Virtual Reality Exposure Therapy for Phobias

Phobias are one of the most common mental disorders in India. The specific phobias can include fear of things or situations such as heights, enclosed, spaces, and social situations. This affects almost 4.2% of people in India. This may seem small, but it still represents millions of people across the country who suffer from debilitating and crippling fears.

Phobias are classified under anxiety disorders and they are characterised as intense irrational fears of specific objects or situations. Some people have a crippling fear of particular objects, such as animals, enclosed, spaces, heights etc. Certain people intensely fear social situations. People who have the fear of the social situation (social phobia) are fearful that they might be judged or subjected to other people’s scrutiny when they are in public. Hence, they often avoid speaking in public, interacting with other people in public or performing certain activities in public such as eating.

There is another class of phobia called agoraphobia, in which individuals fear being in crowded areas or open spaces where they think that an escape might be very difficult. People with agoraphobia very rarely get out of their houses, even when they do they are usually accompanied by somebody. Specific Phobias are one of the most common disorders worldwide. They are also one of the most intense disorders as they significantly impair the individual’s daily functioning in most of the areas of their life.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), Phobias need to typically last for about six months to give a diagnosis of specific phobia. Phobias have a very debilitating impact on the individuals, personal occupational and psychological functioning. Individuals with phobias often go to great lengths in order to avoid the thing or the situation that they fear. A person with claustrophobia (phobia of enclosed spaces), might reject a job because the job requires them to use an elevator to get to their office.

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This can significantly impact their professional as well as their personal life. Apart from the psychological impact, there are also various physical manifestations of phobia. People with phobia tend to experience physical symptoms such as rapid heart rate, shortness of breath, dizziness, and sometimes even fainting. Individuals who are diagnosed with phobias tend to get into a vicious cycle of avoiding the fear object or situation, and that avoidance reinforces the anxiety and thus prevents them from living a fulfilling life.

Why do People Develop Phobias

There are various reasons why a particular person might develop a phobia. One of the reasons for this is experiencing traumatic events in their life. For example, a person who was bitten by a dog when they were young might develop a long-lasting fear of dogs. In this situation, the person has learnt to associate dogs with a fearful response. At times, a person might develop a fear of a situation or of an object, just by observing somebody being fearful of that same object or situation. For example, if a child observes their parents being fearful of the spider, they also might develop a similar phobia.

The evolutionary approach is a fascinating way to explain why humans develop. According to this perspective, phobias are seen as adaptive responses which helped our ancestors to survive. For example, the fear of snakes or spiders or heights might have protected our ancestors from dangerous situations in the past, hence they were able to pass down their genetic material to us. Hence, fear of certain situations might be very useful and adaptive for us. Even though in the modern environment these threats are no longer relevant, still such fears tend to persist. Understanding why some people develop phobia is still a quite complex and multifaceted concept. However, understanding this is very essential as it helps to develop more effective therapeutic methods.

Therapies for Phobia

The most common approaches which are used to treat phobias are Cognitive Behaviour Therapy (CBT), Exposure Therapy and Medication. In cognitive behaviour therapy, the therapist challenges the negative thought patterns and behaviours of the client which are associated with phobia. CBT may also incorporate relaxation techniques like deep breathing or progressive muscle relaxation. It also includes creating a hierarchy of phobia which includes placing the object or situation the person fears the most on the top and the object or the situation the person feels less on the bottom. Together, the therapist and the client worked towards dissolving the phobias by approaching this hierarchy.

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Often time medicines are also used to treat phobias. They are commonly used in association with therapy. Medicine such as certain antidepressants, like selective serotonin retake inhibitors (SSRIs) and benzodiazepines are used. One of the most common and well-established therapies that is used for phobias is exposure therapy. Exposure therapy works by gradually exposing the individual to the object or situation that they fear. This therapy is based on the principles of Classic conditioning which suggest that learned responses can also be unearned over time.

Although exposure therapy has proven to be very effective. It has certain limitations. One of the major challenges is that it does not always have access to the real-life, exposure of certain objects or situations, For example, it is quite difficult to simulate situations such as flying, heights or dangerous animals in a controlled manner. Additionally, there are certain ethical concerns as well, as exposing individuals to these situations can negatively impact the individual. Hence, striking a balance between providing real-life exposure as well as shielding the individual from that distressing situation can be very challenging.

Virtual Reality Exposure Therapy

Virtual Reality Exposure Therapy is one of the forms of exposure therapy. It uses virtual reality technology in order to simulate the fear object or situation in a very controlled and immersive manner. This allows the client to engage in their fears more realistically while keeping the environment controlled and safe. This technique is also particularly effective for phobia related to heights, flying, public speaking, etc, as it is very difficult to simulate these experiences and objects, while still ensuring the safety of the client.

Virtual Reality Exposure Therapy utilises VR headsets, computers and 3D software in order to simulate with 3-D environment of various objects and situations. Unlike the simple image or a static visual exposure, these 3D environments in the VR headsets are interactive in nature. Meaning that the client can move within the virtual space and the virtual space also responds to the actions of the patient. The 3-D environment can be built to simulate a wide range of objects or situations which are related to phobia.

Such as VR sets can include simulated environments for planes for the fear of flying or heights, spiders for the fear of spiders and simulated environments for public speaking for social phobia. One of the biggest advantages of Virtual Reality Exposure Therapy is the level of control that a therapist has over the environment. The therapist can change or control the extent and intensity of the exposure and also gradually increase or decrease its difficulty. This also increases the adherence of the client to the treatment as it makes it less intimidating to approach it. It is one of the most highly flexible and practical tools in modern psychotherapy for the treatment of phobias.

Advantages

While Virtual Reality Exposure Therapy is highly effective and feasible. It is necessary to assess the benefits with the drawbacks.

• One of the major advantages of Virtual Reality Exposure Therapy is the level of control it provides the therapist. The therapist can control the environment entirely, they can adjust the difficulty and the intensity of the VR environment. This ensures that the patient is comfortable and can manage their anxiety
• This therapeutic method also provides us the exposure to highly realistic simulations. This real-life-like environment allows individuals to experience certain places and phobic situations where it is quite impossible or difficult to be. For example, for a person who has a fear of flying, it might be very difficult to them to get on and off an aeroplane as the part of their therapy. It is a much easier and more feasible alternative.
• It also increases adherence to the therapeutic method as it makes it very less intimidating for people. In the case of social phobia, it is much easier for someone to agree to try working through their fears just by sitting in an office rather than actually forcing themselves to physically put themselves in that position.
• It also maintains confidentiality and anonymity for the client as they don’t have to run into other people when they are trying to work through their fears. Moreover, it can also reduce the stigma around phobias by ensuring confidentiality.
• Virtual reality, exposure therapy allows the client to engage with the environment multiple times which allows for repeated exposure to their fears in a very short period of time. This allows for a more efficient desensitising process.
• It is also considered as more cost-effective as it often requires fewer therapy sessions, than other therapeutic methods.
• Most of the time, the VR headset can also record or monitor heart rate or other physiological symptoms related to anxiety. This allows for more objective and measured data for tracking the progress.

Challenges

Despite its plus points, Virtual Reality Exposure Therapy does come with its shortcomings and challenges.

• Virtual Reality Exposure Therapy can be quite expensive. The cost of the VR set and developing the specialised software can be very high. Hence, not all clients or clinics may have access to the technology.
• At times, clients, also experience motion sickness, discomfort or disorientation from using the VR equipments. The feeling of nausea, dizziness or discomfort during the sessions can hinder their progress and also limit the number of clients who opt for this treatment.
• This technology is tailored to a specific population. Certain demographics such as older adults or individuals with cognitive impairment may struggle with using this technology. It might be difficult for them to engage with the virtual environment and adapt to the immersive experience

Conclusion

In essence, Virtual Reality Exposure Therapy is one of the highly effective treatments for phobias. It allows the client to expose themselves to a very real life-like simulation for the fear object and situation. Its highly responsive and interactive nature adds to its efficiency. It allows for a highly controlled environment, thus protecting the client from any significant distress while still allowing for the desensitising process. However, there are certain limitations to Virtual Reality Exposure Therapy as well. It can be a tad expensive because of the VR set and equipment. It often does not cater to older individuals or individuals with cognitive impairments as it can be difficult for them to engage in this method thus making it ineffective. Recent advances in the technology as well as the theoretical basis will allow space for improving these limitations.