Research shows that Virtual Reality-based Graded Exposure Therapy (GET) techniques can improve PTSD symptoms and associated disorders, indicating wider potential applications of Virtual Reality in psychotherapy.

In the recent past, virtual reality has attracted much attention as a potential method for psychotherapy to treat patients with phobiasaddictionsanxiety disorders and posttraumatic stress disorder. Various techniques based on virtual reality—such as virtual reality immersion therapy (VRIT), and virtual reality graded exposure therapy (VR-GET)—have been experimented with and proven to be very effective.

Posttraumatic Stress Disorder and Exposure Therapy

Posttraumatic stress disorder (PTSD) may develop when a person goes through one or more traumatic events such as sexual assault, serious injury, narrowly escaping death, domestic violence or watching a fellow soldier die on the battlefield.

People with PTSD typically suffer from disturbing recurring flashbacks, hyperarousal, bad dreams, frightening thoughts, emotional numbness and strong feelings of depression, guilt and worry.

Exposure therapy, a Cognitive Behavior Therapy (CBT) technique, is the most widely employed tool to help victims manage PTSD symptoms. By helping patients to confront—rather than avoid—the memory of the traumatic event, exposure therapy techniques support the ability to overcome anxieties and fears.

Using other relaxation techniques, victims slowly gain control over responses to traumatic events and learn to cope in a much better way. Exposure therapy has been found to be very effective in treating PTSD, and has a high success rate in treating patients with specific phobias.

Virtual Reality Exposure Therapy

Virtual reality, with its advanced visual immersion devices, specially programmed computers, and three-dimensional artificially created virtual environments, takes exposure therapy to a whole new level—allowing the patient to confront a traumatic experience in a safe and controlled manner.

The most extensive research regarding the applications for VR-based therapy for treating posttraumatic stress disorder was funded by the Office of Naval Research, starting in 2005. This initiative was part of a program to develop new technologies to assist combat veterans of Iraq/Afghanistan in managing PTSD symptoms.

Using new software, hardware, simulations, physiologic monitoring, skills training and therapeutic methods based on Virtual Reality, scientists have experimented with exposing combat veterans to their traumatic experiences in a graded manner.

The advantage of this VR-based Graded Exposure Therapy (VR-GET) is that it helps patients who find it difficult to identify or talk about a traumatic event—which impacts the ability to learn the required skills to cope with a number of anxiety-inducing situations.

In this setting, the combat veteran relives the traumatic episode in a simulation that captures the essential elements of the event—all in a safe and controlled manner—while trying to recognize and manage any excessive autonomic arousal and cognitive reactivity.

The Effectiveness of VR-GET in Treating PTSD

In a randomized, controlled trial of VR-GET to treat combat PTSD, Robert McLay, research director for mental health with the US Naval Medical Center San Diego, Dr. Brenda K. Wiederhold, Executive Director of the Virtual Reality Medical Center and others have demonstrated that 70% of patients who received VR-GET showed improvement in their PTSD symptoms after 10 weeks of treatment.

The same study also proved that while patients who got the usual treatment—which consists of cognitive processing therapy, eye movement desensitization and reprocessing, prolonged exposure, group therapy and psychiatric medication management—demonstrated an improvement of 9 points in the severity of symptoms as measured by the Clinician Administered PTSD Scale (CAPS), those who received VR-GET demonstrated a 35-point improvement on the scale.

“We teach them how to control breathing, heart rate, respiration, sweat gland response, and teach them some processes to control automatic thoughts,” says Dr. Wiederhold. “It keeps them from becoming overwhelmed by the emotion. It starts to bring up a lot of memories but not in an overwhelming manner. If his heart rate goes too high, we offer to stop, to do breathing exercises, or to exit the virtual world.”

Currently VR-based therapy for PTSD is being offered at more than 60 Veteran Affairs hospitals, military bases and university centers in the United States.

Applications of VR Therapy beyond PTSD

Virtual reality therapy has been used to treat phobias very effectively. Trials at Kaiser Permanente treated acrophobia (fear of heights) with more than 90% effectiveness. Of the 40 patients who underwent the therapy, 38 reported marked reductions in phobic reactions to heights.

By exposing patients to heights in a virtual environment and gradually increasing the height in a controlled manner, VR therapy instills the confidence to face the same situation in real life.

Studies have also shown that VR therapy can be effective as adjunctive therapy in treating patients with chronic pain. By using virtual reality as a means of distraction, inducing positive emotions and creating the perception of ‘swapping’ a limb or affected body part in a virtual environment, the subjective perception of pain has been reduced and that of relief has been increased.

A similar approach of ‘virtual body swapping’ has been employed with patients suffering from Complex Regional Pain Syndrome (CDPS). While no reduction in pain intensity was reported, a marked improvement in body perception disturbance has been noted, suggesting future applications for VR in treating CDPS.

Virtual reality therapy has also been used successfully to induce positive emotions and improve the overall quality of life in patients suffering from fibromyalgia (perception of chronic widespread pain in the body and a heightened response to pressure without any obvious physiological causes).

In addition, a team of psychologists and computer scientists from University College London (UCL), the University of Barcelona and University of Derby have used virtual reality to reduce self-criticism, boost self-compassion and feelings of contentment in 43 healthy, but self-critical individuals.

Virtual reality therapy has also been found useful in treating stroke patients suffering from unilateral spatial neglect, a condition in which patients fail to process or perceive a side of the body or environment that is contralateral to their damaged brain lesions—even though their visual fields are normal.

As advances continue in VR technologies—as well as research that supports its effectiveness—we’re sure to see an expansion of this application as a therapeutic modality.

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