I hear you do Virtual Reality Exposure (VRE) Therapy. That’s sounds interesting, but what is it?

Exposure therapy is one technique that is used in the context of CBT to treat a variety of anxiety disorders such as Panic Disorder, Social Anxiety Disorder, Posttraumatic Stress Disorder, and Specific Phobias. Prior to 1995, exposure therapy was primarily conducted using Imaginal exposure (thinking about the fears) or in vivo exposure techniques (real world). Before utilizing exposure techniques, the therapist teaches the client anxiety-management strategies and ways to address thoughts that perpetuate anxiety. Together they develop a hierarchy of anxiety producing situations or stimuli and then begin the process of exposure to the elements identified on the hierarchy. For many types of anxiety disorders, in-vivo exposure is considered the “gold standard” of treatment, however it can be both time consuming and costly. For this reason, virtual reality software has been developed to allow for exposure therapy within a virtual environment.

Around 1995, researchers at Emory University and Georgia Institute of Technology (both in Atlanta, Georgia) teamed together to develop, test, and eventually patent the first virtual reality exposure software to treat anxiety disorders (this led to the forming of Virtually Better, Inc.). Since then, VBI as well as other academic institutions and companies around the world have developed virtual reality software for variety of health-related applications. Studies have shown that virtual reality therapy can be just as effective as in-vivo exposure, and many people seek out VRT as a way of addressing long-standing fears. VRE therapy does not replace standard CBT, it simply becomes one more technique at our disposal at the point in therapy when exposure therapy becomes the primary intervention.

VRE therapy is a newer form of therapy (first studied in 1995) that is most often used to treat anxiety disorders, such as specific phobias (of heights, flying, storms, elevators), social anxiety (and fear of public speaking), and Post Traumatic Stress Disorder.  Using this approach, the person faces their fear in a virtual world, which simulates the feared situation using virtual reality technology. The person wears a headset covering ones eyes and ears, and experiences visual, auditory, and kinesthetic (or physical) information immersing them in the situation. The person is an active participant in a computer-driven three-dimensional world, responding to the virtual situation as if it were real. VRE therapy is especially helpful when in vivo exposure is difficult to arrange or hard to control for the client’s comfort. For instance, in treating a fear of public speaking, it can be very difficult to assemble a group of people to serve as an audience, and also leaves much up to chance. Using VR, the person can give as many talks as they want, and the therapist can help control the virtual audience so that their responses can range from pleasant all the way to hostile audience reactions so that a person feels well-prepared to manage their anxiety in front a variety of audiences.

Here is an example of the treatment process at our clinic using cognitive-behavioral therapy and VRET for a person seeking treatment for fear of flying:

Fear of Flying

VRE therapy for fear of flying is conducted in the therapist's office and offers many advantages over standard exposure therapy. These advantages include decreased cost, decreased travel time, protection of client confidentiality, safety for client and therapist during exposure, complete control over the virtual flight, and shorter therapy sessions. In VRE therapy, the client is seated in the passenger cabin of a computer-generated virtual airplane in which they experience all of the sights, sounds, and physical effects of air travel. Clients wear a helmet-like head-mounted display consisting of display screens for each eye, earphones, and a tracking device that allows the “virtual world” to move with the client as he/she moves, creating a 3-dimesional effect.  All of these features recreate the look and feel of actual flight, allowing the client to become immersed in the experience and feel as if they are in it. In VRE therapy the client is gradually exposed to a hierarchy of flying situations such as:

• Sitting on an airplane with the engines off
• Sitting on a plane with the engines on
• Taxiing on the runway
• Takeoff
• Flying in good weather
• Flying in bad weather • Landing

At every step of the virtual flight, the therapist can see and hear what the client is experiencing in the virtual plane.

Session 1
Assessment

All treatment procedures and their rationale are explained and informed consent for treatment is obtained. Various questionnaires that help assess ones feared situations and the breadth of the fear are completed. A clinical interview with your therapist allows a hierarchy of feared situations to be created that will help guide the exposure. Reading assignments may be given at the end of the session 1 or 2.

Session 2
Training

Training in anxiety management techniques begins and continues from one to three additional sessions. Examples of these techniques include breathing retraining and “cognitive restructuring” to help you challenge your fear-based thinking. Homework is assigned and practice is required between sessions to maximize treatment.

Session 3-5
A comprehensive review

A comprehensive review of anxiety management techniques is undertaken. Virtual Reality Technology is added to therapy, beginning with the least fearful flying environment.

Remaining Sessions
Hierarchical Virtual Reality exposure to the feared situations

A client is placed in an immersive VR environment and, in collaboration with the therapist, the feared experience is increased to fit the individual needs of the client. Anxiety management techniques are practiced and applied within the VR session and are used throughout all remaining sessions. Ultimately, the treatment focus is on preparation for an actual flight.

For a list of the disorders we treat using virtual reality, please click here: VR environments.

Virtually Better Home | 2440 Lawrenceville Highway, Suite 200 | Decatur, GA 30033 | p: 404.634.3400 | f: 404.634.3482