Immersive Interventions: How Virtual Reality Can Take Talk Therapy To The Next Level

​You are sitting in the therapy chair. You have had this debilitating anxiety over presenting to your team at work for months. It is just getting worse. Every time it’s your turn to present, your heart races, you stumble through it, and find yourself having a panic attack later in the bathroom. It’s starting to impair your work performance and your boss has expressed concern over how anxious you seem around the office. You’ve had enough, and that’s why you are here. So your therapist is having you close your eyes and imagine yourself in the room, presenting to them. She’s teaching you some breathing exercises to try before you present, and some grounding exercises to do during it.
 
Then she says, now try all these things at work. But when it’s your turn to present again, you choke again, even after all that effort and planning. Your mind goes blank, and you can’t remember any of the skills you learned in therapy. What gives?

This is an example of public speaking anxiety, but you could easily fill in the blank with any fear you experience. In traditional evidence-based therapy, exposure to a feared person, place, thing, or situation is part of the therapy process. After all, if all you do is think about, it doesn’t actually change your ability to do the thing that scares you, so approaching your fears is a necessary part of growth.
 
The problem is, the actual object or person or situation is not physically present in the therapy room. Therapists can’t easily bring a snake into the room, or a tall cliff, or a place where something bad happened to you, or a bunch of professionals in a board room staring at you.
 
So therapists frequently use something called imaginal exposure – they have you close your eyes, and vividly recall the thing you fear, processing the experience in the moment. This does indeed work. Over time, thinking about the feared situation in a present-focused, detail-oriented way reduces the intensity of the fear (a process we call in nerdy psychology terms “habituation.” I’ll save diving into this concept for another post). However, the issue is, the homework itself is still fundamentally different from your imagination. You can’t smell, and feel, and hear in your imagination. You also can control your imagination better than the outside world. That means you can filter it, censor it, leave out the really scary parts. And as I discussed in a previous post, the brain naturally tries to avoid pain, so you may find yourself avoiding some of the sticky details in your mind, even if you aren’t intending to.
 
This is where virtual reality comes in.
 
Virtual Reality is usually associated with gaming, but it is so much more in the healthcare field. VR exposure therapy was first developed to address post-traumatic stress. It is currently being studied in the military as a  way to help soldiers confront traumatic events that occurred while they were deployed, and it’s really working. Now, there are VR programs to help with any fear you can imagine, from heights, to public speaking, to enclosed spaces like elevators, to spiders. When immersed in VR, you see things in crisp three dimensional detail, while knowing you are still safe in the therapy room. You have your provider there with you to help you employ the tactics and techniques for calming the body while being confronted with something that scares you. This acts as a stepping stone between simply imagining something and actually encountering it. That way, you can face down the fear quickly, and get back to engaging in your life fully.
 
Interested in VR therapy? I offer VR enhanced mindfulness training and exposure treatment in my downtown San Francisco office. Feel free to reach out to discuss more.