vast improvements in the technology and application. Back in 2010, a VR set-up cost over $20,000. It consisted of two monitors, a keyboard, a mouse, a wired headset connected to the computer, an amplifier, a 3-by-4 feet vibrating platform and two sets of headphones.

VR has come far since then. Today, most head mounted displays cost under $1,000, and many are under $200. And unlike the previous setups, they’re compact, which allows her to take the set-up to group sessions, conventions and workshops.

While overcoming a fear involves confronting it, McMahon admits that VR exposure is not going to work for everybody. She also predicts that VR apps will become readily available through mobile app stores, overhyping their effectiveness.

“Like any powerful tool, you have use, you have misuse,” the psychologist said. “It may be very helpful to some, not helpful and potentially harmful to others.”

Aside from her private practice, McMahon teaches continuing education workshops at the California Psychological Association and American Psychological Association conventions. Recently, Psious, a Barcelona-based software company that McMahon uses, asked her to write a 10-session course for therapists who are looking to use its software.

McMahon is convinced that virtual reality will be considered best practice when it comes to treating fears.

“There’s nothing more gratifying than seeing someone become free to do what they want to do,” she said.