VR Exposure Therapy
"Unlocking the Healing Potential: The Transformative Benefits of VR in Therapy."
Imagine treating soldiers with post-traumatic stress disorder (PTSD) in a combat situation rather than an office. Soldiers were immersed in digital simulations of combat; the experience brought back to life through 3D images, sounds, vibrations, and even smells. By working through their trauma in a simulation, soldiers previously unable to share were helped to talk about what had happened.
Virtual reality (VR) has proven to be a powerful tool to help people overcome PTSD and many other mental health issues including phobias, anxiety, and depression.
How VR Help
The potential for VR in therapy is incredible and exciting. Success using such immersive technology has the potential to help the lives of those experiencing (Bohil et al., 2011; Maples-Keller et al., 2017):
Phobias – through controlled exposure to the feared object or situation
Social anxiety disorder – virtually meeting new people and speaking publicly
Post-traumatic stress disorder – alongside, and in some cases replacing, existing treatments
Generalized anxiety disorder – in conjunction with biofeedback, a valued approach for learning relaxation techniques
Panic disorder – helping clients by repeatedly presenting situations that cause panic
Acute and chronic pain – decreasing pain through distraction rather than a drug regime
Addiction – providing safe and controlled exposure to drug-related cues
The above list only tells part of the story. While further work and exploration of the benefits continue in all the above areas of mental health, research breaks new ground in schizophrenia, autism, eating pathology, promoting cardiovascular health, and the mental health benefits of exercise (Zeng et al., 2018).
Treatment of Disorders: PTSD, Anxiety, and Depression
PTSD VR exposure therapy has proven valuable in helping people with PTSD. The therapist begins with an initial assessment of the patient’s needs based on the type and degree of trauma. The VR environment can then be made specific to the individual and their requirements. For example, a particular time of day, noises specific to the equipment used (gun model or vehicle, etc.), and the landscape can be personalized (Maples-Keller et al., 2017). Research has shown a significant reduction in anxiety when virtual reality is used to treat people exposed to terror attacks – such as on September 11, 2001 – disasters, and war. As few as six one-hour VR sessions can reduce anxiety by up to 90% (Difede, Hoffman, & Jaysinghe, 2002; Difede & Cukor, 2007).
Anxiety Anxiety disorders are the most common mental health disorder in adults. In addition to causing significant distress, they can significantly impair a patient’s quality of life. And yet, despite clear evidence of exposure therapy’s effectiveness, it remains an underused treatment for anxiety disorders due to cost, availability, and logistical challenges (Boeldt, McMahon, McFaul, & Greenleaf, 2019). Virtual Reality Exposure Therapy (VRET) is seen as a valuable and effective treatment for fear and anxiety. It offers a way of increasing the availability of such treatment while ensuring standardization. Based on the emotion-processing theory, fear memories are thought to be structures that contain information about our fears, including stimuli, meaning, and responses. VRET systems facilitate emotional processing by immersing the patient in a tailored environment specific to those fear structures (Maples-Keller et al., 2017). The anxiety reduction seen in the virtual environment over repeated exposures generalizes well to real life. Due to the high degree of success in treating anxiety, VRET may, in the future, form part of a standardized approach to e-therapy.
Depression People with depression can exhibit low mood symptoms, poor appetite, disturbed sleep, lack of energy, and feelings of worthlessness. Not only is VR seen as a cost-effective tool for helping people with anxiety, but ongoing research also confirms its value as a treatment for depression (Fodor et al., 2018). The use of VR has led to a significant reduction in symptoms in clients with depression, but further research is required to find the optimal balance with existing treatments (Zeng, Pope, Lee, & Gao, 2018).
10 Benefits of VR-Based Therapy
While VR should be seen as a tool rather than the answer to every mental health challenge faced by a client, it does offer several advantages (Boeldt et al., 2019; Bohil et al., 2011; Maples-Keller et al., 2017):
A high degree of ecological validity. The environments within such a digital reality are increasingly complex and believable.
Direct control over the environment and degree of exposure. For example, when treating a fear of flying, turbulence can be removed or included, as required.
Settings can be made incredibly relevant and personal by including objects, sounds, and even smells from a client’s past.
Therapy can be more consistent and either repeatable or progressive.
Stimuli can be introduced gradually and removed as needed. For example, a fear of spiders can be handled delicately and stopped when needed.
Software is becoming increasingly easy to use and can be adapted for the therapist’s specific needs.
Sessions are available for replay, and results can be collected for ongoing assessment.
VR may provide the only option for difficult-to-arrange exposure therapy scenarios; for example, bad weather flying, facing large audiences, and handling dangerous environments.
The therapy is more acceptable than reconstructing a real environment for patients who have been through trauma.
It is helpful for clients who are unable to picture the situation sufficiently to produce their normal levels of anxiety.
Ultimately patients have reported high levels of satisfaction with VR treatment, probably due to the sense of control it offers and its effectiveness as a therapy (Maples-Keller et al., 2017).
How Does It Work? A Look at the Psychology Behind It
VR works because the digitally created sensory feedback from the artificial world replaces our everyday experiences.
To feel immersive and present, systems typically include two visual displays – one for each eye – that differ slightly, as they do when we view any object in the non-digital world.
For example, look at your finger with one eye closed, then swap with the other eye. You will notice a slight shift in the image.
Our brain takes inputs (artificial or real) from both eyes to create a 3D mental representation. The virtual world is made more realistic by adding additional sensory information: auditory stimuli enter through both ears to create a 3D spatial surround sound, and haptic feedback creates the sensation of “physical contact with the virtual world” (Bohil et al., 2011).
Perhaps the most fascinating part of VR is the ability of the wearer to interact with the environment. By moving the head, pointing at or grabbing something, or even redirecting our gaze, we can change the environment in front of us.
The degree of (sensorimotor) immersion reflects the amount of physical stimulation that we experience through our senses and the system’s sensitivity to receiving information about how we move.
Therefore, the sense of reality depends on the quality and quantity of the sensory experience and our ability to interact with the environment.
But why does it feel so real?
Because we feel present. Presence is our everyday experience of being here, sitting reading this article or walking through a virtual environment (Bohil et al., 2011). While immersion refers to how technically advanced the VR kit is, presence is psychologically and physiologically how it feels to be inside the experience. Typically, the more immersive the experience, the more present we feel.
Such increased presence is linked to multiple brain areas, notably higher activation in the parietal brain – crucial for spatial processing, navigation, and integrating sensory information to form a single perception (Baumgartner, Valko, Esslen, & Jäncke, 2006).
VR feels real because to the brain, it is.