Imagine a therapy session where you’re not just talking about your fears, but actually facing them in a world that feels real and yet feels safe. An environment where you are an active participant in multimodal, multisensory experience rich with scenery, sounds, and in some cases, touch. A canvas to explore, project, and make sense of psychological themes that have been buried deep. If such a scenario appears reminiscent of science fiction, it would indeed have been an accurate assessment two decades ago. Fanciful, grand, and yet, we now find ourselves on the cusp of an era where this vision is becoming reality. We are witnessing a paradigm shift in mental health care, where the once unimaginable is now inevitable.
A brief history
To fully appreciate how far we have come, we must first acknowledge where we started. Virtual Reality, or VR traces its roots back to the 1950s with Morton Heilig, an American Technologist and Ivan Sutherland, a computer vision pioneer where the world’s first VR head mounted display was created. Bestowed the name, the Sword of Damocles, this headset incorporated two CRT monitors that could display wireframe graphics in digital form. Utilizing a combination of mirrors and prisms, it projected these graphics onto the user’s view of the real world. The wearer of the headset could shift their head to view simple 3D models from various perspectives. However, due to the substantial weight of the VR headset, it required suspension from the ceiling, reminiscent of the sword that loomed over Damocles during the lavish feast hosted by Dionysius within Greek mythology.
Thankfully, we are no longer burdened with a physical manifestation of impending doom. And through a combination of Moore’s law and technical innovation, we have arrived at a much smaller device that rests comfortably on human heads of all ages and sizes. VR now enjoys, once a staple of gaming and entertainment, has now found a profound purpose in healing and the treatment of clinical conditions. The evolution of the clinical applications of VR Is perhaps best understood in waves each representing a leap forward in both technology and therapeutic understanding.
The first wave
While VR today is a genre of entertainment and business tool in its on right, the first foray within the clinical space occurred around the mid 1990s where exposure therapy formed the main thrust of the interest. The rationale was simple: VR exposure is safer than the in vivo equivalent exposure therapy and served as a logical step for exposure treatment protocols. An added bonus was, of course, the ability to enable a convenient and linear version of the fear hierarchy which provided patients and clinicians alike with the ability to control the exposure scenario. By 2012, there was over 20 randomized control trials of VR exposure therapy showing that VR exposure outperformed wait list controls and non VR protocols. Currently, VR exposure therapy is the gold-standard for the treatment of many phobias and various forms of pain management. The initial wave of VR therapy, though promising, was in part hindered by physical cumbersomeness of the early devices, a lack of public understanding in the technology, low graphical fidelity, and a lack of clinical research.
The Second Wave: Anxiety and Trauma Disorders
Many of the constraints mentioned in the initial wave started to lose significance by approximately 2015, where consumer VR platforms such as the Occulus (later purchased by Facebook), which revived interest in VR. From here, we also see smart-phone based VR platforms which provided a low-cost solution which increased the adoption rates of VR and renewed a general interest in the technology. Clinically, VR also expanded from a strong evidence base with anxiety and phobias to post traumatic stress disorder, personality disorders, and neuropsychological conditions. Addressing many of the limitations cited in the earliest foray, VR therapy by 2015 solidifies itself as a valid and effective treatment modality, albeit optional, for a wide range of clinical conditions and perhaps ushers in what we might call the second wave of VR therapy. Another feature of the second wave of VR therapy relates to the nature of the integration into clinical practice. With the ability to craft and finely tune a specific reality, VR experiences tend to be bound to a specific clinical disorder, modality (e.g., cognitive behavioural therapy), or type of psychoeducation. For instance, combat scenarios for PTSD, tall buildings for acrophobia, or mindfulness and relaxation games for developing self-regulation techniques. While this is certainly a strength and one of the unique value propositions that VR brings, it nonetheless is a limiting factor in more widespread clinical use.
The Third Wave: Free-Form VR Therapy
Finally, as we enter what may be termed as a third wave in VR therapy, we are starting to see more customizable VR experiences alongside improved graphical fidelity, reductions in cost, and a linear decrease in the weight and size of devices. Clinicians are now able to tailor pre-made experiences that go beyond providing an off-the shelf solution for an otherwise highly personalised experience. We also see new VR therapy solutions that take on a more bottom-up, grounded approach that is treatment modality and presentation agnostic, where there is more of a blank canvas to build therapeutic experiences around. And this is where it becomes the most interesting: VR therapy goes beyond a targeted experience for a specific condition to a dynamic tool that can be integrated into any treatment modality for any condition – a highly personal, transdiagnostic, and creatively driven approach. A virtual space is extended from the therapeutic alliance where psychodynamics can be virtually projected, psychoeducation can be engagingly delivered, and memories and new insights can be codified and stored. The promise of VR therapy lies within this third wave.
*This article was originally posted at www.vcps.com.au