In the future, therapy patients may spend less time sitting in a therapist’s office and more time exploring virtual worlds.
Researchers have created a new virtual reality (VR) app to treat the fear of heights. The app just had a clinical trial. And the treatment seemed to work. Participants reported being much less afraid after using the program for just two weeks.
People have developed other VR therapies in the past. These programs needed a real-life therapist to guide patients through the treatment. But the new system only uses an animated avatar within the app. The avatar coaches patients as they climb a virtual high-rise. This kind of therapist-free counseling could make it much easier for people to get help for fears and other disorders. The researchers described their results online July 11 in the Lancet Psychiatry.
This is “a huge step forward” for VR therapy, says Jennifer Hames. She’s a clinical psychologist at the University of Notre Dame in Indiana who wasn’t involved in the work. With this system, people don’t need to visit a therapist’s office to get expert help. They could get help in their regular doctor’s office, or even at home. That could be good for people who aren’t comfortable with face-to-face therapy, or who can’t afford it, she says.
People use the app with a VR headset, handheld controllers and headphones. In the virtual world, an animated character guides the user through a 10-story building. The upper floors overlook a ground-level atrium. On every floor, the user performs tasks to test their fear responses. The tasks also help them learn that they’re safer than they might think.
These activities start out relatively easy, such as standing near a dropoff where a safety barrier gradually lowers. Then the challenges get harder, such as riding a moving platform out into the open space over the atrium.
By working through these activities, “the person builds up memories that being around heights is safe,” says Daniel Freeman. This counteracts their fears, he says. Freeman is a clinical psychologist at the University of Oxford in England.
On the edge
To test their app, Freeman and colleagues recruited 100 adult volunteers. All the volunteers were moderately to severely afraid of heights. The researchers randomly assigned 49 people to have VR treatment. That meant using the program for about six 30-minute sessions over two weeks. The other 51 participants got no treatment.
Before the experiment began, participants filled out a questionnaire that rated their fear of heights from 16 to 80. A score of 80 was the most severe. They filled out the same questionnaire right after the treatment. Then they did it again two weeks later.
The scores of patients who got no treatment stayed the same. But people who used the VR app dropped an average of about 25 points on the scale. Also, after using the app, participants “could go to places that they wouldn’t have imagined possible,” Freeman says. Those places included steep mountains, rope bridges or simply escalators in shopping malls.
“When I’ve always got anxious about an edge, I could feel the adrenaline in my legs, that fight/flight thing; that’s not happening as much now,” one participant said. “I’m still getting a bit of a reaction to it, both in VR and outside as well, but it’s much more brief, and I can then feel my thighs soften up as I’m not bracing up against that edge.”
The results give strong evidence that the new VR program is more helpful than no treatment at all. But researchers still need to study how VR therapy compares to sessions with a therapist, Hames says. And Freeman’s team only studied participants for a couple of weeks after their treatment. So they know don’t how long the effects of this therapy last. (Previous research on VR treatment led by a therapist has found that improvements lasted for at least a year.)
Fully automated VR therapy may be good news for people who fear heights. But it’s not clear how well this type of system could work for more complex mental health issues, says Mark Hayward. He’s a clinical psychologist at the University of Sussex in England. Hayward wrote a commentary on the study that appears in the same issue of the Lancet Psychiatry.
Virtual reality may be good for helping people who fear everyday situations, Hayward says. That includes people who have common phobias, social anxiety or paranoia. But when it comes to helping people with more severe symptoms, VR probably won’t replace trained therapists any time soon.
“We can’t get carried away and say we can automate all [mental health] treatment,” says Albert Rizzo. He develops virtual reality therapies at the University of Southern California in Playa Vista. Rizzo wasn’t involved in the new work. But he says the new therapist-free system for helping fear of heights is “an excellent first effort.”
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adrenaline A hormone produced by glands (adrenal) when someone is stressed by fear, anger or anxiety. It can make the heart beat faster and allow muscles to perform better than normal. Adrenaline is part of the body’s “fight or flight” response to stress. It can briefly help someone run faster or temporarily boost the performance of muscles (as for lifting weights).
anxiety A nervous reaction to events causing excessive uneasiness and apprehension. People with anxiety may even develop panic attacks.
app Short for application, or a computer program designed for a specific task.
avatar (in virtual reality) An electronic rendering of some image. It becomes the virtual form of some character (even a computer or game user) that will be moved and manipulated by a computer user. It can interact with its environment and other characters.
average (in science) A term for the arithmetic mean, which is the sum of a group of numbers that is then divided by the size of the group.
clinical (in medicine) A term that refers to diagnoses, treatments or experiments involving people.
clinical trial A research trial that involves people.
colleague Someone who works with another; a co-worker or team member.
commentary (in science) An opinion piece, often written to accompany — and add perspective to — a paper by others, which describes new research findings.
disorder (in medicine) A condition where the body does not work appropriately, leading to what might be viewed as an illness. This term can sometimes be used interchangeably with disease.
mental health A term for someone’s emotional, psychological and social well-being. It refers to how people behave on their own and how they interact with others. It includes how people make choices, handle stress and manage fear or anxiety. Poor mental health can be triggered by disease or merely reflect a short-term response to life’s challenges. It can occur in people of any age, from babies to the elderly.
online (n.) On the internet. (adj.) A term for what can be found or accessed on the internet.
paranoia The feeling of persecution — that people are out to “get” you — or that other people cannot be trusted. It can cause the affected person to feel intense anger, hatred or a sense of betrayal.
phobia An extreme or irrational fear of or aversion to something.
psychiatry (adj. psychiatric) A field of medicine where doctors study and treat diseases of the human mind. Treatments may consist of talking therapies, prescription drugs or both. People who work in this field are known as psychiatrists.
psychologist A scientist or mental-health professional who studies the human mind, especially in relation to actions and behaviors.
questionnaire A list of identical questions administered to a group of people to collect related information on each of them. The questions may be delivered by voice, online or in writing. Questionnaires may elicit opinions, health information (like sleep times, weight or items in the last day’s meals), descriptions of daily habits (how much exercise you get or how much TV do you watch) and demographic data (such as age, ethnic background, income and political affiliation).
social (adj.) Relating to gatherings of people; a term for animals (or people) that prefer to exist in groups. (noun) A gathering of people, for instance those who belong to a club or other organization, for the purpose of enjoying each other’s company.
social anxiety Feelings of apprehension caused by social situations. People with this disorder may be so worried about interacting with others that they withdraw from social events altogether.
symptom A physical or mental indicator generally regarded to be characteristic of a disease. Sometimes a single symptom — especially a general one, such as fever or pain — can be a sign of any of many different types of injury or disease.
therapy (adj. therapeutic) Treatment intended to relieve or heal a disorder.
virtual Being almost like something. An object or concept that is virtually real would be almost true or real — but not quite. The term often is used to refer to something that has been modeled — by or accomplished by — a computer using numbers, not by using real-world parts. So a virtual motor would be one that could be seen on a computer screen and tested by computer programming (but it wouldn’t be a three-dimensional device made from metal).
virtual reality A three-dimensional simulation of the real world that seems very realistic and allows people to interact with it. To do so, people usually wear a special helmet or glasses with sensors.
Journal: D. Freeman et al. Automated psychological therapy using immersive virtual reality for treatment of fear of heights: a single-blind, parallel-group, randomised controlled trial. Lancet Psychiatry. Published online July 11, 2018. doi: 10.1016/S2215-0366(18)30226-8.
Journal: M. Hayward. Increasing access to psychological treatments for mental illness. Lancet Psychiatry. Published online July 11, 2018. doi: 10.1016/ S2215-0366(18)30262-1.