Progressive Fidelity XR Exposure Therapy

Published in

XR for Good

5 min readDec 21, 2018

According to the National Institute of Mental Health, approximately 9.1 percent of adults in the U.S. have experienced specific phobias in the past year. That’s an estimation of almost 23 million people. We can leverage spatial technology to help mitigate this phenomenon.

Previous Research

Throughout recent years, there has been stacking evidence supporting the efficacy of Virtual Reality Exposure Therapy (VRET) from a clinical psychology standpoint. A 2007 meta-analysis conducted by Dr. Thomas Parsons and Dr. Albert A. Rizzo at the University of Southern California’s Institute for Creative Technologies revealed that VRET had statistically large effects on anxiety disorders and specific phobias across numerous analyzed studies. In a more recent study conducted by Dr. James Lake, Virtual Reality Graded Exposure Therapy (VRGET) was supported to be more effective than conventional imaginary exposure therapy and just as effective as in vivo exposure therapy. Furthermore, according to Dr. Lake, VRGET was shown to require 33 percent fewer sessions to achieve similar results as Cognitive Behavioral Therapy (CBT) for the treatment of panic disorder with agoraphobia.

Current Offerings

Companies are already offering VR experiences as viable alternatives to in vivo exposure therapy. Virtually Better offers VR experiences to help treat PTSD as well as a variety of common specific phobias such as fear of flying, heights, elevators, bridges and more. Limbix, another company that offers therapies for specific and social phobias, appears to leverage 360 videos as their spatial stimulus for many of their treatments. This results in a high fidelity viewing experience that can be accessed through a mobile headset. You can read about other companies working in this space in an article written by Kirsten Weir, published by the the American Psychological Association. As wonderful as it is to see commercially available offerings making exposure therapy more accessible to people in need, there is always room for iteration.

Potential Advancement

I am referring to my proposed methodical iteration as Progressive Fidelity XR Exposure Therapy. Let me explain…

Imagine, Corey, a 26 year old who is extremely frightened by dogs. He can’t stand to be around them; he experiences involuntary psychophysiological responses of elevated heart rate, perspiration, breathing, stress, anxiety and fear. This condition has plagued him for years. Corey developed cynophobia after being violently attacked by a large dog during childhood.

Progressive Fidelity XR Exposure Therapy includes multiple modalities that can be applied to help Corey. The two obvious modalities are Virtual Reality and Augmented Reality (no need to get hung up on V/A/M/X/R semantics here). VR can be leveraged to facilitate a completely controlled, immersive, and interactive experience, while AR can be utilized to facilitate a primarily in vivo experience with virtual stimuli.

Virtual Reality

Corey dons a VR headset while guided by a trained professional. He is introduced to a low-fidelity stimulus in a controlled, immersive environment. The low-fidelity stimulus is a cartoonish, sketch-like rendition of a dog. Throughout the duration of the therapy, each session introduces an incrementally higher fidelity stimulus. By the end of the therapy, Corey may be positively interacting with a high-fidelity virtual dog. Depending on Corey’s performance during the VR exposure therapy, he may be asked to participate in a second round of therapy that involves another modality of spatial experience.

Augmented Reality

Corey dons an AR headset while guided by a trained professional. He is then introduced to a virtual stimulus, that seemingly exists within his immediate physical environment. AR may be leveraged to bridge a potential gap between VR and in-vivo exposure therapy. Of course, the stimulus fidelity can be manipulated during the AR modality of exposure therapy as appropriate.

Measuring Performance

Now that I’ve described the gist of Progressive Fidelity XR Exposure Therapy, a question remains: How do we effectively measure Corey’s response to the stimulus? In short, we may utilize wearable technology to gather biometric information in order to infer the cognitive state of the participant. A good example of a comprehensive measure is Design Interactive’s Operational Stress Index (OSI). Something like the OSI could be leveraged to gather stress data in real time, as the participants make their way through the therapy sessions. Subsequent therapy sessions could be customized depending on various aspects of participant stress level during previous sessions.

In Conclusion

The idea of virtual reality exposure therapy isn’t novel. With that said, augmented and mixed reality devices also deserve a seat at the table in this field of study. Leveraging the entire range of available spatial modalities within clinical psychological settings may open the door for new possibilities to study cognition and improve therapies. Furthermore, as I may not be the first person to ponder the modification of stimulus fidelity in XR exposure therapy, I do hope that this article has illustrated the power of spatial technology — for it is an amazing power that we can employ as designers, developers, researchers and technologists to positively impact the world.

If you are interested in discussing therapeutic applications of spatial technology, or any other impactful uses of technology, feel free to connect with me on LinkedIn. Furthermore, if you would like to join a growing community that is focused on the implementation of XR for good, complete this form to receive your invitation to the Slack workspace.

Thanks for reading!