Social anxiety disorder—that is, possessing the fear of social situations in which one must interact with other people—remains a prevalent mental health issue in North American society. According to the Social Anxiety Association (SAA), a U.S. non-profit organization that “promotes understanding and treatment of [the] disorder”, at any given time, approximately seven percent of the population suffers from social anxiety. And more than 13 percent of the population face the possibility of developing social anxiety at some time during their lifetime.
SAA’s website explains that based on “the latest epidemiological data . . . social anxiety disorder is the third largest mental health care problem in the world today”. Recently, however, therapists and professionals in the field of psychology are part of a current explosion in the application of virtual reality that, when used in therapeutic settings, allows psychotherapists to control and assist patients with anxiety-based disorders--to face their apprehensions and successfully practice behavior in realistic situational simulations.
In her recent article published by the American Psychological Association (APA), writer Kirsten Weir described the work of Sean Sullivan, Psy.D., the head psychologist at Limbix, “a startup producing virtual reality therapy software to help treat anxiety-based disorders with exposure therapy, provide relapse prevention for substance abuse and teach mindfulness and relaxation”.
Weir explained that Limbix is one of several virtual reality platforms being used “to address phobias, post-traumatic stress disorder (PTSD), substance use disorders and more”. The benefits of virtual reality were being investigated and proven almost 25 years ago. Based on the results of a 1995 study published in The American Journal of Psychiatry, Emory University’s Barbara Rothbaum, Ph.D. and her colleagues concluded that virtual reality-based exposure therapy could assist people in reducing their acrophobia—or fear of heights.
Rothbaum believed in the possibility for even more benefits of applying virtual reality in exposure therapy clinical settings. Since “people respond physiologically to their virtual experiences,” Weir wrote of Rothbaum’s perspective, “an important part of managing anxiety is learning to control the body's fear response.”
Early on, Rothbaum envisioned that virtual reality experiences could cause real situational responses—rapid breathing and a racing heart, for example. "People often think virtual reality won't scare them, since they know it's not real. But it doesn't take a whole lot to tap into that fear," Rothbaum said. "Their brains and bodies fill in the details, and suddenly they are shaking and hyperventilating."
In the years since Rothbaum’s research, “the field has exploded thanks to newer systems that operate through cellphones, making them less expensive, more portable and a lot more practical than their predecessors,” Weir wrote.
She quoted Sullivan’s comparison of the technological evolution of virtual reality over the past decade: "Even 10 years ago, it cost $30,000 to set up a virtual reality rig, and it was big and clunky and limited. Now that virtual reality can be delivered through mobile technologies, you can do it on a cellphone with a $70 headset," Sullivan said. "For the first time, it's really accessible."
Even with virtual reality still in its infancy, professionals and therapists were quick to recognize it could assist in providing patients with exposure therapy, having patients face their fears in a safe environment.
Weir referred to the work of Albert ‘Skip’ Rizzo, Ph.D., a psychologist from the University of Southern California. Rizzo studied virtual reality programs in clinical settings. “As a patient makes progress confronting his or her fears, virtual scenes can be adjusted to make the feared stimulus more provocative,” Weir quoted Rizzo. “At its core, virtual reality is essentially a controlled stimulus environment,” he said.
While the positive results of virtual reality use with patients suffering from social anxiety disorders are encouraging, some professionals caution against assuming success is ubiquitous for all patients in all situations. “As virtual reality takes off in so many directions, researchers are enthusiastic—and cautious,” Weir wrote.
She indicated one study, published in 2009 by Media Psychology, in which researchers Kathryn Segovia, Ph.D. and Jeremy N. Bailenson concluded “that when elementary school-age children watched a virtual version of themselves swimming with whales, many later believed it had happened in real life," Thus, over the next few years as these technologies continue to improve and evolve, “more research is needed to understand the risk of creating false memories through virtual reality,” added Weir.
Laura Stiles, in an article this month for Psychiatry Advisor, presented commentary from a study by Kristiina Kompus, PhD, from Bergen University in Norway, who questioned “whether the benefits that virtual reality can bring to therapy extend to complex challenges involving social cognition, such as positive and negative symptoms or social participation in patients with psychosis.”
Stiles noted that results from the Kompus study and others recognized that the technology is indeed a positive addition to therapy, but “more research is needed to determine the long-term effects of virtual reality”.
Social Anxiety Association. (Retrieved February 21, 2018). Social Anxiety Fact Sheet: What is Social Anxiety Disorder? Symptoms, Treatment, Prevalence, Medications, Insight, Prognosis. http://socialphobia.org/social-anxiety-disorder-definition-symptoms-treatment-therapy-medications-insight-prognosis
Stiles, L., Editor., (February 8, 2018). Psychiatry Advisor. Virtual Reality Can Reduce Anxiety, Improve Social Interactions in Psychosis. https://www.psychiatryadvisor.com/schizophrenia-and-psychoses/schizophrenia-psychosis-anxiety-paranoia-social-avoidance-cbt-cognitive-behavioral-therapy-vr/article/742962/
The American Journal of Psychiatry. (Retrieved February 21, 2018). Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of acrophobia. https://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.152.4.626
Weir, K., (February 2018). American Psychological Association. Virtual reality expands its reach. http://www.apa.org/monitor/2018/02/virtual-reality.aspx