A June 21, 1995, headline on page 11 of the New York Times read: “‘Virtual Reality’ Conquers Fear of Heights.” The article told the story of Chris Klock, a junior at Georgia Tech, who donned a head-mounted display once a week for seven weeks, and was transported to a 3-D environment simulating various altitudes. He stared down from a 20-story balcony, traversed narrow bridges suspended above water, and ascended 49 floors in a glass elevator—all without leaving the therapy room run by clinical psychologist Barbara Rothbaum. Klock was one of 17 students to complete Rothbaum’s experiment, which was the first controlled study using virtual reality (VR) to treat a psychological disorder. The study was published in the American Journal of Psychiatry, and the researchers found that those treated with VR reported reduced anxiety and avoidance of heights. Post-treatment, Klock was able to ride a real glass elevator to the restaurant atop Atlanta’s Westin Peachtree Plaza, rather than trudging up 72 flights of stairs.

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“Our phones were ringing off the hook,” recalls Rothbaum, now the director of the Trauma and Anxiety Recovery Program at Emory University School of Medicine and the Emory Healthcare Veterans Program. The study, she explains, “presented VR in a whole new light.”

The term “virtual reality” had been coined less than a decade prior in 1987 by computer scientist Jaron Lanier—although cinematographer Morton Heilig built the first immersive virtual experience, known as the “Sensorama,” back in 1960. At the time of Rothbaum’s study, the nascent technology was still primarily considered entertainment, and so the notion that it could have clinical utility was unexpected.

Rothbaum and her collaborator, computer scientist Larry Hodges, were set on devising a virtual alternative to traditional exposure therapy, in which therapists help patients confront anxiety-inducing stimuli in real life or by simply visualizing triggers. Using VR meant that Rothbaum didn’t have to rely on her patients’ imaginations, or physically take them to the highest heights to face their phobias. She could also precisely control the environment and grade the exposure. For example, when she is treating someone for a fear of flying, she can determine when and if to introduce turbulence. And, her patient can take off and land as many times as needed during their hour-long session.

Virtual Reality Glass Elevator View
In 1995, study participant Chris Klock rode a virtual glass elevator up 49 floors, which has since been updated to look like this. Virtually Better, Inc

In the several decades since Rothbaum’s first experiment, medical professionals have primarily used VR to treat anxiety disorders, but they have also applied the technology to depression, addiction, pain, ADHD, autism, Alzheimer’s disease, traumatic brain injury, stroke and more. As VR continues to become more sophisticated and affordable, it has transitioned from an expensive toy to a multifaceted technology with the potential to improve patient care. However, as encouraging as the growing body of clinical evidence is, VR still faces barriers to widespread implementation, as well as lingering ethical concerns about personal data sharing. While researchers work to address these remaining issues, many predict VR treatments will soon become available to anyone who needs help—whether or not a patient has access to a real-life therapist.

Broadly speaking, virtual realities are interactive, 3-D computer-generated environments. Some VR is “non-immersive”—that is, delivered on a phone, computer or television, and akin to playing a modern video game. Other VR experiences, like those Rothbaum employs and the examples covered in this article, are “immersive.” They involve some combination of head-mounted displays, sensors for tracking the user’s position and eye movement, and multi-sensory feedback systems like haptic gloves and scent delivery devices, which create the illusion of interacting with the virtual space.

According to Rothbaum, it typically takes about 20 years for technology to transition from academia to society. Computer scientists and medical professionals like Rothbaum must work together to create virtual scenarios that can be applied to clinical settings. Then, the researchers must test these reconstructions with patients, and demonstrate their efficacy and reproducibility in peer-reviewed journals. It’s now been nearly 30 years since Rothbaum demonstrated that VR could be used to attenuate fear of heights, but, she says, “I still don’t think it’s completely commonplace; I still think that there are some barriers.”

Even once a VR treatment has been rigorously tested, it’s often difficult to disseminate widely. Daniel Freeman, a clinical psychologist at the University of Oxford, says one barrier to implementation is that VR is often used as an aid for therapists, rather than a standalone treatment, and there are too few skilled therapists to meet the high treatment demands. Many patients may also be unable to physically attend therapy sessions due to rigid work schedules or lack of transportation, and others are firmly against attending “traditional” therapy altogether because they fear stigmatization. VR could break down those barriers to care and more.

To reach those without access to a highly trained therapist, Freeman is building high-quality, automated VR therapies featuring computer-generated avatar guides, so a real-life therapist doesn’t need to be present at all times. Last month, his team debuted their newest automated VR cognitive therapy, known as gameChange. The program is designed to attenuate the agoraphobia, or fear of entering spaces from which escape might be difficult, that individuals with schizophrenia often feel. Approximately six times over the course of six weeks, participants met with a virtual coach inside their head-mounted displays, who guided them through everyday scenes that would be too scary to navigate in real life—whether that be a cafe, local shop, pub, bus, doctor’s office waiting room or simply opening the front door to face the outside world.

There will always be sensitive cases where a real-life expert must parse the underlying causes of an issue and devise the best treatment plan, Freeman says. But VR treatments like gameChange, combined with the arrival of affordable and easy-to-use VR equipment, have the potential to grant millions of people access to the help they need. “If we can actually automate and get it to people, then that’s really solving one of the huge issues in mental health.”

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