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| Source: popsci.com |
Exposure therapy is defined a psychotherapy that utilizes the repetition of real, visualized, or simulated exposure to a feared situation, traumatic event/memory, or object in order to achieve habituation.
In lay-man's terms, it is a form of therapy that asks the patient to face their fear repeatedly so that they can get used to it or conquer it.
Traditionally, exposure was achieved through in vivo, or real life, confrontation or through visualized confrontation (where the patient has to visualize or imagine a confrontation).
VRET introduces an alternative that can be considered the best of both worlds as it allows for a virtual confrontation experience where human-computer interaction can allow the user to become an active participant in a computer generated three dimensional environment.
The two major techniques used to immerse patients into a virtual environment are a head mounted display (HDM), or a computer automatic virtual environment (CAVE).
For VRET to be successful, there are three conditions that need to be met, according to the theory of Foa and Kozak.
The first of these conditions is that participants need to feel as if they are a present and first person active player in the environment instead of feeling as if they are a third person viewer watching a movie.
The second condition is that the virtual environment must be able to elicit emotional reactions from the patient and must be able to cause them actual distress and anxiety. Should the environment not be able to elicit a strong enough reaction, then being exposed to it cannot help the patient make any progress because they are not actively being exposed to their fear.
The third condition states that the effects of the therapy must transfer from the virtual environment to the real world. Extinction of the phobia and the co-occurring cognitive changes must generalize to real-life situations so that the patient will feel a decrease in desire to avoid them or less anxiety when encountering them.
VRET has been found to be a successful alternative to real exposure therapy in treating common phobias such as of fear of heights, flying,and spiders, and PTSD
VRET introduces an alternative that can be considered the best of both worlds as it allows for a virtual confrontation experience where human-computer interaction can allow the user to become an active participant in a computer generated three dimensional environment.
The two major techniques used to immerse patients into a virtual environment are a head mounted display (HDM), or a computer automatic virtual environment (CAVE).
For VRET to be successful, there are three conditions that need to be met, according to the theory of Foa and Kozak.
The first of these conditions is that participants need to feel as if they are a present and first person active player in the environment instead of feeling as if they are a third person viewer watching a movie.
The second condition is that the virtual environment must be able to elicit emotional reactions from the patient and must be able to cause them actual distress and anxiety. Should the environment not be able to elicit a strong enough reaction, then being exposed to it cannot help the patient make any progress because they are not actively being exposed to their fear.
The third condition states that the effects of the therapy must transfer from the virtual environment to the real world. Extinction of the phobia and the co-occurring cognitive changes must generalize to real-life situations so that the patient will feel a decrease in desire to avoid them or less anxiety when encountering them.
VRET has been found to be a successful alternative to real exposure therapy in treating common phobias such as of fear of heights, flying,and spiders, and PTSD
VRET is still a relatively unknown treatment method and though the general public may question its validity, it has been found to be better than, or on par with, in vivo and visualization therapy.
In a study on the treatment of acrophobia, or fear of heights, it was found that VRET is a relatively cheap and effective alternative to in vivo therapy. The patients who underwent VRET had comparable results and post treatment benefits.
Similar results were found when studying the treatment of fear of flying (FOF). VRET and in vivo exposure were essentially equivalent post treatment on standardized questionnaires, willingness to fly, anxiety ratings during the flight, self-ratings of improvement, and patient satisfaction with treatment.
VRET was also found to be effective in treating post-traumatic stress disorder (PTSD) for world trade center survivors and vietnam war veterans.
In a case study of a world trade center survivor, VRET was shown to decrease the patient's Subjective Units of Distress after each therapy session and after completion of treatment, the patient no longer qualified for PTSD, Major Depression, or any other psychiatric disorder when examined by a third party independent assessor.
A case study of Vietnam war veterans also found similar results. The patient was exposed to two virtual environments, a virtual Huey helicopter flying over a virtual Vietnam and a clearing surrounded by jungle. After treatment the patient experienced a 34% decrease on clinician-rated PTSD and a 45% decrease on self-rated PTSD and these treatment gains were maintained even after a 6-month followup.
VRET was also found to be effective in treating post-traumatic stress disorder (PTSD) for world trade center survivors and vietnam war veterans.
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| Source: Virtual Reality Exposure Therapy for WTC PTSD: A Case Report |
A case study of Vietnam war veterans also found similar results. The patient was exposed to two virtual environments, a virtual Huey helicopter flying over a virtual Vietnam and a clearing surrounded by jungle. After treatment the patient experienced a 34% decrease on clinician-rated PTSD and a 45% decrease on self-rated PTSD and these treatment gains were maintained even after a 6-month followup.
A meta-analysis of current data available on VRET concluded that "VRET has potential for the treatment of anxiety and several specific phobias” and it can successfully reduce anxiety and phobia symptoms in patients.
Advantages of virtual reality therapy include cost, increased safety, control, confidentially, and unlimited repetitions exposure to feared situations
VRET, as aforementioned, can be considered to be the best of both worlds because it offers a middle ground between the cost-effectiveness and safety of visualization and the life-like exposure of in vivo therapy.
For example, in vivo exposure therapy for phobias such as fear of flying can be expensive but VRET is comparatively cheaper than buying plane ticket every time and offers the patient a greater chance of reimbursement from insurance as the sessions would be much shorter, making the total cost much more bearable for the patient.
VRET can also allow for countless repetitions and attempts because all you need to do is restart the computer to recreate the simulation once again. In vivo therapy does not allow for recreation with as much ease.
In vivo cannot let the doctor control the degree of exposure (ex. increase or decrease the number and size of spiders a patient with arachnophobia sees) and exercise complete dominion over all external factors like VRET can either.
Dr. Kent Norman, professor of psychology at University of Maryland, explains how VRET allows for customization of the environment as well (ex. is the spider in the bedroom or the kitchen).
Since therapy is always conducted in the office there is less danger of confidentiality breaches or of public interference in treatment (ex. meeting a friend while outside for treatment).
Scheduling is also much more convenient and can be done with a higher frequency due to comparatively small amount of logistics that have to be taken care of in VRET.
The disadvantages to virtual reality exposure therapy are that you can have technological difficulties with the computer, its effectiveness is dependent on the patient, the technology required is expensive to manufacture, and administration requires doctors to have extra training and certification
When utilizing VRET, a major part of the treatment system is dependent on the computer. This means that technical problems are likely to occur and cause issues.
Should there be a glitch in the system, the flow of the session can be interrupted or the patient could suffer side effects. This means that proper administration of this treatment will require a lot of technological maintenance.
VRET can also allow for countless repetitions and attempts because all you need to do is restart the computer to recreate the simulation once again. In vivo therapy does not allow for recreation with as much ease.
In vivo cannot let the doctor control the degree of exposure (ex. increase or decrease the number and size of spiders a patient with arachnophobia sees) and exercise complete dominion over all external factors like VRET can either.
Dr. Kent Norman, professor of psychology at University of Maryland, explains how VRET allows for customization of the environment as well (ex. is the spider in the bedroom or the kitchen).
Since therapy is always conducted in the office there is less danger of confidentiality breaches or of public interference in treatment (ex. meeting a friend while outside for treatment).
Scheduling is also much more convenient and can be done with a higher frequency due to comparatively small amount of logistics that have to be taken care of in VRET.
The disadvantages to virtual reality exposure therapy are that you can have technological difficulties with the computer, its effectiveness is dependent on the patient, the technology required is expensive to manufacture, and administration requires doctors to have extra training and certification
When utilizing VRET, a major part of the treatment system is dependent on the computer. This means that technical problems are likely to occur and cause issues.
Should there be a glitch in the system, the flow of the session can be interrupted or the patient could suffer side effects. This means that proper administration of this treatment will require a lot of technological maintenance.
Though the sessions might be comparatively cheaper to in vivo, they are by no means cheap in and of themselves. The hardware and software required to construct a virtual reality experience is very expensive and not produced commonly or on large scales.
This also makes it extremely difficult to produce environments that are specifically tailored to the patient because the creation of such an environment would require the expertise of an actual video game developer who could write the script and create an entire story.
As a result it has to be carefully judged when VR exposure therapy is the best treatment route as not all patients are good candidates on whom this treatment can have a noticeable effect.
Due to these complications, administration of this treatment will require doctors to undergo an extra stage of training and preparation, which is an extra expense. This also makes finding trained and competent professionals more difficult for patients.
Dr. Norman Kent summarizes some of these pros and cons in the following interview. He also introduces the problem of virtual reality sickness that 20% - 30% of people have, which consists of nausea, headaches, and eye aches.
Regardless of these disadvantages, Virtual reality is a viable treatment option for phobias and requires further research and more societal acceptance so that in the future, it can have a greater positive impact on phobia treatment .
VRET exposure therapy requires more research so that it can be streamlined into a more flawless method of treatment. There is also a need for more research on how to distinguish patients upon whom VR exposure therapy is most likely to yield results.
We also need to support the further development of VR technology (such as Occulus Rift) in general because they could have possible benefits in medical treatment.
According to Dr. Kent, attention also needs to be given to augmented reality, which differs from virtual reality in that it alters the real world in some useful way instead of creating a completely new virtual world.
Augmented reality provides the potential to have a higher transfer rate of treatment effects from the virtual world into the real world.
VRET contains the potential to give way to an era where phobias and anxiety disorders could possibly be treated in the home of the patient with the long distance guidance of a doctor, or even on the battlefield or on the site of a disastrous or traumatic event.
It is up to us as a society to ensure that the right steps are taken so that this treatment method can be explored to its fullest and all its potential benefits reaped.
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