A new wave of psychological research has allowed virtual reality to demonstrate its power as a tool for psychology and mental health. Where will this take us to in the future?
In the winter of 2020, I did something really remarkable. I performed “Once Upon a December” with the cast on Broadway’s “Anastasia,” only to walk onto the famous The Voice UK audition stage three minutes later. I bet that’s not something anyone has done. Technically speaking, I haven’t either. If the experiences were for real I’d panic for not having practiced hours meticulously beforehand. I’d freeze on stage like the two rubber ducks in my backyard, choke on my voice, and probably avoid anything public ever again. Luckily for me, what I walked into was a simulation of the experiences from a virtual reality headset.
Virtual reality (VR) is a 3D environment crafted by computers that allow users to engage with a digital simulation of reality. It enables a sense of immersion in an alternative universe by incorporating devices that track your motion and change images displayed accordingly. Using this technology, I used exposure over and over to practice overcoming my fear of making mistakes performing publicly, whether it’s playing a song or giving a presentation. When you’ve sung your heart out more than 10 times on Broadway’s “Anastasia” you’ll understand that the next school presentation becomes a simple conversation.
VR’s Niche in Psychiatric Treatment
If VR was able to help me dissipate my fear of public performance with simulated exposure to scenarios, it can surely make a positive impact on changing the way psychiatric treatments go about.
Psychiatric Disorders and Exposure Therapy
Psychiatric disorders are mental illnesses that interrupt your thoughts, emotional state, behavior, and greatly increases one’s risk of pain or loss of freedom. About 1 in 5 U.S. adults suffer from one, to be precise, 51.5 million in 2019. This includes anxiety, post-traumatic stress disorder (PTSD), and specific phobias.
Of the current treatments for these disorders, one of the most effective is certainly exposure therapy. Exposure therapy is when patients are strategically confronted with their feared stimuli to reprogram their brains into lowering their emotional reaction in the future toward the fear. Around 60–90% of people have none or almost no symptoms of their original disorder after completing exposure therapy.
Exquisite Control and High Satisfaction
Despite exposure therapy’s effectiveness, some fears are extremely difficult, if not impossible, to confront in the first place. Military veterans from combat in Iraq or people afraid of flights go through exposure therapy relying on their imagination, or on the costly construction of the exposures. This isn’t a problem in VR where war combat and flights can not only be repeated dozens of times but can be controlled down to single variables. For example, the height someone looks down toward if they have a height phobia. This complete control gives patients personalized and optimized pacing through treatment.
From past studies, patients have found VR therapy to be favored over traditional methods: the refusal rate for VR therapy is 3% compared to 27% in traditional exposure treatments. A majority of a sample of 352 post 9/11 US soldiers claim they are willing to use most tech-based methods for mental health care while 19% of those sampled report being willing to use VR approaches for mental health care despite refusing to talk to a counselor in-person. With such high potential, let’s look at VR has already been flexibly adapting to treat a range of psychiatric disorders…
Anxiety - Where Most VR Treatment Is
Anxiety disorders are defined by feelings of worry and fear so impactful that it interrupts one’s daily life. To name a few, it includes specific phobias, Post-Traumatic Stress Disorder (PTSD), and Social Anxiety Disorder (SAD). Exposure therapy for anxiety disorders is based on the modification of fear structures. Fear structures are memories in our minds that store information about the feared stimuli. When patients emotionally process experiences in a VR feared environment adjusted to certain aspects of their fear structures, it creates the opportunity to learn a contradiction of what they remembered about their fear. This not only reduces symptoms but results in a stable long-term positive impact.
Specific Phobias (SP)
When it comes to anxiety disorders, specific phobias (SPs) are identified to be excessive fear toward certain objects or situations like heights, flight, and animals. Flight phobias are one of the most researched disorders and putting a patient straight on an airplane to let them confront their fear is definitely not the safest and most controlled option. VR-based exposure to flight has been studied to not only decrease flight anxiety significantly but increase one’s willingness to board an airplane after treatment. Flight simulations in VR have the advantage of being very controlled, safe, more feasible, and less costly. There’s also a high level of personalization because different factors like turbulence can be eliminated in situations depending on what the patient’s pacing is.
Studies have also been done on phobias involving the fear of heights, spiders, and driving, all showing promising results of decreased symptoms. SPs range practically infinitely, but VR can provide an exposure simulation to each one because the whole experience can be programmed in a digital world. VR branches out to help patients confront fears that may not be cost-effective, feasible, or safe to be exposed to traditionally.
Post-Traumatic Stress Disorder (PTSD)
Now what if the disorder is marked by the experience of a traumatic event with later symptoms of heightened reactivity, avoidance, and negative mood alterations? One investigation into VR’s effectiveness in treating Post-Traumatic Stress Disorder (PTSD) observed groups with participants like civilians, firefights, and disaster workers who experienced the horror of 9/11. The study also included a waitlist control group and found that the VR group had significant reductions in PTSD scores after the treatment compared to the waitlist group. The results stayed consistent after 6 months.
Another study investigating the effects of VR therapy but with Vietnam War veterans. Although the results didn’t show significant differences in PTSD scores post-treatment, it was noted that VR therapy had longer positive effects 6 months after treatment. The sample size was small, but a further combat-related PTSD VR-therapy study with 156 post 9/11 veterans indicated major improved PTSD symptoms with results that sustained 12 months post-treatment. War and disaster aren’t events one can be repeatedly, safely, and meticulously exposed to for therapy, but VR allows all three.
Social Anxiety Disorder (SAD)
Social Anxiety Disorder (SAD) is when patients struggle with social interactions, including conversations, public speaking, and meeting others because of excessive fear of being judged. VR treatments of SAD involve simulated social environments with virtual audiences in classrooms, auditoriums, conference rooms, and etc. In two randomized controlled trials, VR-based treatment for SAD is just as effective as traditional exposure therapy for SAD. Additionally, though, VR treatment has superior control over factors like the number of people in the audience, size of the stage, the intensity of light, etc. The VR treatment is also cost-effective and less time-consuming to conduct.
Improving the Control of Addiction
VR treatment can also cover the role of creating controlled therapeutic environments where patients are given the opportunity to be more mindful of their addictions when presented with exposure to repeated cues of their addiction.
Eating Pathology
VR treatment can apply to address weight concerns, eating concerns, and body image disturbances. VR can be used to set up challenges to overcome body image distortions and practice the identification of food cues that trigger eating and weight concerns to practice more effective eating strategies. One investigation designed several VR environments like rooms with food items to explore patients' habits that influence their shape and perception of their body. It supported the fact that treatment improved body awareness in binge eating-disordered patients and obese patients. The following investigation of 28 obese patients found that VR treatment led to significantly increase improvements in body satisfaction, anxiety level, and problematic eating.
Abstaining from Drugs, Alcohol, and Smoke
In 2017, 1 out of every 8 adults dealt with alcohol and drug use disorders simultaneously. Drug and alcohol addiction stems from a constant reactivity to drug-related cues. Repeated exposure to these cues during therapeutic practice is used to reduce cue-reactivity to prevent action being taken on the craving. In a nicotine-dependent randomized control trial, a VR smoking environment designed with drug-related cues increased the craving for patients but observed decreases in the response over the 4-week course of the treatment. Another trial on smokers founds that participants of the VR treatment have a higher quit rate and significantly fewer cigarettes smoked per day. Repeated cue exposure treatments in VR environments are thus effective in triggering cravings to allow patients to practice abstinence.
The Promise in Treatment
In both the treatment of psychiatric conditions and clinical research, VR shows the potential to emerge as a viable tool to help numerous disorders. The technology’s strength is most demonstrated in its effectiveness in exposure therapy applying to anxiety disorders or the practice of abstinence to addiction cues. With lasting effects, controlled therapeutic spaces, and personalized treatments, it’s likely VR treatments will multiply into a hopeful future for psychiatric treatments.
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