Virtually Fearless

Sit Back, Relax, and Enjoy the Therapy

In its long, strange trip to define itself, virtual reality has been put to a multitude of uses, from arcade games to architectural drawing to fighter-pilot training. VR's forefathers, as Fred Moody wrote in 'The Visionary Position,' are strange bedfellows: computer scientists, military researchers, geeky engineering students, and iconoclasts have all played an integral role in dreaming up the sometimes far-fetched applications.

Add to this mix mental health professionals, who have integrated VR with contemporary phobia therapy principles to treat fears of flying, heights, thunderstorms, shopping malls, and, most recently, to help Vietnam vets suffering from post-traumatic stress disorder. A handful of hospitals around the country offer VR therapy, including, in the New York area, the Hillside Hospital Division of the North Shore–Long Island Jewish Health System in Great Neck, which uses it to treat fear of flying.

What is unique about VR's use as a phobia treatment is its apparent effectiveness despite the relatively low-tech design of the software.

"Our goal was to make it the least realistic, and as simple to operate as possible, yet still integrate what has been shown to work for therapy," said Larry Hodges, associate professor of computer science at Georgia Tech University, who created the VR phobia treatment. The software—which controls goggles, a sensory feedback chair, stereoscopic vision, and lifelike jet noises—runs on a normal high-end PC. Hodges says he sacrificed flashiness and complex sensory illusions for functionality. His fear-of-flying package costs $25,000 for the complete set of software, goggles, and chair; not many mental health facilities will make even that kind of investment. Increasing the complexity would not only drive up the price, but would make the program's memory requirements skyrocket.

Hodges's team also focused its energies on making the program operate with only a few keystrokes—another RAM-consumption trade-off. "We wanted to allow the therapists to devote their attention to the patient," Hodges said, rather than having to fuss with complex keyboard commands, which would be distracting.

VR phobia therapy began in 1992 in Hodges's laboratory at Georgia Tech. At first, the idea was to design software to help people conquer fears of public speaking. But because of the technical complexity of modeling people, he shelved the idea. Then Hodges found Barbara Rothbaum, associate professor of psychiatry and behavioral sciences at Emory University in Atlanta, who advised him on contemporary phobia treatments and methods. The two soon began research and development, and, a couple of years later, their grants from the National Institute of Mental Health evolved into a small start-up company called Virtually Better. They now have seven different VR phobia apps, with more in development.

Virtually Better's newest VR app is for people who suffer from post-traumatic stress disorder from the Vietnam War. Veterans "face their demons" during simulated ambushes in open fields, and fly over the rice paddies and jungles of Vietnam, to movie soundtracks of Huey helicopters, gunfire, jungle noises, and people screaming. Dr. David Ready, a psychologist at the Veterans Administration Hospital in Atlanta who works with PTSD veterans, says the simulation is "real enough" for the vets, who are sometimes so plagued with horrific war memories that they cannot function in society. Recently, the National Center for PTSD in Boston joined the Atlanta facility in offering VR therapy.

By most accounts, VR phobia therapy works. Rothbaum, Hodges, and their colleagues have published studies in major journals documenting the success of the treatment. Though the rates of success vary tremendously, one study, in the journal CyberPsychology and Behavior, found that the success rate increases when virtual reality is used along with standard exposure therapy. Other studies show that VR consistently evokes the intended physiological fear responses from phobics, including rapid heartbeat, heavy breathing, and sweating. But for all the possibilities in modern technology and all the phobics that VR could help, a VR treatment for cyberphobes remains unlikely.

 
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