Using Virtual Reality Exposure Therapy in the Treatment of Phobia

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Using Virtual Reality Exposure Therapy in the
Treatment of Phobia

• Amy Dunn, Gemma Hunt,
• Caroline Osborn and Phil Sequeira

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Phobias

• Phobias are irrational fears of non-threatening
  stimuli, involving physiological and cognitive
  stress

• Phobias are traditionally treated using exposure
  therapy or systematic desensitisation (Wolpe,
  1958)
• Repeated exposure to phobic stimulus relaxation
  techniques components of CBT gradually
  minimised phobic anxiety

• BUT provision of exposure can present some
  serious challenges

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Controversies

• Safety issues - confronting fear in real
  situations (Newman and Adams, 2004)

• Ethical considerations/client confidentiality
  issues resulting from real-world context
  (Davidson and Smith, 2003)

• VR exposure therapy attempts to overcome these
  problems

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VR Exposure Therapy

• Virtual reality exposure therapy (VRET) relates
  to the use of virtual environments (VEs) as a
  tool for the graded exposure to a phobic stimulus

• VRET is not a new therapeutic system, but a tool
  for use in established methods
• e.g. systematic desensitisation and
  cognitive-behavioural therapies (CBTs)
• The use of VR in the treatment of phobia can
  offer increased control and containment of
  therapy (Klinger et al., 2005)

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Controversies in VRET

• Cost

• Presence and immersion
• The feeling of being in an environment even if
  one is not physically present (Robillard et al.,
  2003468)

• Cyber-sickness
• a kind of motion sickness induced by
  discrepancies between visual, vestibular and
  proprioceptive information (Robillard et al.,
  2003468)
• Transferability of skills
• Effectiveness in inducing enough anxiety to treat
  phobias (Krijn et al., 2003)

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The Virtual Reality Suite

• The VR theatre is designed to display large
  stereoscopic virtual imagery to a seated audience

• This is achieved using three separate projected
  displays, which are blended together to create
  one seamless image
• The projectors and a rack containing all the
  image generators are located behind the screen in
  the projection room

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Case Study

• Anxiety and Presence during VR Immersion A
  Comparative Study of the Reactions of Phobic and
  Non-phobic Participants in Therapeutic Virtual
  Environments Derived From Computer Games (TVEDGs)

• Robillard, Bouchard, Fournier and Renaud (2003)

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Aims and Rationale

• TVEDGS
• VEs created using standard computer games, which
  cost less than 50 and are compatible with PCs
• Can be modified by users with little computing
  experience
• Graphic quality is often superior

• Aims
• Do TVEDGs evoke appropriate phobic reaction?
• To assess the impact of simulator-sickness and
  sense of presence

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Method

• Sample
• 13 phobic participants and 13 non-phobic
  participants, matched for age and gender
• Phobias were arachnophobia, acrophobia and
  claustrophobia

• Procedure
• 5 minutes to familiarise with VE and equipment
  (HMD, tracker and game-pad) without phobic
  stimuli
• 20 minute session with phobic stimuli both
  phobic and non-phobic participants experience the
  same phobic cues and are encouraged to interact
  with them
• Verbal reports regarding anxiety, immersion and
  cyber-sickness given throughout and assessed by
  questionnaire at the end

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The Virtual Environments

• Virtual environment for phobia of spiders -
  Version 2 (developed from Max Payne)

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The Virtual Environments

• Virtual environment for phobia of heights -
  Version 2 (developed from Max Payne)

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The Virtual Environments

• Virtual environment for claustrophobia - Version
  1 (developed from Unreal Tournament)

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Results

• Pre-exposure
• Phobic participants had significantly higher
  levels of anxiety and a higher propensity to
  immerse

• During exposure
• All participants except one reported low anxiety
  in neutral VEs

• Post-immersion
• Phobic participants reported greater anxiety and
  sense of presence
• Phobic participants reported greater simulator
  sickness (though not significant)

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Discussion

• Aim 1 Can TVEDGs produce phobogenic stimuli?
• Results show that anxiety was the product of VE
  stimuli and not VR equipment
• Using TVEDGs, for a quarter of the cost of
  commercial VRTs, therapists can provide an
  equivalent level of treatment

• Aim 2 What is the impact of simulator-sickness?
• Results suggest that simulator-sickness has no
  impact on phobogenic efficacy
• Adaptation effects Regan, 1995

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Discussion

• Aim 2 What is the impact of presence?
• Anxiety was importantly related to sense of
  presence
• Group differences show that it was phobic
  participants who had a greater tendency to
  immerse
• Correlations and regressions show that anxiety
  and presence were the most highly correlated
  variables and most predictive of each other
• These findings support a synergistic relationship
  but the underlying reasons remain unclear

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Conclusions of the Study

• Firstly, phobogenic effectiveness of the
  inexpensive software used, shows that VR
  technology is now sufficiently advanced for VRET
  to move into the clinical mainstream

• Secondly, the findings demonstrate that
  high-costs, issues relating to immersion, and
  side-effects such as cyber-sickness, need not
  remain barriers to effectiveness in the use of
  VEs to treat phobia

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Remaining Issues

• Verbal reports
• Impact on immersion
• Demand characteristics

• Retrospective questionnaire
• Accuracy of recall
• Transferability of skills
• Standardised environments Individual
  differences?
• Testing software efficacy/testing therapeutic
  efficacy

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Thank you for listening

• Any Questions?

29
References

• Davidson, J., and Smith, M. (2003).
  Biophobias/technophilias Virtual reality
  exposure as treatment for phobias of nature.
  Sociology of Health and Illness, 25(6), 644-661.
• King, N.J., Muris, P., and Ollendick, T.H.
  (2005). Childhood fears and phobias Assessment
  and treatment. Child and Adolescent Mental
  Health, 10(2), 50-56.
• Klinger, E., Bouchard, S., Legeron, P., Roy, S.,
  Lauer, F., Chemin, I., and Nugues, P. (2005).
  Virtual reality therapy Vs cognitive behaviour
  therapy for social phobia A preliminary
  controlled study. Cyberpsychology and Behaviour,
  8(1), 76-88.
• Krijn, M., Emmelkamp, P.M.G., Biemond, R., de
  Wilde de Ligny, C., Shuemie, M.J., and van der
  Mast, C.A.P.G. (2003). Treatment of acrophobia in
  virtual reality The role of immersion and
  presence. Behaviour Research and Therapy, 42,
  229-239.

30
References

• Newman, C., and Adams, K. (2004). Dog gone good
  Managing dog phobia in a teenage boy with a
  learning disability. British Journal of Learning
  Disabilities, 32, 35-38.
• Regan, E.C. (1995). Some evidence of adaptation
  to immersion in virtual reality. Displays, 16(3),
  135-139.
• Robillard, G., Bouchard, S., Fournier, T., and
  Renaud, P. (2003). Anxiety and presence during VR
  immersion A comparative study of the reactions
  of phobic and non-phobic participants in
  therapeutic virtual environments derived from
  computer games. Cyberpsychology and Behaviour,
  6(5), 467-476.
• Virtual environments. Retrieved May 13th 2005,
  from http//www.uqo.ca/cyberpsy/index-en.html

31
References

• Davidson, J., and Smith, M. (2003).
  Biophobias/technophilias Virtual reality
  exposure as treatment for phobias of nature.
  Sociology of Health and Illness, 25(6), 644-661.
• King, N.J., Muris, P., and Ollendick, T.H.
  (2005). Childhood fears and phobias Assessment
  and treatment. Child and Adolescent Mental
  Health, 10(2), 50-56.
• Klinger, E., Bouchard, S., Legeron, P., Roy, S.,
  Lauer, F., Chemin, I., and Nugues, P. (2005).
  Virtual reality therapy Vs cognitive behaviour
  therapy for social phobia A preliminary
  controlled study. Cyberpsychology and Behaviour,
  8(1), 76-88.
• Krijn, M., Emmelkamp, P.M.G., Biemond, R., de
  Wilde de Ligny, C., Shuemie, M.J., and van der
  Mast, C.A.P.G. (2003). Treatment of acrophobia in
  virtual reality The role of immersion and
  presence. Behaviour Research and Therapy, 42,
  229-239.

32
References

• Newman, C., and Adams, K. (2004). Dog gone good
  Managing dog phobia in a teenage boy with a
  learning disability. British Journal of Learning
  Disabilities, 32, 35-38.
• Regan, E.C. (1995). Some evidence of adaptation
  to immersion in virtual reality. Displays, 16(3),
  135-139.
• Robillard, G., Bouchard, S., Fournier, T., and
  Renaud, P. (2003). Anxiety and presence during VR
  immersion A comparative study of the reactions
  of phobic and non-phobic participants in
  therapeutic virtual environments derived from
  computer games. Cyberpsychology and Behaviour,
  6(5), 467-476.
• Virtual environments. Retrieved May 13th 2005,
  from http//www.uqo.ca/cyberpsy/index-en.html

33
References

• Davidson, J., and Smith, M. (2003).
  Biophobias/technophilias Virtual reality
  exposure as treatment for phobias of nature.
  Sociology of Health and Illness, 25(6), 644-661.
• King, N.J., Muris, P., and Ollendick, T.H.
  (2005). Childhood fears and phobias Assessment
  and treatment. Child and Adolescent Mental
  Health, 10(2), 50-56.
• Klinger, E., Bouchard, S., Legeron, P., Roy, S.,
  Lauer, F., Chemin, I., and Nugues, P. (2005).
  Virtual reality therapy Vs cognitive behaviour
  therapy for social phobia A preliminary
  controlled study. Cyberpsychology and Behaviour,
  8(1), 76-88.
• Krijn, M., Emmelkamp, P.M.G., Biemond, R., de
  Wilde de Ligny, C., Shuemie, M.J., and van der
  Mast, C.A.P.G. (2003). Treatment of acrophobia in
  virtual reality The role of immersion and
  presence. Behaviour Research and Therapy, 42,
  229-239.

34
References

• Newman, C., and Adams, K. (2004). Dog gone good
  Managing dog phobia in a teenage boy with a
  learning disability. British Journal of Learning
  Disabilities, 32, 35-38.
• Regan, E.C. (1995). Some evidence of adaptation
  to immersion in virtual reality. Displays, 16(3),
  135-139.
• Robillard, G., Bouchard, S., Fournier, T., and
  Renaud, P. (2003). Anxiety and presence during VR
  immersion A comparative study of the reactions
  of phobic and non-phobic participants in
  therapeutic virtual environments derived from
  computer games. Cyberpsychology and Behaviour,
  6(5), 467-476.
• Virtual environments. Retrieved May 13th 2005,
  from http//www.uqo.ca/cyberpsy/index-en.html

35
References

• Davidson, J., and Smith, M. (2003).
  Biophobias/technophilias Virtual reality
  exposure as treatment for phobias of nature.
  Sociology of Health and Illness, 25(6), 644-661.
• King, N.J., Muris, P., and Ollendick, T.H.
  (2005). Childhood fears and phobias Assessment
  and treatment. Child and Adolescent Mental
  Health, 10(2), 50-56.
• Klinger, E., Bouchard, S., Legeron, P., Roy, S.,
  Lauer, F., Chemin, I., and Nugues, P. (2005).
  Virtual reality therapy Vs cognitive behaviour
  therapy for social phobia A preliminary
  controlled study. Cyberpsychology and Behaviour,
  8(1), 76-88.
• Krijn, M., Emmelkamp, P.M.G., Biemond, R., de
  Wilde de Ligny, C., Shuemie, M.J., and van der
  Mast, C.A.P.G. (2003). Treatment of acrophobia in
  virtual reality The role of immersion and
  presence. Behaviour Research and Therapy, 42,
  229-239.

36
References

• Newman, C., and Adams, K. (2004). Dog gone good
  Managing dog phobia in a teenage boy with a
  learning disability. British Journal of Learning
  Disabilities, 32, 35-38.
• Regan, E.C. (1995). Some evidence of adaptation
  to immersion in virtual reality. Displays, 16(3),
  135-139.
• Robillard, G., Bouchard, S., Fournier, T., and
  Renaud, P. (2003). Anxiety and presence during VR
  immersion A comparative study of the reactions
  of phobic and non-phobic participants in
  therapeutic virtual environments derived from
  computer games. Cyberpsychology and Behaviour,
  6(5), 467-476.
• Virtual environments. Retrieved May 13th 2005,
  from http//www.uqo.ca/cyberpsy/index-en.html

37
References

• Davidson, J., and Smith, M. (2003).
  Biophobias/technophilias Virtual reality
  exposure as treatment for phobias of nature.
  Sociology of Health and Illness, 25(6), 644-661.
• King, N.J., Muris, P., and Ollendick, T.H.
  (2005). Childhood fears and phobias Assessment
  and treatment. Child and Adolescent Mental
  Health, 10(2), 50-56.
• Klinger, E., Bouchard, S., Legeron, P., Roy, S.,
  Lauer, F., Chemin, I., and Nugues, P. (2005).
  Virtual reality therapy Vs cognitive behaviour
  therapy for social phobia A preliminary
  controlled study. Cyberpsychology and Behaviour,
  8(1), 76-88.
• Krijn, M., Emmelkamp, P.M.G., Biemond, R., de
  Wilde de Ligny, C., Shuemie, M.J., and van der
  Mast, C.A.P.G. (2003). Treatment of acrophobia in
  virtual reality The role of immersion and
  presence. Behaviour Research and Therapy, 42,
  229-239.

38
References

• Newman, C., and Adams, K. (2004). Dog gone good
  Managing dog phobia in a teenage boy with a
  learning disability. British Journal of Learning
  Disabilities, 32, 35-38.
• Regan, E.C. (1995). Some evidence of adaptation
  to immersion in virtual reality. Displays, 16(3),
  135-139.
• Robillard, G., Bouchard, S., Fournier, T., and
  Renaud, P. (2003). Anxiety and presence during VR
  immersion A comparative study of the reactions
  of phobic and non-phobic participants in
  therapeutic virtual environments derived from
  computer games. Cyberpsychology and Behaviour,
  6(5), 467-476.
• Virtual environments. Retrieved May 13th 2005,
  from http//www.uqo.ca/cyberpsy/index-en.html

39
References

• Davidson, J., and Smith, M. (2003).
  Biophobias/technophilias Virtual reality
  exposure as treatment for phobias of nature.
  Sociology of Health and Illness, 25(6), 644-661.
• King, N.J., Muris, P., and Ollendick, T.H.
  (2005). Childhood fears and phobias Assessment
  and treatment. Child and Adolescent Mental
  Health, 10(2), 50-56.
• Klinger, E., Bouchard, S., Legeron, P., Roy, S.,
  Lauer, F., Chemin, I., and Nugues, P. (2005).
  Virtual reality therapy Vs cognitive behaviour
  therapy for social phobia A preliminary
  controlled study. Cyberpsychology and Behaviour,
  8(1), 76-88.
• Krijn, M., Emmelkamp, P.M.G., Biemond, R., de
  Wilde de Ligny, C., Shuemie, M.J., and van der
  Mast, C.A.P.G. (2003). Treatment of acrophobia in
  virtual reality The role of immersion and
  presence. Behaviour Research and Therapy, 42,
  229-239.

40
References

• Newman, C., and Adams, K. (2004). Dog gone good
  Managing dog phobia in a teenage boy with a
  learning disability. British Journal of Learning
  Disabilities, 32, 35-38.
• Regan, E.C. (1995). Some evidence of adaptation
  to immersion in virtual reality. Displays, 16(3),
  135-139.
• Robillard, G., Bouchard, S., Fournier, T., and
  Renaud, P. (2003). Anxiety and presence during VR
  immersion A comparative study of the reactions
  of phobic and non-phobic participants in
  therapeutic virtual environments derived from
  computer games. Cyberpsychology and Behaviour,
  6(5), 467-476.
• Virtual environments. Retrieved May 13th 2005,
  from http//www.uqo.ca/cyberpsy/index-en.html