Everyone experiences fear in their lives. Fear is both natural and necessary for our survival. It drives us to avoid danger and helps us stay alive. Fear is an evolved part of our nature. We are descended from ancestors that had a healthy level of fear and therefore weren’t eaten by some saber-toothed prehistoric monstrosity. So, although fear is a negative subjective feeling, it’s very good for us as a whole!
Even so, in some cases fear can become a problem in itself. When fear reaches the point where it prevents someone from living a normal life or doing all the things they really want to do, then it can be considered a disorder. For example, if you have a severe fear of flying and avoid airplanes at all cost, then you may be missing work or travel opportunities. If you’re afraid of swimming you might never learn how, or might have to avoid important social events.
Debilitating fear of some specific thing or experience is referred to as a “phobia” in psychology, after the personification of fear from Greek mythology.
Living With Fear
There are, of course, degrees of such fears. For example, people with severe arachnophobia (a fear of spiders) might get a panic attack just by seeing a picture of a spider or hearing someone talk about them. Others may be OK with the abstract discussion of spiders, but run in fear if even a small harmless house spider is in the room with them.
Many people who have a phobia learn to adapt their lives in order to live with it. However, advances in psychological therapy and our knowledge of how the human brain works has made it possible to help people get over even severely debilitating phobias using specialized therapies.
One of the most effective methods of helping people get over their phobias is from a branch of psychology known as Cognitive Psychology. Cognitive psychologists study mental processes, treating the brain a little like a computer that can be “programmed” to one extent or another. A more specialized type of therapy was born from cognitive psychology and another, older branch known as behaviorism. This therapy is known as cognitive behavioral therapy, or “CBT”. The specific CBT therapy that can help people suffering from phobias is known as “exposure” therapy.
The idea behind exposure therapy is actually pretty simple. When you are faced with something that makes you very afraid, the natural response is to get away from it as quickly as possible. When you’ve put a safe distance between yourself and the frightening thing you want to escape, the fear goes away. Unfortunately this does nothing to solve the root of your problem – an irrational fear. In exposure therapy you are very slowly exposed to the source of your fear, first at low levels and then with increasing intensity. At each level of exposure the idea is to let your brain, body, and mind get used to that level of presence. We all “habituate” to even extreme circumstances eventually, if given a chance. The point of exposure therapy is to give the person a chance to habituate instead of just avoiding the issue.
More Than Fear
While phobias are the most well-known target of exposure therapy, it’s actually useful for quite a few different problems. People who experience debilitating panic attacks can learn to deal with their trigger in a safe environment. If you have social anxiety or just general anxiety, it also works. OCD sufferers have found relief in exposure therapy too, and people who suffer from post traumatic stress disorder are prime candidates.
VR and exposure therapy seem like they are made for each other, but of course you don’t need VR to practice the method. This therapy model has been around far longer than VR has been a feasible way to deliver it. Traditionally, there are three main channels through which exposure therapy is conducted.
With “in vivo” exposure, people are exposed to the real deal. If you’re afraid of spiders the therapist might bring out a real spider in a terrarium, progressing eventually to handling said spider near the end of therapy. Then there’s “imaginal” exposure. This is where the therapist guides the person through a detailed and vivid mental reconstruction of what caused their problem. By deliberately imagining things, people, places, and experiences, the person in question can become used to the idea of dealing with problematic thoughts. Finally, “Interoceptive” exposure happens when the therapist gets the client to cause particular physical sensations that trigger their negative responses. People who have panic attacks often get triggered by their thumping hearts. By making these people exercise to lift their heart rates, the sufferer can learn that an elevated heart rate by itself isn’t dangerous.
In terms of pace, there are three main ways exposure is delivered. You can do a graded exposure where the person looking for help puts together a list of things related to their issue and then ranks them from not particularly scary to “help I’m going to crap my pants and die”. So they might start out with a picture of a spider, then a video, then a real one in a tank, and so on. “Flooding” is when the therapist flips that ranking and starts with the most difficult trigger, which is pretty rough! In other cases they might systematically desensitize the person by mixing exposure and relaxation exercises.
Each specific mix of methods is unique to each case, which is why this therapy is best done under the supervision of a trained mental health professional.
Bring On the VR
So what is VR’s role in all of this? Well, as you can imagine, a technology that can make people feel they are in a situation that they really aren’t in is incredibly useful. There are plenty of situations where in vivo exposure isn’t practical. It might be too dangerous, too expensive, or simply too much trouble to recreate the real deal.
Virtual Reality also elevates one specific aspect of exposure therapy that’s very important – control. The therapist has complete control over everything the client sees and hears. He or she can dial the intensity of exposure up or down as needed, or stop things when they get out of hand and conjure up experiences that would be impossible by other means.
A Long Time Coming
CBT as a treatment for phobias has been around since the 1950s. Obviously this is quite a long time before VR was even remotely a thing. Still, once VR became more than just an idea it didn’t take CBT practitioners long to figure out that it could play a role in exposure therapy.
Already in the 90s, when VR flopped commercially for the first time, it found some respite within universities and specialized therapy practices. The first paper that detailed how effective VR could be for the treatment of phobias was published in 1995 by Barbara Rothbaum and Larry Hodges. Since then it’s become a fairly normal practice to use VR in the therapeutic setting, and companies that create specialized therapeutic VR software exist to serve this market.
The Modern VR Revolution
Until recently, these therapeutic VR products had been expensive and specialized. There really wasn’t off-the-shelf hardware you could buy to build your own therapy setup, and whatever was available was all clunky and terribly uncomfortable. Now, the best VR experience you can have essentially comes from the top consumer headsets. Products such as the Oculus Rift and HTC Vive offer amazingly lifelike experiences when coupled with standard high-performance hardware. Yes, AAA consumer VR may be expensive from the perspective of normal users. But if you’ve been paying tens of thousands of dollars for proprietary VR therapy systems, it’s a real revolution.
Mobile VR, too, has a big place in this new generation of therapeutic experiences. Even something like a Gear VR is superior to the systems that have been used in the past for VR therapy. The processing power in a typical smartphone is hundreds of times that of a high-end computer from the 90s.
Mobile VR brings with it the possibility of sending your clients home with a way to complete their own treatments outside the confines of therapy. Think about how useful this would be for someone who suffers from anxiety; they could put on a guided meditation app when they start feeling a little tense. Mobile VR also provides the opportunity to treat people whose phobias prevent them from leaving home, although, of course, a laptop and tethered HMD is also an option.
The Dangers of Self Treatment
Then again, easy access to VR and a flood of dubious treatment applications might turn out to be a problem themselves.
First of all, it’s not a good idea to get into mental health treatment completely without the supervision of a mental health professional. Yes, it is sadly true that many people in the world don’t have access to the sorts of help that they need, but unsupervised treatment can do more harm than good.
I don’t think people who suffer from general anxiety can get into much trouble with a meditation application, but if you have a severe phobia there’s no telling what consequences the wrong trigger at the wrong time can have. After all, there’s a whole methodology of constructing personalized exposure regimens for patients.
Because VR hasn’t really been easy to get into public hands until recently, there isn’t really any regulation of applications making therapeutic claims. Perhaps in the future such apps might need approval from a sort of VR therapy FDA. Only time will tell.
Phobos – Affordable VR Therapy
There’s one project in particular that I want to highlight. Phobos is an application platform that its developer hopes will one day provide an affordable and scientifically valid way to get targeted VR therapy for the treatment of fear and anxiety into the hands of the masses. The project has been going since at least 2014, when it had an IndieGogo campaign. Unfortunately, they fell far short of their goal, but the project still seems to be alive.
What makes this project different from the many junk “phobia” apps on mainstream app stores is that all the clinical elements of Phobos is validated by actual mental health professionals. Right now, the team behind the platform is working on getting people to actually experience anxiety and fear triggers in VR in a controlled way. When they’ve got that bit down they’ll move on to expanding Phobos to more general cognitive processes such as memory, attention, and perception. They also plan to make use of AR as well as VR.
Because the source code for Phobos is completely free, institutions can use it as they please for mental health purposes, as long as they can provide their own commercial assets (since those can’t be included in the free code).
Out of Our Minds
Most people will experience some sort of mental health issue at some point in their lives. VR provides a way to reach more people in a more effective way like never before. Who knows? Perhaps one day you’ll have an AI therapist who’ll meet and treat you in VR. For now we can marvel at how far we’ve come since those early days of 90s VR with blocky spiders and simple heights. Now you can count the hairs on a tarantula’s back. If you want to, that is.
Of course, as with all things VR it might end up being mixed-reality that takes over this therapeutic role in the future. A mixed-reality snake or spider might be much more believable when it’s walking over YOUR coffee table. That’s even before we get into the possibilities that advanced haptic technologies can bring to the party. Imagine feeling the air whipping by as you skydive in VR, or the squeeze of a snake held in your hand. The future of VR therapy still has a long way to go, but at the same time it seems brighter than ever.