How can doctors use virtual reality to treat phobias?

By: Jonathan Strickland

Virtual medicine was developed to try and help the millions of people that suffer from phobias. See more modern medicine pictures.
Photo courtesy of Virtually Better, Inc.

Millions of people suffer from phobias that limit their activities and negatively impacting their lives. Many seek psychological treatment in order to manage or conquer their fears. For years, a popular form of treatment was exposure therapy, in which a therapist would expose a patient to stimuli related to his fear in a controlled environment. In many cases, patients would learn to manage their anxiety through repeated exposure coupled with encouragement from a therapist.

Exposure therapy is time consuming. Often it's also expensive and inconvenient, and it can compromise patient confidentiality. For example, treating a patient with aerophobia, or the fear of flying, usually involves a trip to the airport. It might take several visits for a therapist and patient to make their way through security to a gate. Eventually both have to get on a plane and fly to a destination. Now that you have to be a ticketed passenger to pass through security at airports, it can be prohibitively expensive to treat a patient with exposure therapy. Because patients and therapists travel together, the patient's confidentiality is compromised because the public has the opportunity to see the therapy in action.


One alternative to traditional exposure therapy is virtual reality exposure therapy. This kind of therapy uses a virtual reality unit to simulate situations that cause anxiety in phobia patients. It has several advantages over traditional therapy. Doctors don't have to leave their offices. Scheduling treatment is easier. It's less expensive in the long run. And patients are often more willing to participate in a program they know will allow them to deal with their fears in a nonphysical setting. Since patients can undergo therapy inside the doctor's office, confidentiality isn't an issue.

Dr. Larry Hodges, a virtual reality computer scientist at the University of North Carolina -- Charlotte, became interested in a possible therapeutic application of VR technology in the early 1990s. He approached Dr. Barbara Rothbaum, a professor of Psychiatry at Emory University, and together they collaborated on a project that would test VR technology's efficacy in recreating patients' fears. They decided to design a simulation for patients suffering from acrophobia, or a fear of heights. Dr. Hodges felt that it would be relatively easy to create a program giving the illusion of height compared to other, more complex fears.

Dr. Hodges and his team worked with Dr. Rothbaum and volunteer patients to determine what stimuli were particularly powerful. Volunteers would wear a head-mounted display (HMD) that would create the illusion that they were on a tall ledge. Going into the project, Hodges and Rothbaum weren't certain that they would get the same reactions from volunteers in a virtual environment as they would a real one, nor were they sure that by treating someone using virtual environments that progress would translate into the real world.


Virtual Medicine Treatments

Virtually Better may create an environment such as this to help patients overcome their fear of heights.
Virtually Better may create an environment suchas this to help patients overcome their fear of heights.
Photo courtesy of Virtually Better, Inc.

Very early in the simulation, Dr. Rothbaum observed that the volunteer patients were exhibiting classic signs of anxiety, including an accelerated heart rate and shortness of breath. Rothbaum and Hodges had successfully demonstrated that a virtual environment could evoke real physical reactions from users. Dr. Rothbaum began to use the simulations to work with patients as if they were undergoing regular exposure therapy. Before long, several of the volunteers reported they had purposefully sought out experiences in real situations that tested their fear. These were patients who  normally would have avoided these situations at all costs before trying the virtual therapy.

After some additional research, Hodges created the company Virtually Better, Inc. The company designs and sells virtual reality systems that accurately recreate several different classic phobia situations, including social phobias involving crowds of people. Now a therapist can take a patient on a virtual flight without the hassle of scheduling travel, go on a virtual elevator ride without ever stepping out of the office, or give a speech in front of a crowd of people, all without leaving the office or compromising patient confidentiality.


The company also offers scenarios to treat veterans with post-traumatic stress disorder. A program designed for Vietnam veterans can recreate a couple of different situations that were common for most soldiers in the conflict. One simulates a helicopter ride over jungle landscape, while the other puts the patient in the middle of a virtual clearing. Engineers created both scenarios based on veterans' descriptions of situations that triggered their anxiety.

In addition to treating fears and anxieties, Virtually Better uses VR technology to help treat addiction. These scenarios put the user in a situation where characters within the virtual environment are indulging in alcohol or drugs. While it might seem strange to think a virtual character can trigger addiction cravings, Dr. Hodges says their research shows that once someone is habituated to a virtual environment (meaning the user feels as if he's inside and a part of the virtual world) he reacts as if it were the real world. In fact, according to some research projects, virtual characters can impact a real person as if they were acutally real. Dr. Hodges says that the gender of a character seems to make a bigger difference in users' reactions rather than whether the character they see is virtual or real.

Virtually Better has sold units to therapists around the world and continues to develop new therapy applications of VR technology. Dr. Hodges is also continuing his research in the VR field, studying how virtual persons and environments can impact human users.