Rediscover virtual reality therapy for fear, phobias, and other anxiety disorders

Virtual reality therapy is an innovative service that enhances therapies aimed at treating anxiety and phobic disorders.

Virtual reality (VR), in technical terms, is a three-dimensional environment generated by a computer, where people can simulate various experiences. In this imaginary world, you can interact with other people and manipulate various objects.

VR is a tool that streamlines the results of psychotherapy for anxiety and other mental conditions. Exposure to what scares us in a safe environment is one of the ways most phobias are treated.

In behavioral therapy, the patient’s exposure is done in an imaginary plan, with the therapist guiding the patient to mentally construct situations that generate fear.
Through VR (virtual reality), the patient experiences much more authentic stressful situations, and through gradual exposure, desensitization to the phobic object or situation is achieved.

Through virtual reality – VR, the patient experiences the unique and complex feeling of being in contact with what causes fear, while feeling safe at the same time, by being aware of the situation created in the psychotherapy office. Gradually, repeating this exceptional experience leads to the reduction and even disappearance of the problem.

Unlike in vivo exposure, virtual reality allows the therapist to have complete control over the exposure parameters.

How it works:

In concrete terms, during the patient’s exposure to the phobic stimulus, such as flying on an airplane, the therapist records their pulse and breathing. As the patient, under the guidance of the therapist, becomes accustomed and relaxes, their heart rate and breathing rhythm change, which is quantified by recording them accurately. The patient’s direct visualization of the physiological changes occurring in their body contributes significantly to achieving therapeutic objectives.

In order to be effective, exposure to the phobic factor must be graded and repeated.

In virtual environments, the therapist can more effectively use exposure techniques, systematic desensitization, cognitive restructuring, diaphragmatic breathing, muscle relaxation, visualization, etc. Another unique aspect available to therapists using virtual reality – VR is the ability to record and control the level of physiological and emotional activation through the Biofeedback tool.

In recent years, Virtual Reality (VR) and Augmented Reality (AR) have demonstrated high clinical efficacy in the treatment of phobias and anxiety disorders, which affect approximately 20% of the population and tend to worsen if not properly treated.

We will now briefly present some of the conditions in which virtual reality – VR is extremely effective, producing remarkable results.

1. Blood phobia or Hemophobia

Blood phobia or Hemophobia is an extreme and irrational fear of blood.

According to the World Health Organization, this condition ranks third among the most widespread phobias, after those related to animals and the void. As such, approximately 2-3% of the world’s population suffers from this condition.

Hemophobia can negatively impact the quality of life of those who suffer from it. These individuals tend to avoid essential medical interventions, regular medical check-ups (necessary, for example, during pregnancy or chronic illnesses), visits to sick people, or even give up medical appointments altogether.

Symptoms of Hemophobia

While symptoms vary from individual to individual, the most common ones include fainting, nausea, palpitations, panic attacks, and excessive sweating.

Feelings associated with Hemophobia

The most common feelings experienced by a person with hemophobia are the fear of losing control and experiencing a panic attack, the fear of being judged, and feelings of disgust and repulsion.

Treatment of Hemophobia

Recent research has demonstrated the exceptional clinical efficacy of virtual reality in the treatment of this phobia. This technology offers the ideal context for recreating situations that are feared by the patient in a safe and controlled manner within a therapist’s office. Thus, the patient gradually experiences, for example, the process of having blood drawn, while the therapist has the ability to introduce various anxiogenic events or stimuli into a virtual reality session.

2. Fear of flying

The fear of flying is one of the obstacles encountered by one in five people who need to travel long distances. This phobia is characterized by intense and persistent fear, related to thoughts about a potential flight or actual flying experience.

People can experience varied emotions, from discomfort during the flight to real terror when just thinking about boarding, often leading to avoidance of this mode of transportation. The possibility of an accident, including the fear of dying in a plane crash, the idea of being confined in a very small space, fear of heights, distrust in others (such as the pilot’s abilities), fear of losing control (such as experiencing a panic attack during the flight) are among the most common fears.

 

Treatment for the fear of flying

The most effective treatment for the fear of flying is exposure techniques combined with relaxation and cognitive restructuring techniques. In this context, virtual reality is an especially suitable tool, significantly reducing the costs and efforts required for in vivo exposure (in real life).

In order to be effective, exposure to the phobic factor must be graded and repeated. .

Classical therapy for treating the fear of flying

The very high costs and complexity of the experience (the patient practically has to fly several times with the airplane, accompanied and guided by a psychotherapist) leads to the abandonment of such exposure.

The alternative is to experience these sensations in the imaginary realm, a technique that can be inefficient, given the different imagination capacities of patients.

Therapy aided by virtual reality

A significant advantage of exposure through virtual reality (VR) in the fear of flying is given by the possibility that the therapist has to control and introduce different flight parameters, such as the length of the flight, weather conditions, travel time, turbulence, etc.

3. Fear of Heights or Acrophobia

The fear of heights or Acrophobia is a condition that affects 3-5% of the general population. It is not necessarily pathological and only becomes a problem if the anxiety response is uncontrollable, leading the patient to a panic attack or feelings of suffocation, etc

This phobia falls under the category of “specific phobias”, which can cause an intense response and anxiety to a specific stimulus – in this case, when people are exposed to heights.

The fear of heights is considered natural, even adaptive, because the avoidance response could be positive when people feel they are in a risky environment. Psychological intervention is recommended in situations where acrophobia significantly affects the patient’s life, avoiding places that are not at ground level due to fear of a panic attack or high anxiety.


Virtual reality is a good alternative compared to traditional exposure techniques in the treatment of acrophobia for several reasons. Moreover, studies have shown that using VR exposure as a technique is at least as effective as in vivo exposure (Emmelkamp et al., 2002).

Virtual Reality versus Traditional Techniques in the Treatment of Acrophobia – Fear of Heights

Traditional technique

» Difficulty in obtaining an optimal environment in real-life to treat this phobia

» It requires the therapist and patient to move in vivo – in real life and expose themselves to the triggering factor.

» The patient may refuse exposure to the real triggering factor, leading to panic attacks.

Virtual reality

» The therapist has more exposure variables.

» It is less costly logistically – exposure is done in the office, in a virtual environment.

» It is less likely for the patient to refuse exposure to this treatment.

4. Claustrophobia

Claustrophobia is defined by the American Psychiatric Association as the fear and avoidance of enclosed spaces. The patient experiences persistent and irrational fear triggered by the situation of being in a confined space or anticipating being in such places.


It is most often associated by patients with the fear of riding in elevators or undergoing medical investigations using MRI or CT scans. The symptoms associated with this disorder are similar to those of a panic attack: dizziness, feeling of suffocation, vomiting, cardiac discomfort, etc. As a result, the patient avoids the situations mentioned above, thus reducing the quality or safety of their life.

Specialized research indicates that virtual reality is a good alternative to traditional exposure techniques for the treatment of claustrophobia. Unlike in vivo exposure, virtual reality allows the therapist to have total control over exposure parameters. This technology can eliminate the risk of reinforcing existing fear by preventing panic attacks, and exposure can be repeated as many times as necessary, which helps to achieve effective results.

5. Agoraphobia

Agoraphobia – a term derived from the Greek words agora – market and phobia – fear, initially used to describe a pathological fear of open spaces, is defined as the fear of being alone in situations and, especially, in public places from which you believe you cannot easily escape or where there is no available help in the event of a panic attack.
Panic attacks and agoraphobia are the most common conditions encountered in clinical practice. Approximately 50-60% of patients who seek the services of a psychologist or psychiatrist are faced with anxiety, panic attacks, or agoraphobia (Bados, 2009).

How it manifests

When agoraphobic individuals are about to enter an open space, they tend to anticipate a panic attack. The state of fear intensifies as they approach the place and begin to experience feelings of suffocation, dizziness, blurred vision, palpitations, and anxiety. The panic attack actually occurs only by imagining the danger that may arise in those spaces. Anticipating these panic attacks creates a strong desire for agoraphobics to return home, where they feel safe.


Virtual reality versus traditional techniques in the treatment of agoraphobia – fear of public places

Virtual reality

» Virtual reality allows standardization and control over exposure session parameters.

» Exposure can be repeated as many times as necessary. (Botella et al, 2004)

» The occurrence of panic attacks is avoided, and the risk of consolidating existing fear is eliminated.

Traditional technique

» Traditional techniques do not allow standardization and control over exposure session parameters.

» Exposure involves logistics and travel to the environment that triggers the phobia.

» Panic attacks and feelings of suffocation, dizziness, blurred vision, palpitations, and anxiety may occur.

6. Glossophobia - Fear of Public Speaking

The fear of public speaking is classified as a social phobia. Recent research indicates that 34% of the population may experience anxiety when faced with a public speaking situation, which can have negative repercussions on a person’s educational or professional trajectory.

Approximately 3 out of 4 people (74%) experience anxiety when speaking in public or even just thinking about it, and women tend to be more emotional than men when it comes to giving a public speech, according to the Statistic Brain Research Institute.

In reality, according to psychologist Lenke Iuhos, glossophobia is not necessarily a fear of speaking in public itself, but rather a conglomerate of other fears, such as:
• fear of making mistakes
• fear of being criticized
• fear of being booed
• fear of dealing with difficult people in the audience
• fear of not being interesting enough
• fear of having a mental block and forgetting everything you were going to say.

Treatment for this type of phobia typically relies on exposure techniques combined with relaxation techniques, cognitive restructuring, and, in certain cases, public speaking skill training. However, since it can be difficult to provide an appropriate space and audience, it can be challenging to carry out such exposures. Additionally, certain parameters such as controlling audience reactions and other factors beyond the therapist’s control increase the difficulty of exposing the patient to an in vivo experience in the case of social phobias.

Long-term research has shown the effectiveness of virtual reality (VR) for fear of public speaking, which is a special tool suitable for conducting exposure and/or public speaking skill training sessions in a safe and prescribed context.

7. Fear of driving

The fear of driving is characterized by intense and persistent fear that increases with anticipation or exposure to driving stimuli. Recent studies have shown that the prevalence of this phobia is 4% of the population, although the percentage of people with some type of driving-related fear could rise to 22%.

Symptoms of driving phobia

Symptoms of driving phobia can cause significant discomfort and greatly affect the daily lives of patients. Certain factors influence the intensity of the patient’s emotional reaction while driving. The most common and important factors include:
• speed
• weather
• traffic congestion
• distance to be traveled
• time of day when driving: day or night
• road characteristics
• type of vehicle, etc.

Virtual reality has proven to be a good alternative to traditional exposure techniques in the treatment of driving phobia.
• It allows standardization and control of the parameters within exposure sessions.
• It is especially useful in repeating exposure as many times as necessary for those traffic situations that are unpredictable or of limited duration.
• It reduces the chances of having an accident and diminishes the feelings of embarrassment that the patient might develop.

8. Fear of animals

Animal phobia, insectophobia or entomophobia is classified as a specific phobia of certain animals. Nowadays, the fear of animals has become a very common problem. Recent studies show that 7.9% of the population has experienced this type of problem at some point. Fear of cockroaches and spiders are among the most common types of fears.

People who suffer from phobias related to spiders and/or cockroaches usually try to avoid all situations where they believe they may encounter the feared animal, which can lead to serious consequences in their family, social and work life. If they are unable to avoid the situation, these individuals face high and very intense levels of anxiety. Even once the animal has disappeared, they remain in a state of alert.

Among the main fears that people with animal phobias face are:
• the sudden movement of the anima
• its physical appearance
• the sounds it emits
• the breed
• the size
• the animal’s ability to move freely
• the distance from the animal or being accompanied by other people.

It is important to underline that there is not only an intense reaction of fear towards the possibility of the animal approaching and attacking, but entomophobia is also characterized by a strong feeling of disgust and repulsion.

In such cases, the preferred treatment is based on the use of exposure techniques, with a success rate of approximately 90%. Despite this fact, it is very complicated to properly conduct live exposure sessions due to the difficulty of controlling insect reactions, the difficulty of creating specific situations (e.g. killing a cockroach), finding certain species, etc. Leaving aside the difficulty of directly involving animals in live exposure, the therapist faces the refusal of patients to do such direct exposure exercises.

An effective alternative that has emerged in recent years is the use of exposure strategies supported by Augmented Reality (AR). This is a technology that allows the combination of the real world with digital objects. In the case of animal phobia, augmented reality – AR allows the controlled and safe introduction of different animal species into the patient’s familiar environment (e.g. therapist’s office, patient’s home, etc.). Thus, systematic and personalized exposure sessions are constructed for each patient’s needs. All these aspects make AR a valuable resource for the treatment of insectophobia.

9. Social Anxiety

Social anxiety or social phobia is a chronic mental condition characterized by anxiety, fear, shame, and embarrassment in everyday interactions with others, due to the fear of being judged by them.

Virtual reality (VR) is a beneficial tool for the treatment of social phobiabecause it exposes the patient to social interactions, cognitive restructuring, social skills training, and allows the therapist to teach the patient how to relax. Furthermore, virtual exposure can be applied in an anxiety-provoking or unfavorable situation (in a noisy environment, in the midst of conversations, surrounded by various people, etc.), and can be designed according to the patient’s exposure needs.

10. OCD (Obsessive-Compulsive Disorder)

OCD is a common, chronic, and long-lasting condition in which a person has uncontrollable, persistent thoughts (obsessions) and behaviors that they feel the need to repeat (compulsions).

People with this disorder can have obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships. Obsessions are repeated thoughts or mental images that cause anxiety.

The most common obsessions include:

• repeated thoughts about contamination (example: getting contaminated by shaking hands with other people)
• repeated doubts (example: wondering if one has performed a certain act – if they locked the door, if they hit someone in a car accident)
• the need to put things in a certain order (example: intense discomfort and anxiety when objects are placed in disorder or asymmetry)
• aggressive or horrible impulses (example: harming their own child or shouting an obscenity in church); these thoughts, impulses, images are not just fears related to current life difficulties.

Virtual reality is a very effective alternative to traditional techniques used in the treatment of obsessive-compulsive disorders. Virtual reality allows for the standardization and control of exposure session parameters. It is also very useful for repeating exposure to fear or anxiety-provoking situations whenever necessary, which significantly contributes to the success of the therapeutic process.

11. Alcoholism

Alcoholism or alcohol addiction is the consumption of alcoholic beverages, occasionally or periodically, with the goal of changing one’s mood or avoiding unpleasant physical or psychological symptoms caused by withdrawal.


 
The consumption is continued regardless of situations or the consequences of consumption on the person or family. Psychotherapy for people dependent on alcohol using virtual reality – VR is much more effective. In this way, the patient is exposed to those environments and life situations that facilitate and practically lead to consumption. Under the guidance of the therapist, the patient learns to develop mechanisms to cope with temptations and group pressure, aspects frequently encountered in addiction cases.

Schedule a consultation with Med Anima and find out how Virtual Reality Therapy can be helpful for you.

Relaxation in Virtual Reality Therapy – VR

Relaxation is a technique that can be used to control and balance physiological experiences when the patient learns to manage their quality of life. The relaxation technique is also used to treat certain disorders because it aims to reduce overall anxiety and increase self-control.

There are several relaxation techniques, but in virtual reality - VR, the most effective techniques, proven by years of research and studies, are used: diaphragmatic breathing and progressive muscle relaxation.

Diaphragmatic breathing is linked to levels of physiological activity. In fact, it has been observed that a high level of anxiety can be reduced as a result of practicing breathing exercises. Moreover, it is worth mentioning that breathing in an inappropriate way could trigger hyperventilation and even panic attacks. In diaphragmatic breathing, also known as abdominal breathing, the air that enters through the nose fills both the upper and lower parts of the lungs rather than just the upper portion. Compared to the shallow, rapid breathing that the patient has when in panic, deep diaphragmatic breathing is felt to be very calming.

Effective breathing brings many benefits to our body, such as:

» increase in lung volume
» regulation of blood pressure
» decrease in muscle tone
» improvement of gastrointestinal disorders
» pain management
» reduction of anxiety
» improvement of attention, memory, and learning capacity.

Feeling better in their own body, the patient will be more open to confront unfavorable situations, learn to identify different types of breathing, and thus reduce their sense of anxiety.

Relaxing muscle tension is one of the most important components of anxiety management. Although it is produced automatically and unintentionally, it can be controlled in a way. Just like breathing, we can also manage our own muscles after learning and practicing special exercises.

By learning Jacobson’s progressive muscle relaxation, patients can monitor muscle tension in order to achieve relaxation. During muscle relaxation, the patient must be aware of their muscle state, so special attention is given to the tension-relaxation cycle.

Progressive muscle relaxation can contribute to:

✔️ improving tension and muscle contraction, leading to vasodilation and improved circulation
✔️ reducing blood pressure, improving respiration and digestion
✔️ reducing unnecessary energy expenditure, stress, and anxiety.

Mindfulness

Mindfulness is a special way of connecting with oneself. The concept is taken from ancient Buddhist meditation techniques, but today it represents a technique of intentional concentration of attention on the present moment and acceptance without judgment of the thoughts, emotions, and sensations that define us..

Mindfulness is an effective technique in treating depression, but it can also be used in attention deficit hyperactivity disorder (ADHD).

The meditation techniques, in combination with components of cognitive behavioral therapy, help patients become more aware of their patterns of thinking, feelings, and actions. In addition, they help them accept their unwanted inner experiences (Morgan, Danitz, Roemer, & Orsillo, 2016).

People with mental disorders develop various specific behavioral and cognitive processes that contribute to the development and maintenance of disorders (Barlow et al., 2004 and Mansell et al., 2009, cited in Boettcher et al., 2014):

» selective attention (both external and internal)
» attentional avoidance
» interpretation
» recurrent negative thoughts and avoidance
» behavioral assurances (Harvey et al., 2004; cited in Boettcher et al., 2014).

Mindfulness practice addresses these specific processes in particular.

EMDR is a bilateral simulation technique in which, on the one hand, eye movements are made, and on the other hand, the disturbing thought is kept in mind (Marín et al., 2016). This technique was designed for patients with post-traumatic stress disorder (PTSD) who have experienced traumatic events such as natural disasters, attacks, sexual abuse, etc. According to Saphiro (2001), almost all disorders can have a traumatic origin, so the use of EMDR is justified in various problems such as phobias, addictions, depressive disorders, generalized anxiety, OCD, body image in eating disorders, personality disorders, and behavioral problems, etc. Virtual Reality EMDR environment will promote the relaxation effect by projecting the patient into unique and pleasant natural spaces.

In conclusion, the use of virtual reality is highly effective and offers concrete benefits:

1. It provides a higher degree of privacy compared to exposure in reality.

2. It significantly reduces therapy costs, as it is not necessary, for example, for therapists to change locations or hire co-therapists.

3. It allows for treatments in difficult-to-access situational settings (takeoffs, storms, exposure to various types of animals or insects, extended audiences when speaking in public) and facilitates the therapeutic process for patients with imaginative difficulties.

4. It offers greater control over stimuli and stimulation conditions. The therapist can decide whether it is day or night, rainy or sunny

5. It allows for the creation of situations that exceed what can be found in reality. For example, to recreate 10 consecutive takeoffs or to ride an elevator without stopping at any floor for 5 minutes.

6. It facilitates self-preparation and over-learning, as the patient does not have to wait for events to occur in real life, but can produce and reproduce them whenever they want.

7. It allows the therapist to control and observe what the patients experience, which helps him or her to more easily detect stimuli with greater clinical relevance.

8. It allows for the design of exposure hierarchies to the feared situation in a personalized way, going through each step in a very detailed manner.

9. It is an activity in which the patient adopts an active and participatory role (Bruner, Vygotsky, Piaget). In this way, the patient can promote re-learning and behavior modification.

There are also some side effects, limitations, and contraindications in the use of VR:

  • some patients may experience mild dizziness, blurred vision, headaches, or other visual effects (effects also experienced when watching a 3D movie in a cinema);
  • a low percentage of individuals (approximately 0.025%) may experience seizures, nausea, disorientation; seizures are more common in people with epilepsy;
  • exposure to certain virtual environments is contraindicated for certain patients with cardiac or psychiatric diseases without the recommendation of the treating physician.

Would you like to discuss VR therapy with one of our specialists? Ask Med Anima doctors:

Appointments in IAȘI:

0747 202 212 / 0332 505 114

Appointments in TIMIȘOARA:

0754 431 431 / 0356 800 300

Contact Iași:

Str. Străpungere Silvestru nr. 60, bl. CL11, sc. B, ground floor, Iași, county: Iași

Contact Belcești:

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Contact Timișoara:

Str. Simion Bărnuțiu nr. 34, Timișoara, county: Timiș

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