Virtual reality (VR) is a simulated experience aimed to be similar to the real world. We use VR goggles that provide an immersive visual and auditory experience (sense of presence) where the person using the virtual reality equipment is able to look around the artificial world, move around in it, and interact with virtual features or items. These features are programmed to be therapeutic interventions and help the patient create safe and more realistic scenarios to work with. This effect is commonly created by a VR headset that consists of a head-mounted display with a small screen in front of the eyes and earphones that deliver high quality sound cues.
In psychotherapy, virtual environments allow us not only to reproduce relevant stimulation configurations, but also the possibility of manipulating certain variables in order to control and adapt the intervention to the patient’s characteristics. Virtual reality provides the option of evaluating and intervening with a patient “within” a specific situation (for example, in the subway) without the need to leave the office; it allows us to repeat certain conditions (for example, a takeoff) as many times as necessary to work on a therapeutic goal (habituation, reciprocal inhibition of an anxious response, relaxation, etc.), and it helps us plan a personalized treatment strategy where we can tailor the configuration of variables and the moments at which certain events are started, stopped or repeated as needed.
What is VR Therapy?
VR therapy is the use of a virtual reality device for psychological therapy. In this modality, patients use a VR device to experience and complete tasks through a digitally created environment tailored to treat their specific ailment.
Main Advantages of VR Therapy
VR is a non-invasive and safe technique based on the projection of interactive 3D graphics through an VR device (goggles and headphones). The placement of the head device isolates the external stimuli, transporting the user to an environment that is different from the one they are in that moment.
It is in this “virtual” environment, designed for the patient, where the most adequate therapeutic procedure is applied.
As in many other areas, new technologies give us the possibility to facilitate certain processes. In the case of VR therapy, they allow us to control the therapeutic process, that is, we can personalize the interventions in accordance with the patient’s needs. For example, in the case of fear of flying, they allow you to land before taking off, and you can also do it as many times as necessary.
As Gutierrez (2002) points out, there are a series of advantages, which we could call Virtual
Reality’s Decalogue of advantages, from which we and our patients can benefit:
1. It offers a greater degree of privacy in comparison with live exposure.
2. The cost is also lower, as it is not necessary, for example, for therapists to change locations or to hire co-therapists.
3. It allows carrying out treatments in difficult-to-access stimulation configurations (take-offs, storms...), and to solve more easily problems associated with the patient’s imagination difficulties.
4. It provides greater control on stimuli and stimulatory conditions. The therapist can decide whether it is day or night, rainy or sunny... In this way, you can better adjust the therapeutic process to the patient’s needs.
5. It allows creating situations that go beyond what can be found in reality itself. For example, to recreate 10 consecutive take-offs or going up on a lift without stopping at any floor for 5 minutes.
6. It facilitates self-training and over-learning, as the patient does not have to wait for the events to take place in real life, but can produce and reproduce them whenever they wish.
7. It allows the therapist to control and observe what the patient is seeing, which allows them to detect more easily the stimuli of greater clinical relevance.
8. It makes it possible to design exhibition hierarchies in a personalized way, graduating each one of the steps to follow in a very detailed way.
9. It is very safe: therapist and patient control what is happening at all times.
10. It is an activity in which the patient adopts an active and participative role (Bruner, Vygotsky, Piaget). In this way, the patient can promote re-learning and behavior modification.
Could I do this at home?
Maybe, some of the routines we have are available through iPhone or Android apps. We may be able to add your device to our treatment panel. However, we have a much more controlled environment at the office, and also obtain additional measurements that are unavailable at home.
What kind of exposures and training could I do with VR therapy?
At this time, we have environments in which you can work exposure, systematic desensitization, diaphragmatic breathing, muscle relaxation, visualization/imagery and mindfulness techniques. Specific environments available could help with: fear of heights (acrophobia), claustrophobia, fear of flying, fear of driving, fear of the dark, fear of animals, agoraphobia, social anxiety, public speaking, test anxiety, medical procedures, generalized anxiety, neurodevelopment, bullying, depression, OCD, stress and trauma, somatic discomfort and pain, eating disorders, sleep-wake disorders, addictions and sport performance.
Does it have any side effects?
The most common possible side effects associated with the use of Virtual Reality or 3D videos are slight dizziness, blurred vision, eye strain, headaches, or other visual effects. This is what you may have already experienced if you have watched a 3D movie in a theater. If you experience any of these symptoms, let your therapist know and they may stop the use of the equipment and rest. They will consider scheduling shorter VR or AR exercises.
3D motion sickness is a problem that can occur depending on the person’s characteristics: there
are people who get dizzier than others when they watch a 3D movie at the theater. You can anticipate whether you’ll get dizzy, more or less, by evaluating whether you usually suffer from motion sickness in cars, boats or airplanes. If you are a person with these characteristics, we recommend some strategies:
a. Initially, shorter VR exercises, 10-15 min, with rest periods between them. We can use this to evaluate your sense of presence, cognitions, talk about the process of habituation.
b. Do not make sudden head movements. In most environments, we have eliminated or controlled this with the introduction of visual effects, turns and using “interaction targets,” so that you only move when facing the front.
c. Follow what you are seeing in the VR with body movements. For example, if the VR is moving and you are is sitting, we would let you stand, always touching a chair or a table with the back of your legs, and follow the movement by walking in place.
Are there any risks in the use of VR therapy?
A low percentage of people (approximately 0.025%) may experience seizures, nausea, or disorientation when using VR. It should be noted that seizures caused by flashing lights are more common in some epileptic patients, so they may not be able to use this tool or, if you do, make sure your therapist knows and you should be aware of the risk involved. To minimize these risks, our system has controlled the use of scintillating lights in virtual experiences. Again, if you experience any of these symptoms, notify your therapist.
The goggles do not fit well.
It is important to adjust all the fastening straps, unfastening the Velcro, tightening the strap around the head, and refastening it. Try not to tighten the straps too much, as it may become uncomfortable during long sessions. It is also important to center the goggles at the average height of the eyes for a correct visualization.
What if I usually wear glasses? Could glasses be worn under the helmet?
If the glasses have a small correction (few diopters), it will be better to take off the glasses before using the helmet, as they may not fit properly in the cavity and may cause discomfort. To adjust the image to the needs of each person, the little wheel on the top of the helmet must be rotated until the image can be clearly seen. If the glasses have a large correction (many diopters), glasses could be kept on, as many virtual reality devices already allow it, adapting to the size of the glasses. Contact lenses should not cause any difficulties.
Can I stand or walk while wearing the device?
The environments are designed to be experienced while sitting or standing. If indicated by your therapist or if it’s your preference, standing, without moving and always touching a physical reference with part of the body (for example, back of the leg) may be apropriate. It is important that you do not move while wearing the helmet to avoid accidents.
What level of improvement should I expect with VR treatment?
Multiple clinical trials suggest VR therapy results are comparable to face-to-face therapy. In one study of patients diagnosed with fear of heights, VR therapy reduced patients’ fears by an average of nearly 70%. VR therapy has an extraordinary ability to create powerful simulations of the scenarios in which psychological difficulties occur. With VR-enabled therapy, there’s no need for a therapist to accompany a client on a trip to a crowded shopping center or up to a tall building. Results are also better than those expected with the best psychological intervention delivered face to face with a therapist. According to Daniel Freeman, professor of clinical psychology at Oxford University: “VR isn’t just capable of helping us with what seem like more straightforward phobias and anxiety-disorders. It can also help with depression, schizophrenia, paranoia."