Over 20 years ago, Dr. Barbara Rothbaum and colleagues showed that virtual reality-based exposure therapy could help people overcome a fear of heights. Since then, virtual reality platforms have grown not only to fuel research, but also to address phobias, post-traumatic stress disorder (PTSD), substance use disorders and more.
A therapy tool
Exposure therapy
Since the early days of virtual reality, psychotherapists recognized the potential of the technology for exposure therapy, in which patients are exposed to things they fear in safe and controlled settings. Exposure therapy targets behaviors (most often, avoidance) that people show in response to situations or memories that they find frightening or anxiety-provoking. The goal of the therapy is to diminish the avoidance behavior by actively confronting the things that a person fears to learn that anxiety and fear will lessen on their own. It is important, however, that a person confronts a situation that closely maps onto the fear, which is not always possible. For example, a veteran who developed PTSD as a result of combat exposure would not be able to confront a combat situation again.
And here comes virtual reality: in virtual reality exposure therapy (VRET), a person is immersed in a computer-generated virtual environment, either by using a head-mounted display device or entering into a computer-automated room where images are present all around. This environment can be programmed to help the person directly confront feared situations or locations that may not be safe to encounter in real life. Such virtual environments provide visual, auditory, tactile, vibratory, vestibular, and olfactory stimuli to patients. During the session, the therapist closely tracks the patient’s state of arousal by monitoring physiological indicators of stress, including heart rate and respiration.
To date, VRET for PTSD has primarily been examined in Vietnam War combat veterans and to address specific phobias, like claustrophobia, fear of driving, acrophobia (or a fear of heights), fear of flying, arachnophobia (fear of spiders), and social anxiety.
Substance use disorders treatment
Similarly to overcome phobias, virtual reality might be able to help people with substance use disorders. Virtual experiences prove to trigger cravings in people being treated for dependence on tobacco, alcohol or illicit drugs. Such cravings can be used in treatment for addiction, since they give people a chance to practice what they’ll do in high-risk situations. In essence, the mechanism is the same as in PTSD treatment: with the help of highly controlled and adjustable virtual setting, people are confronted with the most challenging situations and try to overcome their usual cravings in a safer environment.
A research tool
Virtual reality, apart from being a promising practical tool, can also assist in studying and measuring human behavior and cognition. The central goal of any psychological research is to understand real‐life human behaviour. Yet, to have scientifically proven results, psychologists have to examine behaviour under highly controlled conditions, ideally with only a few manipulations at a time to allow rigorous scientific inferences. Hence, researchers face a dilemma between experimental control and ecological validity. Virtual reality seems to offer a way out that would help researchers explore human nature in the control surroundings.
Going beyond practice, virtual reality tools are used in research assessing and preventing combat-related PTSD. For example, STRIVE (Stress resilience in virtual environments) system is used to simulate combat situations. Its primary goal is to guide the combatant through a virtual experience while coaching him or her in relaxation and emotion self-regulation. However, it also provides a useful tool for predicting the risk of developing PTSD or other disorders in new recruits prior to actual combat exposure. Recruits who display high resilience and thus presumably at relatively lower risk of developing PTSD might be more suitable for direct combat roles and vice versa.
Virtual reality is widely used in studies of spatial cognition and motor control, as well as in research of human social interaction, where a person interacts with another (real or virtual) person.With virtual characters, it is possible to create infinitely many combinations of social variables and test them against each other in studies of social perception and mimicry, trust and rapport and prejudice in social interaction.
New virtual reality systems also represent a person’s body or body parts within the virtual scene, which is used to study how changes to one’s avatar might affect perception. Similar research using virtual reality could help scientists better understand body image disorders.
At a more general level, virtual reality helps explore basic questions about human perception and cognition. For example, in controlled settings, it is possible to remove all visual aspects of the environment that can be used to navigate, such as street signs or distal mountains, to explore what that means for spatial cognition.
One of such studies explored the phenomenon of vastness, the feeling that the environment around you extends almost forever, making you feel insignificant by comparison. Stefanucci and colleagues showed they could evoke a sensation of vastness using virtual mountain landscapes, suggesting that virtual reality could be helpful for understanding this complex phenomenon.
Benefits of VR therapy
Comparing to the traditional approach, VR-assisted therapy has a number of benefits to patients and therapists:
More controlled: as a patient makes progress confronting his or her fears, virtual scenes can be adjusted to make the feared stimulus more provocative, so that they stay at the level the patient is ready to confront.
More practical: in the real world, exposing people to their fears can be inconvenient or too expensive, like the case of fear to fly where psychotherapists can’t always accompany their clients on airplanes. In this case, facing virtual threats is much easier.
Similar physiological response: though it may sound counterintuitive, VR experiences trigger the same physiological reactions that the real world. As an important part of managing anxiety is learning to control the body’s fear response people can experience a racing heart and rapid breathing during their encounter with a virtual danger and learn to control their bodies.
How to go virtual
Virtual reality systems for psychotherapeutic use are taking off with the first tools available on the market:
- Virtually Better — phobias, substance use disorders, skills development, PTSD, stress/pain management
- Psious — phobias, PTSD, pain management, ADHD, stress management
- Limbix — exposure therapy for anxiety-based disorders, relaxation, mindfulness, skills training, relapse prevention, pain management
- The Virtual Reality Medical Center — fear of flying, pain management, PTSD
However, it is important to understand that using virtual reality in exposure therapy requires special training for sessions not to go out of control leaving the patients facing their fears.
Virtual reality is a relatively new tool in psychotherapy and it is still bumpy and underexplored. It may lead us to better understanding of real‐life human behaviour and add to our well-being.
