How virtual reality can be used to treat anxiety and PTSD

Virtual reality may become instrumental in the workplace, could potentially be vital for reimagining crime scenes, and has even salvaged strip clubs in the midst of a pandemic. Its possibilities and applications are vast, still being discovered and toyed with. Now, new research shows that VR may be an effective treatment for anxiety.

Published by open access digital health research publisher JMIR Publications, the study looked into virtual reality exposure therapy, or VRET. This particular form of therapy is a method in which patients are steadily exposed to a traumatic stimulus with the help of virtual environments. So not confronting the traumatic stimuli in its actual form, but gaining the benefits of overcoming or managing trauma through virtual exposure.

The study in question was funded and conducted at Massey University Strategic Excellence Research Fund and Otago Polytechnic Auckland International Campus, New Zealand. The authors reviewed several past studies about VRET and anxiety, concluding that this type of immersive therapy is a viable and potentially revolutionising method to treat certain mental health conditions.

A blend of VRET and well-established practices in mental health treatment can both augment and enhance other forms of therapy, the research suggests. For instance, VRET could be interlocked with cognitive behavioural therapy (CBT), which is commonly used to treat conditions such as anxiety and obsessive compulsive disorder. The combination can elevate effectiveness and reduce symptoms of mental health conditions.

Patients can ‘confront the situations that cause them fear and anxiety, but in a safe and controlled environment’

Dr. Nilufar Baghaei, Vibhav Chitale (members of the Games and Extended Reality Lab at Massey University, New Zealand), and Professor Richard Porter (faculty at the Department of Psychological Medicine at the University of Otago, New Zealand) are amongst the authors of the study. In a joint statement to Mashable, the researchers say that VRET allows participants to “confront the situations that cause them fear and anxiety, but in a safe and controlled environment, working closely with their mental health professionals.”

Scenarios in which this can be implemented are varied. VRET can be used to treat a fear of flying through virtual flight simulators, or a fear of driving through driving simulators. An aversion to public speaking can be tackled with virtual interviews and presentations.

“VRET allows for customisable virtual environments wherein a patient is exposed to a feared stimuli in a safe and controlled environment. Due to the nature of VR, the patients feel an engaging and immersive experience within the virtual world,” say the authors. “The virtual world can be controlled by the mental health professional, enabling total control of the exposure, and allowing for the manipulation of scenarios specifically tailored towards the individual undergoing the sessions.”

In other words, VRET allows for both safety and innovation in mental health treatment. An Oxford University study back in 2016 tested this, having patients who suffered from extreme versions of paranoid thoughts to step into virtual environments. The VR design allowed researchers to show patients that the spaces that scare them can actually be safe.

Conditions like PTSD and schizophrenia can also be addressed with VRET. For military veterans, for example, a virtual war zone can help to accelerate treatment. This is also effective when it comes to situations that are difficult to replicate due to cost, reality, and privacy concerns.

For the latter, a 2019 clinical trial in the UK tested how VR therapy can be implemented to help patients with schizophrenia. The trial recreated potentially stressful situations, allowing participants to learn how to re-engage with the world in a controlled setting.

Of course, VR therapy comes with its risks. According to a 2018 study by J Clin Med., VR may not be suitable for those with epilepsy, and for others can potentially cause motion sickness, dizziness, or disorientation. Another plausible risk is obsession, with patients becoming fixated and/or dependent on VR. These potential risks do exist. But the overarching conclusions of the studies show that the positives likely outweigh the negatives, especially when it comes to the potential VR therapy holds.

“A lot of studies have reported positive findings post-VRET treatment such in that the participants experienced a decrease in PTSD, depression, social anxiety disorder, public speaking anxiety and/or anger symptoms, and were more relaxed with upbeat mood,” say Dr. Baghaei, Chitale, and Porter.

So far, certain studies (such as this one by the University of York, this by the Clinical Psychology Review, and this by Oxford Medicine Online) suggest that VR can be helpful for anxiety, PTSD, and anger symptoms. Many, such as the above Oxford study, suggest that the emerging field of VRET shows immense promise for a variety of disorders, while also allowing for lower costs and more accessibility. While it may appear that VR technology is expensive and out of reach, the researchers actually believe this technology is becoming more widespread, accessible, and affordable: “the assumption that the equipment needed to use VRET is too expensive will no longer hold.”

The future of therapy may very well be virtual, if research continues on this path. And it may be exactly what some need.

Despite the emphasis on anxiety, researchers believe that there is room for the treatment of depression, too. The authors of the JMIR study point out that although there is less evidence surrounding VRET’s applicability to depression, there is enough of a link between the two to argue it’s a feasible treatment choice.

“A number of studies have shown that as the number of VRET sessions increases, the effectiveness of symptom reduction also increases. The evidence for effectiveness in depression is limited so far – but there is a lot of research in this area and results are promising.” Dr. Baghaei, Chitale, and Porter say.

For instance, they cite a study published by the University of Cambridge press, in which patients were exposed to compassion and self-compassion through virtual reality. The patients each experienced some sort of depression, but during the course of the open trial, saw their depression and self-criticism decreasing significantly.

The future of therapy may very well be virtual, if research continues on this path. And it may be exactly what some need.