VR for CBT: How they work together to overcome anxiety and fears

VR for CBT: How they work together to overcome anxiety and fears

Talk about virtual reality (VR) has skyrocketed in recent years. From gaming features in the Nintendo Wii to clinical applications for patients with anxiety, VR has become so prevalent. 

However, there are still some misconceptions about this groundbreaking technology.

VR is the technological connector that could promise high engagement, low-cost usage, and vast appeal to the general population.

VR isn’t just for gamers though. This common misconception perhaps comes from high-profile gaming platforms that have used virtual reality or augmented reality for popular game titles such as Beat Saber, Rec Room, VR Chat, and others. 

On the contrary, however, virtual reality has extended into other areas of society, including psychology (CBT), healthcare, tourism, and more.

Virtual Reality can include gamification elements to give that “game” sensation. In fact, this gamification element is a very useful tool when implemented in parts of VR therapy.

Want to find out how VR is pushing past gaming stigmas and integrating into real solutions for therapy? Keep reading. 

Why VR is more than just a game

While people rarely present exactly the same set of symptoms in the same way, at the same time, there are defining and typical characteristics of each defined illness that can be treated through standardized therapeutic programs. VR can often be used as either an addition to these programs or even be presented as a standalone treatment. Phobias present a good case of how VR can enhance standardized therapy. Treatment is typically completed through graduated exposure, in which the fearful stimulus (a spider for example) is presented in steps.

The steps begin at an acceptable level of fear for the patient (this may begin by looking at a picture of a spider or imagining a spider). The patient is provided with the time to relax around the fearful stimulus, and the fear will eventually subside. Escalating steps with increased exposure can ultimately lead to a more functional level of fear, in which the patient is no longer negatively affected to a level that impairs them.

For spider treatments, this will of course at some point require an actual spider. This might not be easy for the psychologist to reliably obtain, and for other phobias, the stimulus could be much more difficult to get hold of, a fear of flying for example could require going on a plane, something that can become logistically challenging and expensive.

VR then offers the ability to present the stimulus in a much more accessible way – with enough immersion, all of the exposure steps can be done through the device 


How VR can change Therapy

Presently available VR technology is being used to enhance treatment of anxiety and VR has the potential to improve clinical training. VR could create an engaging, controllable, repeatable, and safe training environment. Advances in VR allow users to enter a fully immersive environment and have simulated interactions with virtual humans. Practice with virtual humans has also demonstrated effectiveness as a way to train for difficult conversations. 

In the near future, VR may help provide standardized clinical training in exposure therapy, making training easier and more accessible. A VR training environment would allow therapists to repeatedly practice with virtual patients while mastering clinical assessment and exposure therapy skills. VR might allow clinical supervisors to vary the scenarios and customize the virtual patients within the training environment. Practicing exposure therapy within VR could increase skills and decrease fears about delivering exposure therapy. Increased therapist comfort with and competence in exposure therapy will help therapists provide evidence-based treatment and counter patients’ fears about the therapy.

Researchers are also beginning to explore the potential of VR to help assess mental health conditions. VR could also be used to help in diagnosing patients quickly and efficiently. 

Clinically, VR exposure therapy  is a practical treatment that makes exposure therapy easier and more acceptable for therapists and patients. It can help patients learn and practice anxiety management skills and permits controlled, gradual exposure, which minimizes distress and optimizes treatment success. Practically, VR is increasingly affordable. The cost of VR software and hardware continues to become more affordable , while the quantity and quality of VR content increases. VR therapy has been shown to reduce anxiety and phobia symptoms. 

Getting in the patient's head

VR Therapy allows the therapist to see what the patient sees in the virtual environment. This addresses four limitations of imaginal exposure: not every patient imagines well; the ability to form mental images declines with age; the patient’s imagery may be too frightening; and the therapist neither knows nor controls what is being imagined. With VR, the therapist can choose the content and personalize it for the patient. Therapists can guide patients through exposure in the office while monitoring and supporting the patient. Patients feel engaged, and the experience feels “real” but is a safe way for a patient to practice before facing a feared stimulus on their own in a real-world setting. Therapists can monitor whether patients are attending to the content. VR also offers exposure therapy to patients who are resistant to other methods of exposure therapy. VR helps engage patients in treatment. Relaxing virtual environments can help patients learn and practice anxiety management skills and can be used to reinforce patient involvement in treatment and increase positive therapeutic growth.


How VR integrates in therapy and CBT

Mental illness is something that affects so many people that it cannot be ignored and certainly shouldn’t be stigmatized.

Cognitive behavioral therapy (CBT) is one of the ways to help people suffering from mental disorders. CBT challenges and eventually changes a patient’s hurtful thoughts, beliefs, attitudes, and behaviors, while improving their capability to control their emotions, as well as teaching them coping mechanisms for stressful situations.

Exposure therapy

Related to CBT is exposure therapy, where patients are gradually exposed to their fear so they eventually become desensitized to it. Exposure therapy is particularly useful for anxiety disorders, but it’s not always practical to perform. For example, treating someone with agoraphobia (fear of crowds) requires the patient to go somewhere busy. This is time-consuming, risks doctor-patient confidentiality, and it can introduce unwelcome variables outside of everyone’s control.

Just as with Cognitive Behavioral Therapy and in-vivo exposure, virtual reality exposure therapy helps people with social anxiety learn to effectively cope with fearful situations, but it does so in a high-tech, non-physical way. 

During a VRET session, the person wears a virtual reality headset similar to the type used by video gamers or the ones that let you view movies on your phone. On-screen avatars move through simulations of common social situations and the individual participates via their own avatar. 

It should then come as no surprise that doctors and therapists have been using some form of virtual reality as therapy to treat their patients for decades already. Creating a virtual simulation, however, used to cost tens of thousands of dollars. Nowadays, consumer headsets such as the Oculus Quest, which only cost a few hundred dollars, have made VR therapy a much more viable option for mental health therapy.


The perks of VRET

Virtual reality exposure therapy (VRET) is inexpensive, private, and gives therapists control over the simulation that they put their patients in. 

Considering the rate of progress of VR technology, the benefits of VR for therapy will only grow stronger over time.

Given that VRET is much more practical for therapists and less stressful for patients, VR exposure therapy might eventually become the preferred option over real-world exposure therapy.

Studies have shown that VR can also help improve the social-cognitive skills for children with autism spectrum disorder (ASD), as well as veterans with post-traumatic stress disorders (PTSD), and people suffering from claustrophobia, eating disorders such as anorexia and bulimia, or even schizophrenia. 

The reason why VR therapy seems to be such an effective way to treat mental health patients is because people will react to fear cues even if they logically know that they’re in an environment that’s not real. This is because the limbic system, i.e. the brain’s emotional command center, responds much faster to stressors than the thinking, logical part of our brain.

While much more research needs to be done before VR can replace traditional therapies such as CBT and exposure therapy, the technology has already proven itself to be a cost-effective, easy-to-use addition to help people recover from mental health illnesses.

The typical method of social anxiety treatment is a combination of Cognitive Behavioral Therapy (CBT) and in-vivo exposure therapy. Through these two modalities, an individual with social anxiety is slowly exposed to small doses of social interaction over time. This will help them gradually build up their tolerances and confidence while desensitizing them to their fears. During treatment, the person also participates in role playing with their therapist to acquire social skills and practices these new abilities in a safe, non-threatening environment.

The drawback to this treatment comes when someone finds that being physically present in an anxiety-laden situation is too traumatic. It can also be problematic for those who have to travel to a physical location, such as for someone who lives in a more rural area.

Enter virtual reality exposure therapy (VRET). Now, people with social anxiety can challenge their fears non-physically, in a realistic, safe, comfortable setting – and in situations they can control.

VR helping people overcome fears and anxiety

People with social anxiety worry constantly that they’ll embarrass themselves in social settings or that they’re always being watched and judged for even the smallest actions. Often, they realize they might be making a bigger deal out of a situation than is warranted, but they can’t help how they feel or change their emotional reactions.

As with anything, social anxiety can be all-consuming or may simply be confined to certain areas of a person’s life. For example, one person might have a hard time participating in a team project at work or find it difficult to give a presentation to their peers. Another individual may feel so traumatized about social interaction that they can’t leave the safety of their home to go to work, shop at a mall, or eat at a restaurant.

With virtual reality exposure therapy, people feel as if they’re actually in the setting, but with the benefit of having more control. If you become too anxious, the therapist can stop the program, instantly removing you from the perceived threat. Although it seems hard to believe, the experience of guiding an avatar through a fearful experience does trigger an emotional response, even if you know you aren’t in a real setting. This is similar to watching a horror movie and jumping involuntarily when the killer leaps out at the person on the screen, despite knowing that the movie is fake.

VR can be an extremely effective tool in helping people overcome fears by immersing themselves into a virtual world and facing that which they fear the most. As the technology advances so will its capabilities, and hopefully we'll see its benefits in the wellness fields not just the gaming.