If you say the words “virtual reality” to most people, odds are they will think about immersive technology for video games and other forms of interactive entertainment, and they probably won’t think of therapy for mental health disorders like specific phobias or PTSD.
But virtual reality is much more than a higher-tech version of Pong or Pac-Man. While its gaming capabilities have drawn considerable attention, virtual reality (or VR) has also been employed in a variety of other fields and industries, including flight simulators, education, tourism, art, engineering, and healthcare.
Initially, VR’s use in healthcare focused on medical applications, such as training surgeons and helping people learn to manage chronic pain.
More recently, researchers have found that virtual reality may also play a beneficial role – as a therapy – in the treatment of people who have been with mental health concerns such as specific phobias and post-traumatic stress disorder (PTSD).
What Is Virtual Reality?
As the name suggests, virtual reality is designed to make users feel as though they are directly interacting with computer-generated objects, people, or environments. VR may be non-immersive, semi-immersive, or fully immersive.
Many standard video games involve non-immersive virtual reality. Players use keyboards, joysticks, or other controllers to move through a virtual (computer-generated) environment that they view on a monitor.
Semi-immersive VR increases the user’s sense that they are in a virtual world, but the user still remains cognizant of their physical surroundings. A flight simulator can be an example of a semi-immersive VR tool.
A fully-immersive VR experience typically involves wearing a headset with goggles that cover the user’s eyes. The user may also wear headphones or earbuds, as well as special gloves.
- When the software is activated, the user’s full field of view is taken up by a computer-generated environment.
- Depending on the specific software and hardware that the individual is using, they may be able to move through and explore this environment, interact with other (real and/or virtual) entities, and even “pick up” or otherwise manipulate objects that exist only within this computer-generated world.
- For gamers, fully immersive VR provides the opportunity to feel as though they are truly inside the game. They can experience and interact with this virtual world via sight, sound, and even touch (through vibrations in specialized gloves or chairs).
The ability to safely transport a person to a different location or even a fictional universe is clearly enticing to those who develop games and other forms of entertainment. As we alluded to at the end of the previous section, this feature has also caught the attention of mental health professionals.
Virtual Reality and Therapy
At its most fundamental level, virtual reality could serve as an environment for traditional individual and group psychotherapy sessions for specific phobias and PTSD.
This type of option – which may be referred to as virtual therapy, remote therapy, or telehealth – has existed for several years in limited situations. However, with the onset of the COVID pandemic in 2020, remote therapy became a much more popular means of safely connecting patients and therapists.
In this context, VR therapy can be an enhanced version of therapy via Zoom or another online videoconferencing platform. The primary difference is that VR can provide a more immersive experience (for example, creating the illusion that the patient and the therapist were in an office together, even if they weren’t in the same location in real life).
Virtual reality therapy can also incorporate avatars or computer-generated characters. In a May 2023 Forbes Health article, Donna Davis, Ph.D., described an avatar-based virtual therapy group for patients with Parkinson’s disease. Davis has been conducting for more than 10 years in the online environment Second Life.
“People in the group create an avatar and they feel more comfortable opening up while their true physical identity is not revealed,” Davis said in the article.
While the Second Life group and similar examples may represent a slight step up from videoconferencing, they barely scratch the surface of virtual reality’s potential. As virtual reality software and hardware continue evolves and improves, it’s likely to help people with phobias and PTSD.
VR and Exposure Therapy for Phobias and PTSD
Allowing patients to participate in therapy sessions from the safety and comfort of their own home is a significant benefit of VR therapy and other forms of telehealth. But the power of VR isn’t limited to providing an alternate means of taking part in traditional therapies.
One example that highlights how VR can transcend previous therapeutic limitations involves an approach called virtual reality exposure therapy, or VRET.
Exposure therapy is a type of treatment that aims to help people overcome fears, phobias, and similar challenges via direct encounters with the objects of their negative emotions.
For example, exposure therapy for fear of spiders may begin by presenting a patient with photographs of spiders. It may progress to having a patient view (and possibly interact with) an actual spider. Throughout the experience, the patient will have the support and guidance of a trained professional
But if a person has a phobia related to heights – or if they have developed posttraumatic stress disorder (PTSD) as a result of military combat or another terrifying experience – it may be extremely difficult or downright impossible to safely expose the patient to the underlying source of their distress.
An October 2019 Frontiers in Psychiatry article acknowledged this while listing the following obstacles to effective exposure therapy:
- Patients’ fears about being exposed to the objects or circumstances that trigger their distress
- Therapists’ concerns that exposure may cause the patient undue psychological pain (and prompt them to discontinue therapy)
- Limited access to therapists who are properly trained in exposure therapy
- The time and expense of arranging effective in vivo (direct, real life) exposures
VRET can be a means of circumventing these obstacles and offering a lifelike exposure experience while ensuring that the patient remains in a safe and supportive environment.
Benefits of VRET
- VRET can provide gradual, controlled exposures.
- Patients may be more willing to participate in VRET than in in vivo exposure therapy.
- VRET allows the therapist to see exactly what the patient is seeing.
- VRET allows the therapist to customize the exposure according to the patient’s specific needs.
- VRET can give patients the confidence they need to progress to in vivo
- Research indicates that VRET can reduce symptoms of specific phobia and other anxiety disorders.
- The costs associated with VRET are declining as the technology advances.
The authors of the Frontiers in Psychiatry article also noted that virtual reality’s potential as a training tool means that it can provide an avenue for more therapists to become experienced with VRET.
Virtual Reality Exposure Therapy for PTSD
Posttraumatic stress disorder is not unique to the military. People of all ages, genders, and professions can and do struggle with PTSD. But the prevalence of PTSD within the military community is higher than among the general population.
This has prompted the U.S. military to play a leading role in the effort to explore more effective treatment options for people who are struggling with psychological distress in the aftermath of one or more traumatic experiences.
In recent years, this effort has involved investigating the benefits of VRET. The authors of a January 2022 article in the International Journal of Environmental Research and Public Health described the rationale for this work in the following terms:
“Virtual reality exposure therapy enables the emotional engagement of patients with combat-related PTSD during exposure to a virtual war environment, bypassing avoidance symptoms and facilitating control on the therapist’s part.”
“The sense of presence provided by an ecologically valid, highly interactive, and multisensory virtual environment facilitates the emotional processing of memories related to the traumatizing war-zone experiences,” the authors added.
The January 2022 article involved a systematic review of 11 papers, as well as a focus group, on the topic of VRET for military veterans who were struggling with PTSD. The researchers who conducted this review and focus group reported the following:
- VRET had a positive impact on a variety of PTSD symptoms, and the subjects who benefitted from this service maintained their treatment gains at three-, six-, and 12-month follow-ups.
- Virtual reality exposure therapy allows patients to explore their emotions and responses while decreasing the sense of actual threat that they feel.
- VRET provides a safe environment in which military veterans can learn how to solve problems and control some of the destructive behaviors that result from PTSD.
- Veterans who participate in a study group noted that realism and immersion are key facets of effective virtual reality exposure therapy. They specifically noted that the ability to replicate smells would be extremely valuable.
One potential limitation, the authors noted, is that virtual reality exposure therapy for combat veterans currently employs pre-programmed scenarios. The present inability to modify VR scenarios according to each veteran’s specific memories and experiences may diminish the effectiveness of VRET in some cases.
The Future of Virtual Reality Therapy
The future of VRET and other forms of virtual reality therapy for phobias and PTSD hinges on several factors, such as:
- Continued improvements in the technology, including the development of more immersive and customized virtual environments
- Decreasing costs of the software and hardware required for VR therapy
- Additional research to document the effectiveness of virtual reality therapy in the treatment of various mental health disorders
- The willingness of more professionals to become trained in VR therapy
At the moment, progress in all four of these areas suggests that the use of VR therapy will continue to expand and its applications within the mental health space will improve. While it is impossible to predict the future with any degree of certainty, at the moment it is difficult to envision a scenario in which virtual reality ceases to be a viable option for certain types of mental health treatment
Gianna Melendez
Jodie Dahl, CpHT