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). The person using the VR equipment is able to look around, move around, and interact with the virtual features or items within the artificial world. These features are programmed to be therapeutic interventions, helping the patient create safe and more realistic scenarios to work with underlying challenges. 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 simulations, but also to manipulate variables in order to support the patient’s needs. VR provides the option of evaluating and supporting 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 to personalize treatment 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 concern.
Main Advantages of VR Therapy
VR is a non-invasive and safe technique based on the projection of interactive 3D graphics through a 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, we can personalize interventions in accordance with the patient’s needs. For example, in the case of fear of flying, we can land before taking off, and repeat the process as many times as necessary.
As Gutierrez (2002) points out, there are a series of advantages, which we 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 us to carry out treatments in difficult-to-access stimulation configurations (e.g., take-offs, storms), and to solve more easily problems associated with the patient’s imagination difficulties.
4. It provides greater control of stimuli and conditions. The therapist can decide whether it is day or night, rainy or sunny, etc. In this way, we can better adjust the therapeutic process to the patient’s needs.
5. It allows us to create situations that go beyond what can be found in reality itself. For example, we can recreate 10 consecutive take-offs, or going up on an evaluator, 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. They 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 determine clinical relevance.
8. It makes it possible to design exposures in a personalized, step by step format.
9. It is very safe. The 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, when desired.
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 encourage rest, and they may modify your treatment plan.
3D motion sickness is a problem that can occur depending on the person. For example, 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 tendencies, we will offer strategies to support you.
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. If you have epilepsy, you may not be able to use this tool. Please be sure your therapist knows of any seizure history. To minimize these risks, our system has controlled the use of scintillating lights in virtual experiences. 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. 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 we may be able to adapt the helmet 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 your body (for example, back of the leg) may be appropriate. 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 is 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."