Virtual reality therapy in anxiety disorders

Abstract

During the last decade a number of studies have been conducted in order to examine if virtual reality exposure therapy can be an alternative form of therapy for the treatment of mental disorders and particularly for the treatment of anxiety disorders. Imaginal exposure therapy, which is one of the components of Cognitive Behavioral Therapy, cannot be easily applied to all patients and in cases like those virtual reality can be used as an alternative or a supportive psychotherapeutic technique. Most studies using virtual reality have focused on anxiety disorders, mainly in specific phobias, but some extend to other disorders such as eating disorders, drug dependence, pain control and palliative care and rehabilitation. Main characteristics of virtual reality therapy are: "interaction", "immersion", and "presence". High levels of "immersion" and "presence" are associated with increased response to exposure therapy in virtual environments, as well as better therapeutic outcomes and sustained therapeutic gains. Typical devices that are used in order patient's immersion to be achieved are the Head-Mounted Displays (HMD), which are only for individual use, and the computer automatic virtual environment (CAVE), which is a multiuser. Virtual reality therapy's disadvantages lie in the difficulties that arise due to the demanded specialized technology skills, devices' cost and side effects. Therapists' training is necessary in order for them to be able to manipulate the software and the hardware and to adjust it to each case's needs. Devices' cost is high but as technology continuously improves it constantly decreases. Immersion during virtual reality therapy can induce mild and temporary side effects such as nausea, dizziness or headache. Until today, however, experience shows that virtual reality offers several advantages. Patient's avoidance to be exposed in phobic stimuli is reduced via the use of virtual reality since the patient is exposed to them as many times as he wishes and under the supervision of the therapist. The technique takes place in the therapist's office which ensures confidentiality and privacy. The therapist is able to control unpredicted events that can occur during patient's exposure in real environments. Mainly the therapist can control the intensity of exposure and adapt it to the patient's needs. Virtual reality can be proven particularly useful in some specific psychological states. For instance, patients with post-traumatic stress disorder (PTSD) who prone to avoid the reminders of the traumatic events. Exposure in virtual reality can solve this problem providing to the patient a large number of stimuli that activate the senses causing the necessary physiological and psychological anxiety reactions, regardless of his willingness or ability to recall in his imagination the traumatic event.

Cyber Health Psychology: The use of new technologies at the service of psychological well being and health empowerment

“…The joystick/wired gloves are the tool through which the user has the ability to interact and modify the surrounding environment; Through the use of these devices it is detached from the position of mere passive observer becoming active component and responsible for the changes within the virtual space in which it is found catapulted (Villani et al ., 2011). The VRI configuration can also include instruments such as cybertute that provide the user with a feed-back in terms of touch, weight and strength (Mitrusia & Giotakos, 2016).…”

“…The purely experiential nature of this type of application makes it particularly useful in the psychological treatment of different problems. In recent years several studies have demonstrated the efficacy of VR in the psychotherapeutic field in the treatment of phobias (Mitrusia & Giotakos, 2016), social anxiety disorder (Anderson et al ., 2013), post-traumatic stress disorder (Botella et al ., 2015), panic disorder (Perez-Ara, 2010).…”

“…The relevance of this methodology is not questioned despite it use a reality imagined (with the limits that it entails), because at the center of the activity of analysis there is the experience and how this is lived also simply through an imagination. Among the limitations of this technique, however, is the fact that the patient may be unable to recreate the scenarios through the imagination due to the pathological avoidance of problematic memories, as often happens in post-traumatic stress disorder (PTSD) (Mitrusia & Giotakos, 2016). The use of VR in this case could exceed this limit, as it allows the patient a realistic three-dimensional visualization of the dreaded situation (Villani et al ., 2011).…”

“…The multitude of advantages and applications that the virtual reality brings out is accompanied however by difficulties and limits to which it still can not easily escape. Until a few years ago the cost of the instrumentation needed to put in place a functional therapeutic setting of virtual reality immersive (IVR) was absolutely out of reach by the economic availability of those who exercised the profession (Mitrusia & Giotakos, 2016). Fortunately, with the passing of time and the evolution of technology, the cost of these instruments decreased dramatically, becoming accessible from the past (Mitrusia & Giotakos, 2016).…”

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“…Distraction is a coping strategy based on the management of emotions and thoughts and it shifts the focus of attention from concentrating on unpleasant stimuli to pleasant and interesting stimuli, through a remodeling of the perceived environment. The exposure to VR provides the patient with a large number of sensory stimulations producing distracting effects (Mitrousia & Giotakos ). Studies show that the effectiveness of virtual environments is linked to the sense of presence reported by people who have used VR devices (Witmer & Sing ).…”