Body of Evidence

Phobias are often considered relatively minor mental health issues, given their ability to be avoided, and the consequent lack of distress prospective clients endure. Nevertheless, they can prove incredibly debilitating, and significantly influence the quality of life experienced by the person in question. While the reasons for this vary as dependent on the nature of the phobia (consider for example, an employee required to travel for work, who has a fear of flying, or someone who is scared of storms, and has recently moved to Thailand), Cognitive Behavioural Therapy (CBT) is an adaptive model, that can appropriately treat such individual differences. While most people (up to 90%) do not seek help (Bennett-Levy et al., 2004(?)), those that do show significant improvement having undergone CBT (e.g. Koch et al., 2004; Ost et al., 2003; Straube et al., 2003). CBT is considered the gold standard for the treatment of specific phobias. The use of this treatment model in producing significant reductions in fear responses toward previously feared stimuli is well established in clinical practice (Choy, Fyer, & Lipsitz, 2007; Öst, 1996).

This treatment model focuses on the interactions between an individual's thoughts, feelings, and actions. It targets the cognitions surrounding the perpetuating cycle clients often find themselves stuck within (e.g. avoidance of feared object/situation). While the cognitive skills and restructuring taught and undertaken with clients typically facilitates a reduction in fear toward the feared stimulus (Koch et al., 2004), it is nevertheless a required part of treatment to confront the fear provoking situation. This is done in a controlled environment, and often under the guidance of a trained therapist.

Given the nature and severity of clients’ fears, it is often appropriate to build up to facing the fear itself. For example, someone scared of spiders may first be challenged with watching a spider on video, prior to confronting it in real life. The client will not be required to undertake a task they refuse to. Significant benefits are reported by those who do undertake treatment, as reported in experiments evaluating treatment of a variety of specific phobias (e.g. Koch et al., 2004; Ost et al., 2003; Straube et al., 2003).

Treating Phobias with Virtual Reality

A key component of the current gold standard in phobia treatment, Cognitive Behavioural therapy (CBT), is the clients confronting their fear. This has traditionally occurred in either real life situations, or through imaginal exposure. Unfortunately, both of these methods are subject to a number of constraints, which often make the exposures difficult, or less effective, than they otherwise could be. A new technological development, Virtual Reality (VR), has been validated as an effective alternative, which mitigates traditional concerns.  This technology involves patients entering a 3 dimensional, artificially constructed “world”, within which they are tasked with confronting their fears.

While some virtual reality programs have been met with some skepticism, after all, isn’t it just a computer simulation? Technological advancements continue to bridge this gap. Currently, a number of aspects of the virtual world contribute to an immersive experience. The constructed world is rich in detail. Additionally, sensory perception of the “real world” is shut out, as the virtual context stimulates our sensory receptors. Additionally, a multitude of sensory experiences are evoked within the VR context (e.g. visual, auditory, and tactile).

A growing area of literature suggests this technology as a viable alternative to traditional treatment methods, particularly regarding the treatment of clients with specific phobias. For example, successful trials have been run for people scared of storms! Patients who have undergone virtual reality exposure, demonstrated significant reduction in fear responses having undergone treatment in virtual reality environments. Additionally, successful trials have been run for people scared of heights! In these studies, those assigned to the VR group demonstrate the same treatment improvements as those who undergo traditional CBT, with some studies reporting greater effect than traditional methods.

References

Botella, C., Baños, R. M., Villa, H., Perpiñá, C., & García-Palacios, A. (2000). Virtual reality in the treatment of claustrophobic fear: A controlled, multiple-baseline design. Behavior therapy, 31(3), 583-595.

Botella, C., Baños, R. M., Perpiñá, C., Villa, H., Alcaniz, M., & Rey, A. (1998). Virtual reality treatment of claustrophobia: a case report. Behaviour research and therapy, 36(2), 239-246.

Emmelkamp, P. M. G., Krijn, M., Hulsbosch, A. M., De Vries, S., Schuemie, M. J., & Van der Mast, C. A. P. G. (2002). Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia. Behaviour research and therapy, 40(5), 509-516.

Harris, S. R., Kemmerling, R. L., & North, M. M. (2002). Brief virtual reality therapy for public speaking anxiety. Cyberpsychology & behavior, 5(6), 543-550.

Milosevic, I., & McCabe, R. E. (Eds.). (2015). Phobias: The Psychology of Irrational Fear: The Psychology of Irrational Fear. ABC-CLIO. Pg. 43

Garcia-Palacios, A., Hoffman, H., Carlin, A., Furness, T. U., & Botella, C. (2002). Virtual reality in the treatment of spider phobia: a controlled study. Behaviour research and therapy, 40(9), 983-993.

Mühlberger, A., Herrmann, M. J., Wiedemann, G., Ellgring, H., & Pauli, P. (2001). Repeated exposure of flight phobics to flights in virtual reality. Behaviour research and therapy, 39(9), 1033-1050.

Graziano, P. A., Callueng, C. M., & Geffken, G. R. (2010). Cognitive-behavioral treatment of an 11-year-old male presenting with emetophobia: A case study. Clinical Case Studies, 9(6), 411-425.

Shiban, Y., Pauli, P., & Mühlberger, A. (2013). Effect of multiple context exposure on renewal in spider phobia. Behaviour research and therapy, 51(2), 68-74.

Srivastava, K., Das, R. C., & Chaudhury, S. (2014). Virtual reality applications in mental health: Challenges and perspectives. Industrial psychiatry journal, 23(2), 83.

Virtual reality exposure therapy for social anxiety disorder: a randomized controlled trial.

https://www.ncbi.nlm.nih.gov/pubmed/23796315

Virtual Reality Cognitive-Behavior Therapy for Public Speaking Anxiety

One-Year Follow-Up

http://journals.sagepub.com/doi/abs/10.1177/0145445511429999

A controlled study of agoraphobia and the independent effect of virtual reality exposure therapy.

https://www.ncbi.nlm.nih.gov/pubmed/22790176

Virtual Reality Exposure Therapy Does Not Provide Any Additional Value in Agoraphobic Patients: A Randomized Controlled Trial

https://www.karger.com/Article/Pdf/342715

Cognitive-behavioral treatment and antidepressants combined with virtual reality exposure for patients with chronic agoraphobia

The combined use of virtual reality exposure in the treatment of agoraphobia.

https://www.ncbi.nlm.nih.gov/pubmed/26150057

Fear reactivation prior to exposure therapy: does it facilitate the effects of VR exposure in a randomized clinical sample?

https://www.ncbi.nlm.nih.gov/pubmed/25460259

Treatment of specific phobia in adults (2007)

http://ac.els-cdn.com/S0272735806001164/1-s2.0-S0272735806001164-main.pdf?_tid=71c20c24-3073-11e7-8216-00000aab0f26&acdnat=1493865984_c0e549626a2110712f485de0a415d29f

Koch, E. I., Spates, C. R., & Himle, J. A. (2004). Comparison of behavioral and cognitive-behavioral one-session exposure treatments for small animal phobias. Behaviour Research and Therapy, 42(12), 1483-1504.

Öst, L. G., Alm, T., Brandberg, M., & Breitholtz, E. (2001). One vs five sessions of exposure and five sessions of cognitive therapy in the treatment of claustrophobia. Behaviour Research and Therapy, 39(2), 167-183.

Bennett-Levy, J. E., Butler, G. E., Fennell, M. E., Hackman, A. E., Mueller, M. E., & Westbrook, D. E. (2004). Oxford guide to behavioural experiments in cognitive therapy. Oxford University Press.

Straube, T., Glauer, M., Dilger, S., Mentzel, H. J., & Miltner, W. H. (2006). Effects of cognitive-behavioral therapy on brain activation in specific phobia. Neuroimage, 29(1), 125-135.