Psychological treatment is adapting more and more to the times being. Virtual Reality (VR) tools, which can be used to address the treatment of different disorders, are the perfect example.

This technique is widely used with anxiety problems and, specifically, with phobias such as flying by plane, heights, public speaking, small spaces, insects or stressful medical environments, among others. It can also be used for relaxation or mindfulness techniques training.

So, what is Virtual Reality and how is it applied in the treatment of phobias?

It is a tool with which patients can be immersed in environments that make them feel anxiety reactions practically identical to those they would feel in the real situation they fear.

Actually, virtual reality has been used for more than 30 years as a tool in psychotherapeutic interventions and evaluations in clinical practice. In addition, research in Psychology already provides a broad empirical base that includes virtual reality or augmented reality protocols, with proven therapeutic efficacy (Andreu et al., 2012 ) .

The materials used in a treatment session of this type are:

  • Virtual reality glasses
  • Headphones
  • Two remote controls (one for each hand) with which the patient can interact with the environment
  • Electrodermal response sensor that adapts to the patient’s fingers to measure their physiological activation response (optional)
Terapia de Exposición con Realidad Virtual (VRET)

Image 1: person using Virtual Reality glasses and remote controls

The therapist controls from his device (usually a computer or tablet ) the start/end time of the test and also the conditions of the scenario that is going to be shown to the patient. The sessions generally take place in the psychologist’s office, although they can also be carried out remotely. It is a harmless technique, although it is advisable to stop the test if the patient experiences any sensation of dizziness.

Why does virtual reality treatment work?

Virtual Reality is capable of generating thoughts, emotions and reactions similar to those that a person would experience in the real situation. This makes of it an effective tool for therapeutic treatment in mental health. This way, the patient can be trained in coping with these situations without having to be physically in the place where they occur.

This is especially beneficial in the treatment of some phobias such as the phobia of flying, where due to logistics and time it is complicated (as well as expensive) to carry out a treatment session in situ.

What defines virtual reality?

1. 3D environments

They are computer generated environments and are not necessarily realistic scenarios. Below there is an example of what a patient with a phobia of flying by plane would see in his Virtual Reality glasses while being exposed to a scene.

Escenario mostrado en sesión de fobia a volar

Image 2: scenario shown in a flying phobia session

Contrary to what it might seems, it has been studied that these types of environments are effective even not being very realistic , and the fact is that the virtual environment does not have to be realistic to work.

Why? Because our brain perceives this reality as believable and what it does is to complete, to build its own reality from the details we are seeing. The key is therefore perception.

Let’s look at an example of how perception works: can you see a white triangle here?

Terapia de Exposición con Realidad Virtual (VRET)

Exactly, there is no triangle. But the brain completes and builds that form as if it existed. This is also the case with the scenarios to which patients are exposed through virtual reality.

2. Interaction with the environment

What the patient sees on the screen changes depending on what he himself is doing: this helps his brain to think that the person is really there. If the patient turns his head, he will see different scenes and objects (as they would in real life) than he would see looking straight ahead or the other way. This interaction is something that does not occur in the cinema or when we watch television.

3. Multisensory stimuli are produced : visual and auditory

Let us remember that when carrying out the virtual reality therapy session, the patient wears glasses and also headphones, so that he sees and perceives stimuli of various types: he does not only visualize but also hears things that are happening and that are also synchronized with his movements. The more the number of sensory channels stimulated, the more the immersion there is and the more effective the treatment.

The combination of these 3 points is what tricks our brain and allows thoughts, emotions and reactions to be very similar to a real situation.

Now we know how Virtual Reality works in the treatment of phobias , but: why should we opt for it when there are already other treatments? What are its advantages?

Among its benefits we find that there is a high degree of control of the environment by the therapist, being able to adapt the conditions of each session to the patient’s needs.

When we talk about control of the environment, we talk about elements within the scenario that is presented to the patient, such as objects, noises and movements, but also about aspects outside of it, such as the place where the session is carried out . Thus, in a first session of a person with a phobia of flying, the psychologist will be able to limit the elements of the environment that may be more aversive, such as turbulence, and opt not to introduce them until more advanced sessions, where storm sounds could be inserted. Also, the patient won’t need to be inside a real airplane, where there might be more turbulence than desired for that point in therapy.

A very interesting aspect of this tool is that it allows the person to repeat scenes that they might have resisted at some point, favoring the feeling of the patient’s perceived self-efficacy.

Among other advantages, Virtual Reality therapy favors greater privacy , as it is not necessary to leave the office to carry out the session.

In addition, the use of this technique generates more acceptance by the patient when exposing himself. The 97% of the patients do not present resistance to it indeed. It is a very positive data compared to a 27% of people who reject the treatment of phobias through live exposure ( Arbona et.al (2007) ).

Thus, we can say that Virtual Reality is here to stay as an effective and advantageous tool in the treatment of phobias. Do you dare to try it?

1. Andreu ‐ Mateu, S., Botella, C., Quero, S., Guillén, V., & Baños, R. (2012). The use of virtual reality and positive psychology strategies in the treatment of adjustment disorders. retrieved from https://ameliavirtualcare.com/es/solucion-realidad-virtual-psicologia/).

2. Arbona , C.B., Garcia-Palacios, A., & Baños, R.M. (2007). Virtual reality and psychological treatments . Medical Publishing.

Irene Bermejo Casado
Division of Psychology, Psychotherapy and Coaching
Irene Bermejo Casado
General Health Psychologist
Adults and adolescents
Languages: English and Spanish
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