Virtual Reality Therapy: A New Way To Self-Treat Phobias

Photo Credit: Maurizio Pesce

Photo Credit: Maurizio Pesce

Crawling spiders are disgusting, hissing snakes are creepy, heights are terrifying, the dark is eerie, and after watching “Psycho’s” famous shower scene, we’ve all, at one point, kept one eye open while shampooing. But for the 19 million Americans who suffer from phobias, overwhelming fear occurs more often than when watching a horror movie or walking home alone on a seemingly deserted street.

For many of us, phobias are a passing thought, but having a phobia can be extremely disrupting to daily routines as well as expensive to treat. Nora Henick of New York, 23, suffers from claustrophobia, the fear of confinement. She is terrified of elevators and has to leave earlier for work because she needs to account for the time it takes her to walk up 16 flights of stairs to her office. “It’s extremely frustrating and annoying because I understand that it’s not rational all the time,” Henick said. “But it feels like it’s out of my control, and people can’t understand that.”

Similarly, Sydney Schwartz of Chicago, 19, suffers from ornithophobia, the fear of birds, requiring her to move lunch reservations inside and leave outdoor events to avoid birds. Not only is it challenging, but also the fear is often humiliating. “It is so embarrassing when I’m with people and all of a sudden, I freak out because a bird flies by,” Schwartz said. “I know sometimes my actions are ridiculous, but it’s as if my body completely transforms whenever I encounter birds.” Beyond modifying their daily routines to avoid their fears, both Henick and Schwartz have spent a lot of money on treatment. Schwartz has spent about $700 trying hypnotherapy for her phobia of birds while Henick estimates spending a total of $10,000 on cognitive behavioral therapy over the course of nine years with three different doctors. “Nothing helps,” Henick said. “My heart still races, I can’t focus on anything else, and I still get extremely anxious and antsy.”

Treatments for phobias can range anywhere from $50 to $300 an hour depending on the rate of the therapist. Licensed Professional Counselor Julie Cross, from Dallas, Texas, who regularly treats phobias said, “Everybody is different and works at a different speed, but if you skip talk therapy and just use total immersion and prolonged exposure to the fear, it might take six to nine continuous sessions.” With multiple sessions, the cost of treatment becomes incredibly expensive.

However, there may be an alternative. Earlier this month, the New York Times surprised thousands of subscribers with a delivery of Google Cardboard included with their Sunday paper. Google Cardboard is a virtual reality viewer that can be used to experience scenes from around the world on The Times’ free app NYTVR. The introduction of this new equipment begs us to explore how else this technology can be applied. While the potential is seemingly endless, in the case of phobias: Can it be the means to an affordable cure?

To understand how to treat phobias, we must first understand how fear works. Dr. Nicolas Maltby from the Anxiety Treatment Center in Connecticut explained, “The primary goal of fear is to predict danger so that you can avoid it and never get near danger at all. It is absolutely required for survival.” Falling, getting hurt, seeing bad things happen, or watching scary movie scenes are all ways one can learn fear. To get rid of a phobia, the brain has to unlearn that specific fear. “Your brain doesn’t wait to unlearn fear easily because that would be stupid,” Dr. Maltby said. “The rules of unlearning a fear are to face that fear, and to do it over and over again without holding back. In the end, therapists are just coaches, so you have to choose to face it on your own.” After enough repetition of facing the fear, your brain realizes it can let go of the anxiety because nothing bad has happened.

Unlike Henick and Schwartz, not all phobics are proactive about overcoming their fears. Dr. Hunter Hoffman, a cognitive psychology research scientist specializing in virtual reality at the University of Washington, said that most people with phobias never seek treatment. “People go for years limping through life with a phobia.” VR helps to fix this: you may never convince an arachnophobic to hold a spider, but you might convince them to face their fears through virtual reality.

According to Dr. Hoffman’s work, “Virtual reality in the treatment of spider phobia: a controlled study” found in the academic journal ScienceDirect, he and other researchers are hopeful that virtual reality treatment will help encourage more people to conquer their fears. “A lot of people who have a phobia say they would not come if there was going to be a real spider,” Dr. Hoffman said. “But they are willing to face a virtual spider.” In the study, 23 arachnophobic undergraduate students were tested. Through virtual reality goggles, the students were placed in a computer-generated kitchen with a Guyana bird-eating tarantula. “VR exposure therapy for phobias involves gradually exposing the person to the object or situation they are having trouble with,” Dr. Hoffman said. Over the course of multiple sessions throughout one year, the goal was that the patients would eventually be able to pick up the virtual reality spider without reporting any anxiety. If they picked up the spider in VR, a toy spider was placed in their hand to simulate a more real life scenario. The results were successful: 83 percent of participants showed a reduced level of anxiety and a clinical improvement when confronted with their fear.

Besides its high success rate, virtual reality treatment offers an affordable alternative for phobias that can’t be realistically confronted or easily accessed. For example, someone with a fear of flying would need to go on many flights with their therapist.  Not only would this be incredibly costly, but it would also be a huge time commitment. At Cornell University’s Weill Medical College in New York City, the Program for Anxiety & Trauma Stress Studies uses VR therapy to treat patients with a fear of flying. Patients sit on a specially designed seat that is mounted on a platform with a speaker underneath to mimic the same feeling as being on an actual flight. Once they enter into VR world, they are put in the window seat of a virtual cabin to imitate the experience of flying. Therapists can activate different scenarios for their patient including taxiing, takeoff, landing, or in-flight turbulence. All images and video surrounding the patient are consistent with a real airplane, even if they look out the window of the virtual flight. At the Weill Medical College, patients must complete three to four assessment and training sessions before being exposed to a virtual reality environment. According to their website, not only does this allow the patient to develop a sense of trust for the therapist that will be in complete control of their virtual experience, but the therapist can also learn more about the individual’s needs and can work at an adequate pace.

During a VR therapy session, the therapist is watching the patient’s behavior. “Wringing of their hands, sweating, increased respiration—these are all visible to the therapist,” Dr. Hoffman said. The more real the VR world seems to the patient, the more effective the treatment will be. Patients must feel anxious and remain that way for a few minutes to prove to their brain that nothing bad will happen. For a fear of heights, a therapist might advise their patient to keep getting closer to the edge of a cliff. Once the patient reports that their anxiety level is very high, the therapist will tell them to stay there for a while, go away, and then do it again. “If you’re not anxious you’re not fixing your anxiety,” Dr. Maltby said. “It’s a lot of pushing because I’m asking the patient to do the most they can do. We keep repeating the action until their anxiety comes down a little bit and then we’ll move on to a slightly higher (cliff).”

For people like Schwartz and Henick, virtual reality may help cure their fears by removing the very real potential of their worst nightmares coming to fruition. Although birds and elevators are easily accessible in a pet store or a skyscraper, phobics are often discouraged from facing their fears because they are scared of the real life outcome like getting attacked by a bird or getting stuck in an elevator. VR would help expose Schwartz to birds or Henick to elevators in a way that they know their biggest fears couldn’t actually happen.

In the past, VR treatment has been very expensive. But now, with the release of Google Cardboard, people could self-treat themselves. “Virtual reality is in the process of becoming widely available to the public,” Dr. Hoffman said. “Facebook, Sony, and others are making VR helmets that are awesome, and will be widely available.” Granted, there wouldn’t be a personal coach walking you through the steps and reporting your progress, however, this offers an affordable alternative to the hundreds or thousands of dollars one might spend on multiple therapy sessions. The most basic VR goggles by Google Cardboard can be purchased for $2.99 on ebay, while Samsung’s fancy Oculus Rift sells for $99 at BestBuy. If VR mobile apps can create a real enough environment and enough programs tailored to various specific phobias, sufferers would finally have an affordable and effective option. “I can see it in the future,” Dr. Maltby said. “There’s a technology hurtle that needs to be passed where these things have a high enough fidelity.”

Another challenge is: Can you push yourself hard enough on your own at home? Dr. Matlby has reservations. “If you feel anxious, can you stay in the situation for your anxiety to come down? Do you understand the real importance of leaving yourself vulnerable? If you are capable of pushing yourself hard enough, then it can work.” So, who’s ready to face their fears?


Anxiety and Depression Association of America

Cornell University’s Weill Medical College, Program for Anxiety & Trauma Stress Studies

Dr. Hunter Hoffman, Cognitive Psychology Research Scientist, University of Washington

Julie Cross, MS, LPC-S, NCC, DAPA

Dr. Nicolas Maltby, Anxiety Treatment Center

Nora Henick, claustrophobic

ScienceDirect, “Virtual reality in the treatment of spider phobia: a controlled study”

Sydney Schwartz, ornithophobic

Photo Credit: Maurizio Pesce

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