Picture this: You’ve boarded an aircraft bound for a holiday destination. As you watch through the window, the landscape begins to flow by, picking up speed as the aircraft’s engines roar to life. Your heart rate accelerates. Your hands feel cold and clammy. You cling to your armrests, white-knuckled and wishing the flight was over. Flying is not your thing.

You close your eyes, practicing a breathing technique you’ve worked on with your therapist. Finally, takeoff! You’re gaining altitude. The captain announces the plane’s reached cruising altitude. You’re on your way!

Sounds familiar, right? But this day’s different—your takeoff didn’t actually happen. Instead, you’ve been sitting in a specialized medical office designed for virtual reality exposure therapy (VRET). Your psychologist is ready to discuss it.

Already, you feel better than you have about past sessions. This time you made it all the way through takeoff—a huge improvement in your treatment for aerophobia (fear of flying).

 

The burden of anxiety

According to the National Alliance on Mental Illness, anxiety disorders such as aerophobia affect an estimated 19.1% of adults in the US.

Anxiety disorders. NAMI: National Alliance on Mental Illness. December 2017.

Additionally, about 7%of children between the ages of 3 and 17 experience anxiety issues. Common anxiety disorders include:

 

• Generalized anxiety disorder

• Panic disorder

• Phobias

• Social anxiety disorder

Traditional anxiety treatment centers on pharmacotherapy, psychotherapy, and cognitive behavioral therapy, often used in combination. For many, these treatments help reduce symptoms of some types of anxiety disorders. For other disorders, such as phobias, conventional therapies don’t seem to work as well.

Lake J. Conventional treatments of anxiety disorders: A concise review of their benefits and limitations. Psychology Today. July 25, 2018.

 

 

What is VRET?

Virtual reality is gaining a foothold in several aspects of medicine as a way for clinicians to help patients work through health issues. The technology uses computers to create a fully immersive, interactive 3D environment that allows patients to experience feared stimuli safely and in a controlled manner.

Boeldt D, McMahon E, McFaul M, et al. Using virtual reality exposure therapy to enhance treatment of anxiety disorders: Identifying areas of clinical adoption and potential obstacles. Front Psychiatry. 2019;10:773.

 

VRET is highly customizable, allowing clinicians to gradually and incrementally expose patients to sources of anxiety and stress. In recent years, a growing number of applications have been created for clinical care settings, and randomized control trials have demonstrated that VRET is as effective as conventional treatment.

Vincent C, Eberts M, Naik T, et al. Provider experiences of virtual reality in clinical treatment. PLoS One. 2021;16(10):e0259364.

 

During sessions, providers can see what the patient sees in the virtual environment, monitoring them for stress and guiding them through stress reduction techniques.

This keeps patients engaged and prepares them for real-world exposure to anxiety-causing stimuli. With VRET, the patient can explore and practice different coping methods to reduce anxiety symptoms and improve comfort and confidence.

 

What providers say about VRET

Most clinicians experienced in VRET share positive feedback. The technology’s flexibility, adaptability, and accessibility all benefit patients when used alone or with traditional therapies. Most also say the technology is very intuitive to use for them and their patients.

However, as a relatively new treatment, VRET does have some drawbacks. Patients may experience discomfort or, in some cases, cybersickness. Others may perceive a virtual experience unfavorably if the scene is unrealistic or grainy in appearance. Finally, most providers are currently unable to bill for VRET, and its cost may prevent clinicians from adopting it.

By extension, the technology may find application to other aspects of medicine. VRET has already emerged as a useful tool for patients dealing with chronic pain syndromes, for example.

Logan DE, Simons LE, Caruso TJ, et al. Leveraging virtual reality and augmented reality to combat chronic pain in youth: Position paper from the interdisciplinary network on virtual and augmented technologies for pain management. J Med Internet Res. 2021;23(4):e25916.

As more patients and providers embrace this technology, it’s likely this approach to mental health treatment will become widely accepted.