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Is It Therapy or Is It a Video Game?

Telepsychiatry's next wave

Head-mounted displays, joysticks and surround sound systems may be coming soon to a therapist’s office near you. Virtual Reality Exposure Therapy, or VRET, is the next wave of a telepsychiatry revolution in full swing. 3-D lifelike environments are being designed to treat mental disorders by triggering and addressing symptoms in a controlled environment. Virtual environments are, of course, intrinsic to the online game experience and are often blamed for video games’ “addictive” quality. Why not use them for something potentially helpful?

Exposure is a cornerstone of cognitive-behavioral therapy, a standard psychotherapy treatment for phobias and several other psychiatric conditions. The patient is gradually “exposed” to the feared situation (e.g., tunnels, planes, elevators, spiders, snakes), until “extinction” of the fear response sets in and symptoms abate. There can be problems with this traditional exposure approach, however, including inconvenience, expense, and possible safety concerns, as when you are trying to extinguish an arachnid or reptile phobia...

VRET tries to provide an alternative. Exposure here is via immersion in a 3-D environment that mimics, in the therapist’s office, the feared scenario. A head mounted display is embedded in a helmet worn by the patient and connected to a computer that generates virtual representations of the anxiety source. Alternatively, a large U-shaped 3-D screen envelops the patient. A third option is a cave-like space where each wall is a screen displaying 3-D images. Sophisticated tools, including steering wheels, navigation controls and spatial motion trackers, enable the interaction between patient and virtual environment and allows therapy delivery.

These methods have been successfully used to treat a number of phobias, including aviophobia (fear of flying), acrophobia (fear of heights), claustrophobia (fear of closed spaces), driving phobia, and public speaking phobia. Studies in other disorders have also shown promise: Patients with social anxiety disorder who were made to interact in a busy virtual bar setting improved, as did Vietnam veterans with post-traumatic stress disorder who were exposed to a 3-D landscape of tropical vegetation and rice fields reminiscent of Southeast Asia.

Much more research remains to be done to fully vet VRET, but preliminary data are encouraging. Still, cost and availability might present an obstacle and limit its adoption. This is where the ever increasing popularity and sophistication of video games is a source of reassurance: Extrapolating from the ubiquity and relative affordability of relatively complex games such as Dragon Age and World of Warcraft, one might expect that VRET-equipped psychotherapy offices may not be so far-fetched or so far into the future.