How can virtual reality be utilized by doctors to treat phobias?

Millions of people are affected by phobias that restrict their daily activities and have a negative impact on their lives. Many turn to psychological therapy in an effort to manage or overcome their fears. One of the most common methods of treatment for years has been exposure therapy, where a therapist gradually exposes a patient to fear-related stimuli in a controlled setting. Through repeated exposure and support from the therapist, patients often learn to manage their anxiety.

Exposure therapy can be time-intensive, costly, and inconvenient, often compromising patient confidentiality. For example, to treat someone with aerophobia (fear of flying), exposure therapy would require trips to the airport, possibly multiple visits through security, and eventually boarding a plane. With the requirement to be a ticketed passenger for airport security, it can become prohibitively expensive. Additionally, traveling together means the patient's confidentiality is at risk as therapy takes place in public settings.

An alternative to traditional exposure therapy is virtual reality exposure therapy. This method utilizes a virtual reality system to recreate anxiety-inducing situations for phobia patients. It offers several benefits over traditional methods. Doctors can conduct sessions in their offices, making scheduling more flexible and treatments more affordable. Patients are also more inclined to engage in therapy knowing they can face their fears in a safe, non-physical environment. Confidentiality remains intact since therapy takes place within the doctor's office.

In the early 1990s, Dr. Larry Hodges, a virtual reality computer scientist at the University of North Carolina -- Charlotte, became intrigued by the potential therapeutic uses of VR technology. He approached Dr. Barbara Rothbaum, a professor of Psychiatry at Emory University, and together they embarked on a project to test VR technology's ability to recreate the fears of patients. They decided to create a simulation specifically for those suffering from acrophobia, or a fear of heights. Dr. Hodges believed that simulating height would be relatively simpler compared to other, more complex phobias.

Dr. Hodges and his team collaborated with Dr. Rothbaum and volunteer patients to identify which stimuli were the most impactful. Volunteers were asked to wear a head-mounted display (HMD) that would create the illusion of standing on a tall ledge. At the start of the project, neither Hodges nor Rothbaum were sure whether virtual environments would trigger the same responses as real ones, or whether progress made in the virtual world would translate into the real world.

Virtual Medicine Treatments

Early in the simulation, Dr. Rothbaum noticed that volunteer patients were showing typical signs of anxiety, such as an increased heart rate and shortness of breath. Rothbaum and Hodges had successfully demonstrated that a virtual environment could provoke real physical reactions. Dr. Rothbaum began to use these simulations for exposure therapy, and before long, several volunteers reported intentionally putting themselves in situations in the real world that tested their fears. These were individuals who had previously avoided such experiences altogether.

Following further research, Hodges founded Virtually Better, Inc., a company dedicated to designing and selling virtual reality systems that authentically recreate various phobia scenarios, including those involving social fears and crowds. With these systems, therapists can take patients on virtual flights without needing to arrange travel, experience virtual elevator rides without leaving the office, or even deliver speeches in front of crowds — all without compromising patient confidentiality.

The company also provides specialized programs for veterans suffering from post-traumatic stress disorder. For instance, a program designed for Vietnam War veterans can recreate two common scenarios that many soldiers encountered. One simulation places the patient in a helicopter ride over a jungle, while the other puts them in the middle of a virtual clearing. These scenarios were created by engineers based on veterans' descriptions of situations that typically triggered their anxiety.

Beyond treating phobias and anxiety, Virtually Better leverages virtual reality technology to help with addiction treatment. In these scenarios, the user finds themselves in a setting where virtual characters are engaging in substance abuse, such as alcohol or drugs. Although it may seem odd that a virtual character could trigger cravings, Dr. Hodges explains that their research shows once a person becomes habituated to a virtual environment (meaning they feel as though they are part of the virtual world), they respond as though it were real. Interestingly, studies suggest that virtual characters can influence a person in ways similar to real people. Dr. Hodges notes that users' reactions seem to be more influenced by the gender of the virtual character than whether the character is real or virtual.

Virtually Better has sold its systems to therapists worldwide and continues to expand the use of VR in therapeutic applications. Dr. Hodges remains actively involved in research, studying the effects of virtual people and environments on human behavior.