What is virtual reality as an alternative therapy?

Introduction

After World War II, computer scientists and engineers developed technology, such as flight simulators, that provided an early foundation for virtual reality through digitization, real-time graphics, and interactive and pointing devices. By the early 1980s, medical and computer science professionals collaborated to integrate their specialties. Some medical professionals incorporated virtual reality as a tool to learn and practice medical procedures, especially surgery, by manipulating virtual organs. Virtual reality underwent a transition from laboratories to hospitals. Physicians reported that virtual reality eased the pain that burn patients felt by distracting them and making them unaware of the real world through immersion in alternative environments such as snowy landscapes, which convinced patients that they felt coolness.

Another foundation for modern virtual reality was the computer program ELIZA. Created in 1966 by Joseph Weizenbaum, ELIZA was not strictly a virtual reality environment but an early form of computer-simulated psychotherapy. Although ELIZA was a grammar program that used only text, it seemed to engage the user in Rogerian therapy. By the early 1990s, virtual reality had expanded to creating both visual and auditory environments.

Virtual reality techniques were appropriated for psychological applications by the early 1990s to influence people’s perceptions and psychological processes. Computer hardware and software were developed to simulate specific situations for therapeutic sessions. This technology enabled phobic patients to interact safely with situations that arouse fear. Phobic patients often prefer virtual reality therapy because they can encounter their fears in private instead of in public situations. In 1998, CyberPsychology and Behavior: The Leading Psychology Journal for Internet, Multimedia, and Virtual Reality Research began providing a centralized forum to advance virtual reality as a therapeutic tool. Software improvements enabled the creation of more virtual environments to meet therapeutic demands. Although there was significant interest in virtual reality therapy early in the twenty-first century, by 2005 much of that enthusiasm had cooled, although there has been renewed interest in using virtual reality platforms such as Second Life, Multiverse, and Active Worlds to address psychological issues.

Therapies

Six types of virtual reality therapies have been tested. All rely on convincing people that they are experiencing an environment by making it realistic to their senses of sight, hearing, and touch. The desktop method involves interacting with images on a computer screen by using pointing devices. Projected virtual reality casts the patient’s image into an artificial setting. Cave virtual reality displays images on the walls of a small room, allowing several people to participate in therapy simultaneously. Telepresence delivers a setting from another place on a video screen that the patient observes. Augmented virtual reality uses objects that enhance the setting for specific therapies. Immersive virtual reality is used most frequently and includes aspects of other virtual reality types. In contrast to two-dimensional computer images, virtual reality creates a three-dimensional environment composed of computer graphics. People believe they are immersed in and participating in the simulation. This illusion is enabled by devices that participants wear that aid them to interact with and manipulate the virtual setting. A head-mounted visor has a stereoscopic optical display. The scenery is adjusted by motion-tracking sensors attached to people’s heads and limbs, and the experience seems more realistic because graphics respond convincingly to movement. Additional sensors in datagloves improve the illusion by suggesting that the participant is interacting with items located in the virtual world and navigating through the setting.

Treatment

Many psychologists have been skeptical as to whether virtual reality can be advantageous for therapeutic use. Many professionals consider the expense associated with equipment and operation of some types of virtual reality therapy to be prohibitive. In addition, they consider virtual reality at worst to be an irrelevant technology more suitable for entertainment than therapy and at best to be an experimental therapy requiring additional research. Gradually, the benefits of virtual reality have secured the approval of some mental health practitioners, many of whom admit to being surprised at patients’ successful improvement due to virtual reality exposure (VRE) therapy. Virtual reality therapy has been used to address a variety of potential psychological problems and other difficulties, including phobias, post-traumatic stress disorder, autistic spectrum disorders, and addictive behaviors. It has been used in the area of cognitive assessment and for self-improvement in the area of weight management.

Phobias

Virtual reality’s most frequent psychological application is treatment for phobias. VRE therapy parallels traditional therapy in which a patient’s exposure to a situation or object stimulus that arouses acute fear and anxiety is gradually increased. Such exposure is either in vivo (actually experienced by the patient) or in vitro (imagined by the patient). The degree of exposure is deliberately increased over time. Individuals become conditioned and desensitized, learn not to panic, and develop more receptive attitudes.

Virtual reality creates a safe, private environment in which patients can confront their fears without being publicly embarrassed or risking physical harm. Compared with most real settings and props, such as airplanes and animals, that are necessary for conventional phobia therapy, virtual reality is inexpensive and more controllable. Multiple stimuli can be presented. Specific stimuli can be isolated, and distractions can be eliminated. Virtual reality also allows therapists to develop settings not easily located in their communities.

Patients can face frightening situations and objects virtually that they could not initially handle in person. These virtual depictions of dangerous settings are more realistic than most patients would imagine. Virtual reality enables people to overcome the limitations of their imagination and memory. Active interaction with anxiety-arousing stimuli causes patients to feel more in control, confident, and capable than undergoing more passive observational and listening therapies. Virtual reality allows people in remote places to experience settings and fears that are not available to them in their immediate surroundings.

Virtual reality has proven effective in countering acrophobia (fear of heights), claustrophobia (fear of enclosed spaces), agoraphobia (fear of open spaces), arachnophobia (fear of spiders), and aerophobia (fear of flying). Patients with social phobias such as fear of public speaking can practice skills with virtual reality to interact more comfortably with people. Research teams are also considering the possibilities of patients and therapists being immersed in virtual reality settings together.

Post-Traumatic Stress Disorder

Chronic post-traumatic stress disorder (PTSD) has been addressed through the use of virtual reality. At the Georgia Institute of Technology’s College of Computing, a group of Vietnam veterans with PTSD were treated using virtual reality therapy. During virtual reality sessions, therapists encouraged veterans to narrate their military experiences. The veterans were asked to repeat their stories many times to bolster their memories. Although many veterans were reticent to share their stories in traditional therapy, virtual reality freed them to become more talkative and physical as they interacted with virtual comrades and enemies in a setting that included combat sounds.

Such experiences helped the veterans deal with guilt about such things as being the sole survivor of an attack. Although their PTSD was not eliminated, many veterans experienced a lessening of problems after they revisited their memories via virtual reality. Veterans’ hospitals have incorporated virtual reality equipment into therapy treating chronic anxiety disorders.

The Weill Cornell Medical Center in New York City has used virtual reality to address a variety of PTSD situations, including among veterans of the Persian Gulf and Iraq wars. Virtual reality therapy has also helped survivors of the terrorist attacks on the World Trade Towers on September 11, 2001. The treatment includes virtual exposure to the towers before, during, and after their collapse for individuals who experienced the attacks from within the towers and from afar. All treatment is under the guidance of a therapist who makes sure the patient does not become overwhelmed by the experience.

Autistic Spectrum Disorders

Through virtual reality worlds such as Second Life, individuals can seek out others for social interaction. In Second Life, users create an avatar that is a representative of themselves and use that avatar to interact with the virtual environment and other avatars in that virtual environment. Self-help groups are not uncommon in Second Life. Through virtual reality, individuals with autistic spectrum disorders can reach out to others with similar concerns and problems. Geographically diverse individuals can interact and help each other. For example, a young man with Asperger syndrome established Naughty Auties, a resource center for individuals with autistic spectrum disorders, in Second Life. However, seeking help in the unregulated environment of virtual reality carries significant risk in that the avatars’ real identities are unknown, as is the veracity of their statements. Despite this drawback, virtual reality, which does not have the same pressures as real-life social interactions, seems to provide an optimum place for individuals to practice social interactions in a variety of virtual settings without the risk of failing in the real world. Research is just beginning in this area, but some results have been promising.

Addictive Behaviors and Self-Improvement

Virtual reality has been used to deal with addictive behaviors such as smoking. In virtual reality environments, patients can practice coping skills when confronted with virtual simulations of situations and stimuli that trigger their addictive behaviors. The virtual environment seems to provide the right balance of believability of stimuli without the risk of real-life failure. Virtual reality also has been used therapeutically for patients’ self-improvement.

Eating disorders have been successfully treated with virtual reality methods that often supplement traditional forms of therapy. The virtual-reality-based experiential cognitive treatment of obesity and binge-eating disorders assists people to modify their flawed body perceptions. Improved body awareness obtained through an integration of virtual environments and traditional cognitive behavioral and visual-motor therapies results in awareness of latent feelings, decreased problematic eating, and displays of more normal social behavior.

Research has also confirmed that virtual reality can be used to make exercising more enjoyable. Similar to watching television or listening to music while exercising, virtual reality can provide a distraction. Instead of biking in the gym, virtual reality can allow the individual to bike through the English countryside or on the course for the Tour de France.

Measurement, Neuroscience, and Education

Virtual reality environments allow patients who are unable to function in normal settings to respond to stimuli presented in real time. Neuroscientists can then gauge individuals’ cognitive abilities. Virtual reality has proven effective in rehabilitating some individuals who are cognitively impaired because of brain injuries or diseases such as Alzheimer’s. Patients are tested with virtual reality scenarios that researchers can control and adjust as needed to assess how well individuals function.

Virtual settings offer people with neurological impairments the opportunity to interact with an environment to which they would otherwise lack physical access to enrich their sensory and motor skills. Virtual reality classrooms have been designed to evaluate and measure the cognitive abilities of children who possibly have attention-deficit hyperactivity disorder (ADHD). Most cognitive researchers consider virtual reality tests less biased than traditional tools and do not consider its lack of realism, comparable to that of a photograph, problematic. Virtual reality has proven beneficial in working with children with a variety of reading disabilities and delays. School districts have used virtual reality games that engage students with a story line to increase reading scores. Virtual reality has also been used to successfully teach other subjects.

Side Effects and Risks

Virtual reality is limited by its costs, complexity, technology, and reliability, as well as the technical proficiency of users. Time delays, noise, and distortions (particularly in body image sessions) can impede therapy, although technological advances will continue to address these issues. To improve techniques, virtual reality researchers have begun investigating human-computer interaction with clinical tests. They are interested in how people perceive and accept or reject computer-generated worlds as a mental health treatment method. Researchers evaluate whether virtual reality therapy is more time- and cost-effective than traditional techniques.

Some patients may experience simulation sickness, which is a form of motion sickness, and nausea. Careful design of virtual scenarios and screening of patients can minimize such adverse reactions. Some people’s neck muscles are too weak to support heavy virtual reality helmets, and many claustrophobic patients are reluctant to wear the bulky helmets. Some users experience depth perception problems. Sometimes virtual reality confuses patients, and virtual experiences replace real experiences in memories. Migraines and seizures are also a possibility. Despite these risks, many patients, however, seem receptive to virtual reality techniques.

Although virtual reality does present many opportunities for treatment and growth, the unregulated environment of many virtual reality worlds, such as Second Life, Multiverse, and Active Worlds, presents many opportunities for the development and expression of pathologies. This particular negative aspect of virtual reality has received little research attention, although warnings abound. In virtual reality, just as in the online environment in general, where the usual social constraints on behavior are often lacking, individuals can behave in very pathological ways, and far from practicing positive social interactions, individuals may find themselves engaging in relationships that mirror the negative patterns they follow in real life or that exhibit an even higher degree of pathology. Behaviors such as stalking, emotional abuse, and manipulation are all possible. Vulnerable and needy individuals may lose sight of where reality ends and virtual reality begins. Their online relationships and interactions can become more real to them than their real-life relationships and interactions.

In the virtual environment, people engage in all sorts of behavior that they would not otherwise engage in. They have virtual sex with strangers and sell their virtual bodies. In a recent divorce case in England, the husband was engaging in virtual sex with prostitutes in Second Life. His wife cited his online behavior as a cause for divorce. The virtual world also offers a multitude of opportunities to find others who share a person’s pathologies and thereby can confirm these negative beliefs and reinforce them.

Bibliography

Baumann, Stephen, and Michael A. Sayette. “Smoking Cues in a Virtual World Provoke Craving in Cigarette Smokers.” Psychology of Addictive Behaviors 20.4 (2006): 484–489. Print.

McLay, Robert N. At War with PTSD: Battling Post-Traumatic Stress Disorder with Virtual Reality. Baltimore: Johns Hopkins UP, 2012. Print.

Mühlberger, Andreas, Heinrich H. Bülthoff, Georg Wiedemann, and Paul Pauli. “Virtual Reality for the Psychophysiological Assessment of Phobic Fear: Responses During Virtual Tunnel Driving.” Psychological Assessment 19.3 (2007): 340–346. Print.

North, Max M., Sarah M. North, and Joseph R. Coble. Virtual Reality Therapy: An Innovative Paradigm. Colorado Springs: IPI, 1996. Print.

Riener, Robert, and Mattias Harders. Virtual Reality in Medicine. London: Springer, 2012. Digital file.

Riva, Giuseppe, Brenda K. Wiederhold, and Enrico Molinari, eds. Virtual Environments in Clinical Psychology and Neuroscience: Methods and Techniques in Advanced Patient-Therapist Interaction. Amsterdam: IOS, 1998. Print.

Rothbaum, Barbara O., and Larry F. Hodges. Virtually Better: Therapist Manual for Fear of Flying. Atlanta: Virtually Better, 1997. Print.

Villani, D., F. Riva, and G. Riva. “New Technologies for Relaxation: The Role of Presence.” International Journal of Stress Management 14.3 (2007): 260–274. Print.

Wiederhold, B. K., and G. Riva. Annual Review of Cybertherapy and Telemedicine 2012: Advanced Technologies in the Behavioral, Social and Neurosciences. Amsterdam: IOS, 2012. Digital file.