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Virtual Reality Graduated Exposure Therapy for Anxiety

A safe and effective therapy for many anxiety disorders.

Virtual Reality Graded Exposure Therapy (VRGET) is an effective treatment of specific phobias, generalized anxiety, panic disorder, and agoraphobia.

As technology costs continue to decrease and internet service becomes more available, VRGET will become a widely used and cost-effective treatment for panic attacks, post-traumatic stress disorder, agoraphobia, social phobia, and specific phobias.

Like in-vivo and imaginal exposure therapy, VRGET has the goal of desensitizing the patient to a situation or object that would normally cause anxiety or panic. Controlled studies confirm that VRGET is more effective than conventional imaginal exposure therapy (using mental imagery to provoke the feared object or situation), and is comparable to in-vivo exposure therapy. Many anxious or phobic individuals are unable to tolerate conventional exposure therapy and remain chronically impaired because they never become desensitized to a feared object or situation.

VRGET is an effective treatment of many anxiety disorders including specific phobias, generalized anxiety, panic disorder with agoraphobia, and post-traumatic stress disorder. In a controlled study, VRGET and conventional cognitive-behavioral therapy were equally effective in the treatment of panic disorder with agoraphobia. However, patients who underwent VRGET required 33% fewer sessions (Vincelli 2003).

Controlled studies have also demonstrated the effectiveness of VRGET for many specific phobias including fear of flying, fear of heights, fear of small animals, fear of driving, and others. In one study, 65% of adults (45 total subjects) diagnosed with a specific anxiety disorder reported significant reductions in four of five anxiety measures (Maltby 2002). VRGET is as effective as conventional exposure therapy for fear of flying and is more cost-effective because both patient and therapist avoid significant time commitments and the need to use airplanes.

VRGET is beneficial for individuals who have been diagnosed with post-traumatic stress disorder (PTSD). A virtual environment that simulates the devastation that took place following the September 11, 2001 attacks of the World Trade Towers has been successfully used to treat individuals who suffered from severe PTSD following the attacks (Difede 2002). A previous blog post reviewed findings on VRGET for combat veterans diagnosed with PTSD. Combining VRGET with D-cycloserine, a partial NMDA agonist, may result in greater improvement in acrophobia symptoms compared to VRGET alone.

Several VRGET tools are currently available over the internet, permitting mental health professionals to guide patients in the use of these computer-based advanced exposure protocols through real-time video conferencing anywhere high-speed internet access is available.

In the coming years, standard treatment protocols for phobias, panic disorder, social anxiety, and PTSD will combine VRGET with biofeedback in outpatient settings or in the patient’s home via broadband internet connections, with conventional CBT, mind-body practices, and medications.

Safety considerations and contraindications in VRGET

Fewer than 4% of individuals report mild symptoms of disorientation, nausea, dizziness, headache, or blurred vision when in a virtual environment. “Simulator sleepiness” is a feeling of generalized fatigue that occurs infrequently. Intense sensory stimulation during VRGET can trigger migraine headaches, seizures, or gait abnormalities in individuals diagnosed with these medical problems.

VRGET is therefore contra-indicated in these populations. Chronically anxious patients with alcohol or substance use disorder should be cautioned against using VRGET. Patients who have disorders of the vestibular system (the part of the inner ear responsible for balance) should be advised to not use VRGET. Psychotic patients should not use VRGET because immersion in a virtual environment can exacerbate delusions and potentially worsen reality-testing.

About the Author
James Lake, MD

James Lake, M.D., a clinical assistant professor at the University of Arizona College of Medicine, works to transform mental health care through the evidence-based uses of alternative therapies.

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