Why use virtual reality in the treatment of phobias ?

First of all, specific phobia is, according to the DSM-5, listed in the category of “anxiety disorders” with a one-time prevalence rate of patients with a phobic disorder of between 4% and 8.8%, and for a lifetime of between 7.2% and 11.3%. It is defined by a persistent and intense fear of an unreasonable or excessive nature, triggered by the presence or anticipation of confrontation with a specific object or situation.

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ARTICLE : WRITTEN BY MARGAUX JACOBSON

October 31, 2016

First of all, specific phobia is, according to the DSM-5, listed in the category of “anxiety disorders” with a one-time prevalence rate of patients with a phobic disorder of between 4% and 8.8%, and for a lifetime of between 7.2% and 11.3%. It is defined by a persistent and intense fear of an unreasonable or excessive nature, triggered by the presence or anticipation of confrontation with a specific object or situation.

Psychotherapy in the management of phobia, remains today the only effective therapeutic means (Gasman I. Allilaire J.-F 2009). No single drug treatment in the phobia recovery process has been shown to be effective (Pull et al. 2008), nor has the introduction of an anxiolytic combined with cognitive behavioral therapy psychotherapy (Barlow et al. 2000).  It is important to know that a therapist must propose the most effective scientifically validated treatment to his patient (Abramowitz et al., 2011). Yet, Jonathan S. Abramowitz (2013) argued that exposure therapy (repeated and systematic confrontation of feared stimuli (Moscovitch, Antony, et Swinson, 2009) is the most relevant psychotherapy in the treatment of people suffering from anxiety disorders.  It should be noted that patients suffering from anxiety disorders, and more particularly phobic disorders, present disturbances in the fear circuit (Telzer et al. 2009). This disturbance leads to a hyper-activation of the amygdala (Pichon J.-A., Vuilleumier P., 2011), pathological activation of the thalamo-agmydal circuit and hypo-activation of the prefrontal cortex (Bishop 2007). Negative sensory stimulation is directly transmitted to the thalamus, which transmits (without passing through the hippocampus, sensory cortex and prefrontal cortex allowing moderation of the amygdala and thus an adapted response (Bar-Haim  et al. 2007)) sensory information to the amygdala which then triggers stimulation of the endocrine system and neurovegetative and neuromuscular stimuli.  When the phobic patient is exposed to a phobic stimulus or environment, the role of the hypothalamus directly influences the fear behavior. (Canon W & Bard P. 1920-1931). The objective of this fear behavior is the preservation of the individual translated at the body level by the secretion of adrenalin by the adrenal medulla resulting in an increase in blood pressure, an acceleration of the heart rate. (Darwin 1899 – Prime G. 2013) as well as orthosympathetic manifestations such as increased sweating, tremors and skin pallor. (Prime G. 2013).

Wolpes, in 1958 in « Psychotherapy by reciprocal inhibiton », proposed the first treatment by systematic desensitization as well as in vivo exposure.

In vivo exposure is a method of intentionally, repeatedly, and without avoidance directly confronting a real-world object or situation perceived as dangerous (Rosqvist, 2005). According to Foa and Kozak’s (1986) theory of emotional processing, repeated exposure to the phobogenic situation or object would allow a change in the perception of the negative stimulus and thus a habituation. However, this in vivo exposure technique has certain disadvantages including, in particular, the limitation of the possible field of exposure for the therapist or the patient depending on the actual phobic object or situation.

To compensate for this lack of therapy and thanks to the progress of computer science virtual reality « offers an original work support to patients who are unable or almost unable to imagine certain scenes and/or are too phobic to experience the situations in reality » (Roy, 2001).

Virtual reality exposure therapies thus allow the patient a more real exposure than they would have imagined (Vincelli et Molinari, 1998), but also a better management of the intensity and frequency of the stimuli to which the phobic patient will be exposed with virtual reality (Virole B, 2007). The therapy by exposure to virtual reality also makes it possible to manage the unforeseen and the accessibility, to reduce the avoidance, the reduction of the costs according to the environment or the phobic object, a speed of treatment of the phobia thus allowing a reduction of the costs for the social security, a better adhesion and follow-up of the treatment (Hodges, Rothbaum, Watson, Kessler et Opdyker, (1996). Concerning its efficiency, Pertaud B.P et al. en 2002, claimed that both in vivo and in virtuo exposure had the same short- and long-term results.

It should also be noted that Garcia-Palacios, et al, in 2007, surveyed 777 students asking them what their choice would be between in vivo and virtual reality therapy as a potential phobia treatment. The results obtained amounted to 76% in favor of virtual reality exposure therapy.

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FAQ

Virtual reality (VR) is an innovative technology that enables patients to be exposed to immersive and controlled environments, facilitating the management of numerous psychological and psychiatric disorders. Its use in mental health offers several advantages:
  • Gradual and Controlled Exposure: VR allows patients to confront anxiety-inducing situations in a secure environment, gradually adjusting the intensity of stimuli to promote habituation and emotional regulation.
  • Realistic and Reproducible Environments: Unlike traditional techniques, VR provides immersive scenarios that can be consistently reproduced, ensuring a coherent and effective approach.
  • Increased Patient Engagement: The interactive and immersive nature of VR enhances treatment adherence and motivates patients to continue their therapy.
  • Personalized Treatment: Virtual environments can be adapted to meet the specific needs of each patient.
  • Versatile Applications: VR is used to treat anxiety disorders (phobias, post-traumatic stress disorder, obsessive-compulsive disorders), addictions, mood disorders, and even cognitive remediation.
The use of virtual reality in healthcare is not new! It has been studied and utilized for over 30 years in the medical and psychological fields. As early as the 1990s, researchers began exploring its potential for treating anxiety disorders, particularly phobias and post-traumatic stress disorder. Since then, numerous scientific studies have confirmed its effectiveness in addressing various psychiatric, neurological, and cognitive disorders.
Today, VR is widely integrated into therapeutic and medical practices, with clinically validated protocols. It is used in hospitals, clinics, and psychologists' offices worldwide to provide patients with innovative, effective, and safe treatments.
To use virtual reality, one must immerse themselves in a virtual environment. There are several ways to achieve this.
In the past, the CAVE system (Cave Automatic Virtual Environment), a 3D setup consisting of multiple screen walls, was the primary method used. This system allowed users to be fully immersed in the virtual world, with their movements detected in real-time. However, this technology was expensive and not widely accessible.
Since around 2016, with the introduction of virtual reality headsets like the Oculus Rift and HTC Vive, VR has become much more accessible. These headsets immerse users in virtual reality through an enclosed screen that projects digital images. The user's head movements are tracked, enabling them to look around and interact with the environment as they would in the real world.
Today, VR headsets are wireless and standalone, providing maximum comfort and ease of use without requiring external sensors or cables.
A virtual environment is an immersive digital simulation created through virtual reality. It allows users to navigate in a 3D space that accurately replicates everyday situations or specific contexts.
In mental health, these environments are designed to help individuals gradually face certain situations, manage their emotions, or enhance cognitive skills. By interacting with these virtual spaces, patients can engage in meaningful experiences tailored to their needs.
You need to equip yourself with a virtual reality headset. Our software is compatible with Meta Quest 2, 3, and 3S. 
You will then only need an internet connection. 
Numerous studies confirm that virtual reality is safe to use. However, some restrictions are in place to protect users from potential adverse effects.
For instance, individuals with epilepsy and pregnant women should avoid this type of therapy.
As with any immersive technology, prolonged use may cause visual fatigue or mild discomfort, particularly for those sensitive to motion sickness. Therefore, it is recommended to take regular breaks and adjust session durations according to individual needs.
Virtual environments are designed to be gradual and controlled, minimizing the risk of excessive anxiety. Most users quickly adapt to immersion and experience the benefits of this innovative approach from the first sessions.
Anxiety disorders and phobias can be effectively treated using virtual reality. Patients are gradually and progressively exposed to anxiety-inducing situations in various environments while remaining in a safe space. This process helps develop a sense of habituation, ultimately reducing or even eliminating anxiety over time.
Behavioral and substance addictions can also be addressed through virtual reality. By incorporating synthetic stimuli into the environments that trigger craving responses, patients struggling with addiction can work on their cravings to diminish the urge to consume.
Additionally, multiple environments—such as bars, casinos, and social settings—enable cognitive work on dysfunctional beliefs associated with specific temptation scenarios.
Regarding eating disorders, virtual reality software helps target key etiological factors, such as body dysmorphia, allocentric lock (a tendency to focus on others rather than oneself), and food cravings.
Currently, our TERV (Virtual Reality Exposure Therapy) solutions include multiple software programs designed to address critical psychiatric, psychological, and neuropsychological determinants such as relaxation, cognitive stimulation, behavioral activation, and social skills training.
Reminiscence therapy is also a major therapeutic tool in treating depression. By allowing patients to relive sensations linked to past pleasurable activities (such as sports, driving, or traveling), virtual reality stimulates hypoactive brain areas, enhancing therapeutic success. VR serves as an excellent mediator for reigniting engagement in enjoyable activities.
Moreover, cognitive stimulation for elderly individuals is another area where virtual reality proves beneficial. By leveraging technology to make stimulation activities more engaging and accessible, patients and nursing home residents can improve executive functions and memory through specially designed applications.
Today, virtual reality in mental health care is advancing rapidly. Researchers, clinicians, and developers continue to explore new therapeutic targets to offer innovative and effective treatment solutions in the near future.
VR can be used by all healthcare professionals assisting patients with anxiety, phobias, post-traumatic stress disorders, addictions, or other psychological challenges.
It is particularly beneficial for psychologists, psychiatrists, neuropsychologists, specialized nurses, as well as psychomotor therapists, physiotherapists, dietitians, sophrologists, and hypnotherapists. With a wide range of immersive environments, VR enhances therapeutic approaches and provides innovative tools to improve patient care.
Healthcare providers incorporating virtual reality exposure therapy (VRET) expand their range of treatment options. VRET is a well-established therapeutic technique with scientific validation from cognitive-behavioral therapy research.
  • Professional Differentiation: Integrating VR into practice allows therapists to stand out from traditional treatment options.
  • Scientific Validation: VRET is backed by extensive research, reinforcing its credibility as an effective treatment method.
  • Improved Patient Engagement: The interactive nature of VR fosters greater patient involvement in therapy.
  • Time-Saving: VR provides direct access to various exposure environments without needing external logistics.

One of the considerable advantages of virtual reality is that it is effective on a wide spectrum of populations. Existing data from the literature on the subject shows us that it is entirely possible to expose a wide age group to virtual reality, with real therapeutic benefits.

The studies attest, in fact, to excellent feasibility and significant results; particularly in adults, in the treatment of anxiety disorders (including school phobia), autism, addictions, eating disorders, neuropsychological disorders, psychotic disorders and mood disorders.

The results are identical for adolescents with a significant added value concerning therapeutic engagement where virtual reality promotes adolescents' interest in their therapy.

Among elderly subjects, study results encourage the use of virtual reality with the aim of working on cognitive stimulation, on behavioral disorders but also on anxiety.

One of the major advantages of virtual reality is its effectiveness across a broad spectrum of the population. Existing literature on the subject shows that virtual reality can be used with individuals of various age groups, providing significant therapeutic benefits.
Studies confirm excellent feasibility and significant results, particularly among adults in the treatment of anxiety disorders (including school phobia), autism, addictions, eating disorders, neuropsychological disorders, psychotic disorders, and mood disorders.
The results are equally promising for adolescents, with a notable advantage in terms of therapeutic engagement, as virtual reality enhances their interest and participation in treatment.
For older adults, research supports the use of virtual reality to improve cognitive stimulation, behavioral disorders, and anxiety management.
However, people with epilepsy and pregnant individuals are not advised to undergo this type of therapy.
Yes, all our environments are grouped within a single application.
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