Virtual Reality Therapy as Exposure Therapy Alternative: Early Studies, Best Examples, and Possible Future of VR Therapy for Mental Health
August 01 2022
Virtual reality (VR) has grown far beyond its roots and reputation as a video game technology. Over the past few years, it’s seen use in entertainment, education, real estate, engineering, and more – and now its showing promise in mental health treatment. Virtual reality therapy technology is becoming increasingly common.
Table of contents
- What Is Virtual Reality Therapy?
- Virtual Reality Tech Used as Controlled Exposure Therapy
- How Does It Work?
- Benefits of VR Therapy
- Potential Disadvantages of VR in Therapy
- VR Therapy Case Studies
- Is Virtual Reality Therapy Effective?
- Despite Obstacles, VR Therapy Holds Significant Promise
It can take a while for new technologies to catch on in medical circles, given the surrounding regulations and concerns. Still, early impressions of VR therapy paint a promising picture. Here’s a closer look.
What Is Virtual Reality Therapy?
Virtual reality therapy first emerged in 1995 when researchers at Georgia Tech used VR to treat people with a fear of heights. Students wore a VR headset once a week for seven weeks to experience virtual environments resembling high places. After the experiment, one student could ride a glass elevator to a rooftop instead of walking up 72 flights of stairs.
VR therapy lets therapists and clinicians walk their patients through controlled, simulated environments to address many different conditions. That could involve exposing people to simulations of their fears to fight phobias or recreating controlled versions of stressful situations to help people with post-traumatic stress disorder (PTSD).
In many cases, therapists sit in the same room as patients to control their virtual experiences. However, with advances in VR technology and wireless communication, VR therapy could also happen remotely. Therapists could use VR to work with patients hundreds of miles away.
While VR therapy hasn’t become a mainstream form of treatment yet, it’s grown considerably since the ‘90s. Experts predict strong growth for the market as VR tech improves and mental health awareness increases.
Virtual Reality Tech Used as Controlled Exposure Therapy
At its core, virtual reality therapy is a form of controlled exposure therapy. Exposure therapy involves gradual and repeated exposure to the stimuli at the source of their anxiety. Traditionally, that means being in the physical presence of this stimulus, whether it’s a living thing, inanimate object, activity, or experience.
VR therapy applies the same principles but removes the physical elements. Therapists use virtual reality headsets to place patients in a simulated vr environment where they can interact with digital versions of these stimuli. That could be as simple as standing next to a 3D virtual spider or taking an immersive virtual tour of an undersea environment to fight a fear of the ocean.
Just as the metaverse uses immersive experiences to enrich social interaction, VR therapy uses them to enrich therapy sessions. It provides all the benefits of exposure therapy but with more control.
How Does It Work?
This VR-aided exposure therapy works by conditioning patients to be around their anxiety-causing stimuli. Evidence-based treatment, where therapists explain why a certain response may be unhelpful or unwarranted, has limited effectiveness. It’s often much more impactful to have first-hand experience, even if those experiences are virtual.
Some teachers have found that students retain information 400% better when using VR lessons instead of traditional lectures. VR exposure therapy can reflect the same idea and similar benefits. Just as students learn better when they can see and interact with things in immersive virtual environments, patients can understand their anxieties more when exploring them in VR.
By being around simulations of these stimuli in controlled, virtual environments, patients learn to adapt to them. Therapists can also adjust the VR experience to meet their specific needs. They can control the scale, intensity, or realness of the simulation to gradually increase patients’ exposure, helping them become more and more comfortable with them.
Benefits of VR Therapy
Exposure therapy, in general, has several benefits over other treatments for anxiety disorders. Because patients come face-to-face with their feared stimuli, they gain real-world experience and confidence that they can manage these situations. Patients learn first-hand to attach healthier, more realistic feelings to these stimuli, reducing and even eliminating their anxiety.
Virtual reality exposure therapy carries many of the same benefits as traditional, in-person exposure treatments. Studies show that VR exposure shows a strong correlation to decreasing anxiety symptoms, similar to conventional exposure therapy. When looking at multiple cases together, VR therapy has even demonstrated higher efficacy than in-person exposure.
VR therapy also has several unique advantages over traditional exposure treatments. Here are a few of the most significant.
The most immediately apparent benefit of VR therapy is that it’s more accessible than conventional treatments. Some anxiety disorders are difficult, if not impossible, to tackle with in-person exposure. Flying a veteran with PTSD to their old station or taking someone with a fear of heights skydiving likely isn’t viable. VR provides a convenient way around that problem.
With VR, therapists can immerse their patients in these experiences without leaving their office. Just as VR facilitates remote work and education, it provides remote access to far-away or even imagined locations and situations. Patients can experience unique scenarios that specifically address their anxiety without travelling.
This accessibility can help avoid travel expenses and obstacles patients and therapists may face with traditional exposure therapy. Removing these inconveniences may also make more patients willing to partake in this form of treatment. Consequently, VR therapy could help more patients receive the help they need.
VR’s remote accessibility could also bring exposure therapy to telehealth. If patients have a VR headset, they wouldn’t even have to leave their homes to get help. Therapists could guide them through virtual experiences remotely, bringing these treatments to an even broader audience.
Virtual reality therapy also gives therapists more control over these situations. Conventional exposure treatments can involve some risk in that patients may have anxiety over hazardous conditions. Taking someone near a high ledge or near an animal involves uncertainties therapists can’t control that may endanger patients or hinder their progress.
In contrast, therapists have total control in a virtual environment. They can increase or roll back some elements according to patients’ needs and don’t have to worry about unknown or uncontrollable factors. If the exposure becomes too much for a patient to handle, they can always turn the headset off.
Patients also benefit from a stronger sense of control in these situations. While these experiences are immersive, patients know going into them that they’re not real. That can help them approach the treatment more calmly and may improve participation rates. When patients know they have more control, they may be more willing to undergo these treatments.
Virtual reality’s immersion factor can also improve exposure therapy treatments. While VR offers more control than in-person exposure, it also provides a stronger sense of presence than smaller, controlled, in-office exposures. It goes deeper than simply showing patients images of their feared stimulus. It helps get to the core of the issue, but without any real-world danger.
Tuning out the real world also has benefits. Patients show dramatic decreases in pain perception when using VR during treatments. That can help physical injury patients receive care while being distracted from the pain, and it has similar benefits for mental health patients.
If someone has an anxiety disorder tied to a physical injury, VR can distract from the injury itself as they approach the fear stimulus. Tuning that part of them out can help tackle the feelings and associations around the stimulus without the distraction or reminder of the injury.
In some situations, VR can provide more immersion than would be possible in the real world. Patients with PTSD or similar anxiety-related disorders can immerse themselves in simulations of events or places from their past. This provides a much more impactful experience than revisiting memories, possibly leading to better treatments.
Potential Disadvantages of VR in Therapy
While virtual reality therapy has many advantages, it comes with some potential downsides, too. It’s important to understand these disadvantages to inform future experiments and see how the technology and practice could improve. Here are some of the leading obstacles to virtual reality exposure therapy (VRET).
The most notable disadvantage of VR therapy is a shared obstacle for virtually all VR applications. It can be expensive. VR apps require high render resolutions and frame rates, so users may need high-end graphics cards and other PC components on top of VR headsets.
Despite these costs, VR therapy may still be more cost-effective than conventional exposure treatments, especially since one system can treat many patients. However, it may still be too much for some practices, and patient costs may be prohibitively high for some people. VR’s technical requirements may make remote exposure therapy inaccessible for some patients, making telehealth exposure impossible.
Technology’s rapid pace of innovation may exacerbate these costs. Practices or patients may spend a lot on VR gear, only for it to become outdated within a couple of years. That may lead to even more spending to retain top-of-the-line equipment and contribute to e-waste as users upgrade. Electronic waste already accounts for 70% of toxic waste in landfills, so this rapid upgrading could have an environmental effect, too.
Another potential roadblock to widespread virtual reality therapy is the technology’s reliability. While VR has come a long way in a relatively short time, it can still struggle to deliver consistent uptime. In entertainment applications, that’s an inconvenience, but in therapy, it could stand in the way of effective treatment.
If a simulation doesn’t render correctly or glitches during a session, it could be jarring for the patient. These unexpected disruptions could make the immersion and exposure needlessly stressful, possibly attaching more negative associations to the stimulus at the issue’s center. That could set patients’ progress back, potentially requiring more treatment to undo the damage.
VR Therapy Case Studies
While virtual reality therapy has yet to reach mainstream adoption, it’s already been applied in many areas. As mentioned earlier, its first formal example treated patients with phobias – specifically a fear of heights. Since then, many of its applications have centered around other anxiety-related disorders.
Early studies on PTSD patients found that some 9/11 survivors experience a 90% decrease in symptoms after six VR therapy sessions. Similarly, 16 out of 20 Iraq War veterans no longer met the diagnostic criteria for PTSD after undergoing VR therapy.
Albert “Skip” Rizzo, a clinical psychologist who specializes in VR therapy at University of South California said: “the biggest use of virtual reality in clinical settings is probably in the area of exposure therapy and that is probably because the technology is well-matched to the needs of the clinical trials. We see with exposure therapy the goal really is about helping a patient, whether it’s due to a simple phobia or PTSD, to engage, to confront and to process difficult, traumatic memories.”
VR therapy has also shown promise for treating obsessive-compulsive disorder (OCD). Patients with moderate to severe OCD showed similar anxiety symptoms in VR as they did in real-life exposure. This suggests virtual exposure therapy could be just as effective as conventional treatment in immersing patients in their fear stimuli.
Other studies have looked into VR’s potential for helping patients with autism. After six months of VR therapy, 38% of children with autism experienced alleviated anxiety around their phobias. Research has also demonstrated that VR simulations can help children with autism learn to navigate social situations like job interviews or public speaking.
Several studies have centered on using VR therapy to treat addiction. Overall, this research shows that VR effectively triggers craving in both substance abuse and behavioral addiction cases. This can help therapists and patients get to the core of the issue and recognize cognitive distortions at the heart of the addiction.
VR shows potential in physical therapy, too. Reviews across multiple studies find that VR occupational therapy’s efficacy is equal to or greater than that of conventional therapy. Similar practices could help treat patients with chronic pain, as well.
Source: Cedars-sinai.org | Brennan Spiegel, MD, employs virtual reality to help a patient combat pain. Photo by Cedars-Sinai.
Is Virtual Reality Therapy Effective?
These case studies suggest that virtual reality therapy could be as effective, if not more, than conventional treatment for many patients. While things may vary between conditions and specific patients, early results are promising. Most of the research up to this point affirms VR as an effective replacement for traditional exposure therapy.
Dr. Andrew Huberman, a neuroscientist at Stanford University, confirms VR therapy’s potential. He emphasizes its usefulness for understanding anxiety biomarkers, saying, “VR is hands-down the most powerful way to do visual neuroscience in humans in the laboratory.” Since VR can track eye movements and measure pupil size, it can help researchers understand signs of stress and how anxiety affects the body.
Andrew Huberman, Source: https://scopeblog.stanford.edu/
These findings can help refine exposure therapy in the future. As researchers learn more about these factors, they can create more effective treatment methods.
Providers of Virtual Reality Therapy
There are already a number of providers that are utilizing virtual reality technology for therapy use. Karen Vanderpool, one of Circuit Stream’s students, designed and developed a VR application to help her mother with pain relief.
“My personal experience comes from taking care of my mom for a really long time. I've seen the possibilities of VR that could have really helped her, and given her a respite from her pain and her lack of mobility.”
Some of the companies that are providing professional services VR therapy are:
- Amelia Virtual Care - Company that helps with different phobias such as fear of flying, acrophobia, needles, various animals, public speaking, social anxiety or agoraphobia.
- Virtually Better has over 20 years experience developing VR solutions to treat mental health conditions and disorders.
- Bravemind by University of South California focuses on VR exposure therapy to treat PTSD. Clinicians gradually immerse patients in a controlled virtual world and monitor stress responses with advanced brain imaging.
- Firsthand Technology specializes in pain relief with the use of smart virtual environments powered with biosensors.
- AppliedVR is a startup that calls itself as a “Netflix” of validated therapeutic content aimed at pain relief.
Despite Obstacles, VR Therapy Holds Significant Promise
The biggest potential seems to be the use of VR Therapy with a combination of cognitive behavioral therapy (CBT). A number of studies published on Frontiers in Psychiatry have shown a positive effect on patients with anxiety disorders. The effectiveness of virtual reality is showing great promise with health professionals specifically for treating mental health issues and substance abuse interventions. However, more time and more prolonged exposure therapy studies and randomized controlled trials are needed.
As VR technology develops, obstacles like cost and reliability will fade. That advancement will make VR therapy even more accessible, bringing its benefits to more people. These treatments could help patients across the globe minimize or eliminate their symptoms, improving their quality of life without the downsides of conventional exposure therapy.
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