More and more often, today, we hear about virtual reality. But what is it about?
There virtual reality It is a relatively new technology that allows people to immerse themselves in a virtual world. The user, wearing a viewer, is projected into a simulated reality that is recreated and processed with the help of a computer. In addition, he can have a controller that allows him to interact and move within the digital world.
This technology has been used in the treatment of various psychological disorders, such as anxiety disorders, post-traumatic stress disorder, eating disorders, addiction disorders, etc.
Virtual reality and psychotherapy
Scientific research has shown the effectiveness of the use of virtual reality as a tool of support for psychotherapy: It, within a therapeutic path, can represent a valid tool of help for both the patient and the therapist.
The results of the use of this technology are very encouraging as regards the treatment of anxiety disorders, in general, and social anxiety disorder, in particular.
Those who suffer from social anxiety disorder experience fear or anxiety marked in relation to one or more social situations in which the individual could be exposed to the possible judgment by others, or even only in their presence, and, therefore, tries to avoid these situations.
Cognitive behavioral therapy for social anxiety
Cognitive-behavioral therapy currently represents the Gold Standard treatment for people suffering from social anxiety disorder. A crucial technique is that of the patient’s gradual exposure to the feared situation: the subject is urged to face the situation that triggers his fear for grades.
Often in these treatments the first step consists in interpreting roles during individual sessions or in the context of small therapy groups, to then face exposure to larger public situations (Marks, 1995). Following prolonged exposure, anxiety generally extinguishes (Hope, Heimberg & Bruch, 1995).
The cognitive-behavioral intervention protocol for social anxiety disorder provides, among other things, theexposure in vivoor in real life, to the situation feared by the subject. However, the exposure in vivo in this disorder can present limits.
Firstly, it can be very demanding and take a long time to look for the most appropriate exposure situations for each patient. Also, being the social anxiety disorder A disorder in which the person’s tendency is strong to avoid the feared situation, it may be that in vivo exposure is delayed a lot over time by the patient. Last but not least, the exhibitions are very often assigned by therapists as “homework” and, therefore, the therapist can only give the patient a retrospective feedback which will therefore be strongly dependent on the patient’s subjective story.
Virtual reality for social anxiety disorder
There Virtual reality therapy It can offer a solution to these limits (Freeman et al., 2017). Virtual environments can be made to measure and customized according to the social situations that trigger the reaction of anxiety and fear of each subject. Furthermore, it is possible to implement social behavior and practice repeatedly within virtual reality in the presence of the therapist who can thus provide direct feedback.
In a 2019 pilot study, carried out at the University of Groningen, Geraets and colleagues evaluated the effect of cognitive-behavioral therapy based on virtual reality (VR-CBT) in patients with severe generalized social anxiety.
The participants in the study were 15, they had an average age of 34.9 years and an average duration of the 9.4 -year social anxiety disorder. Each participant was subjected to treatment with virtual reality (VR-CBT) which provided for a maximum of 16 individual sessions of one hour, paid once or twice a week by psychologists. The treatment protocol has been adapted by the authors on the basis of existing cognitive-behavioral protocols. Specifically, the main adaptation concerned the fact that all in vivo exhibitions were actually conducted virtual reality.
During the first two sessions, virtual reality technology was introduced to the patient, the case conceptualized and the objectives of the treatment were defined. From the third session, i patients actually exercised virtual reality for 40 minutes per session. Virtual reality software was available inside the virtual environments such as roads, buses and supermarkets.
The software allowed therapists to manipulate virtual environments in terms of crowding (they could be present from 0 to 40 virtual humans), of ethnicity, gender, intensity and frequency of hostile looks and interpersonal distance. Virtual humans could pronounce pre -aggravated phrases; In addition, sounds like sirens and laughter were also available. Before each exercise therapists and patients agreed the environment, crowding and characteristics of virtual humans. Further Therapeutic strategies They included psychoeducation and cognitive renovation of dysfunctional beliefs.
The first research data
The results of this study were promising: social anxiety, detected by administering the social interaction anxiety scale at the beginning of the treatment, at the end of the and follow -up, was significantly reduced after treatment and this improvement was maintained at the follow up.
The depression scores (measured with the Beck Depression Inventory-II) were significantly lower than the follow-up compared to pre-treatment. In addition, the quality of life increased significantly between pre-treatment and post-treatment.
Subsequent studies
These results are in line with those who have previously arrived other researchers in their works: in particular, Kampmann and colleagues (2016) have shown, with a randomized controlled study, that the therapy based on virtual reality exposure had proved to be effective in reducing social anxiety And stress in patients with generalized social anxiety. However, in vivo exposure therapy had led to better results than in virtual reality exposure.
Bouchard and colleagues (2017), using both cognitive and behavioral elements unlike the previous study that used only behavioral elements, discovered that cognitive-behavioral therapy based on virtual reality was more effective than that with in vivo exposure.
In light of what has been said so far, it is noted that virtual reality offers numerous advantages in the treatment of social anxiety disorder.
Advantages of the use of virtual reality
First of all, compared to the imaginative exposure, virtual reality allows the patient a more vivid exposure than what some patients can be able to recreate with their imagination. Consequently, it allows them to experience a more realistic environment by stimulating their participation.
The virtual reality system can also provide multimodal stimulisuch as visual stimuli and auditory stimuli. The exposure in virtual reality allows, in addition, to the therapist to work in the immediately on the dysfunctional beliefs of the patient who are more accessible and vivid during the performance of the activities in the virtual environment compared to a later time.
Furthermore, the therapist can exercise control over the different components of the virtual environment in order to adapt them, in general, to each patient and, in particular, to the times and progress of each of them. The patient can be exposed within protected virtual environments and develop a gradual exposure. For example, you can start exposing the subject into an almost empty road and gradually increase the level of difficulty.
In vivo exposure does not always allow this amount of control as therapists and patients cannot control daily life environments. This allows you to point more and more adapted treatments with greater precision to specific needs of individual patients.
Conclusions
In conclusion, it can be said that virtual reality can currently be considered a very useful tool in the treatment of social anxiety disorder and many other psychological disorders.
However, further studies and research is needed, including controlled trials, so that this technology can be implemented in treatment protocols already validated and in the clinical use of routine.
Bibliographic references
- Bouchard, S., Dumoulin, S., Robillard, G., Guard, T., Klinger, è., Forget, H., Lorang, C. & Roucaut, FX (2017). Virtual Reality Compared With in Vivo Exposure in the Treatment of Social Anxietydisorder: A Three-HermranomizedControlled Trial. British Journal of Psychiatry, 210276-283.
- Freeman, D., Reeve, S., Robinson, A., Ehlers, A., Clark, D., Spanlang, B. & Slater, M. (2017). Virtual Reality in the Assessment, Undersanding, and Treatment of Mental Health Disorders. Psychological Medicine, 472393-2400.
- Geraets, C., Veling, W., Witlox, M., Staring, A., Matthijssen, S., & Cath, D. (2019). Virtual Reality-Based Cognitive Behavioraltherapy for patients with Generalized Social Anxied Disorder: A Pilot Study. Behavioral and Cognitive Psychotherapy, 47(6), 745-750.
- Hope, from, Heimberg, RG, & Bruch, but (1995). Cognitive-Behavoral Group Therapy for Social Phobia dismantling. Behaviour Research and Therapy, 33637-650.
- Kampmann, Il, Emmelkamp, PMG, Harr, D., Brinkman, WP, Zijlstra, Bjh & Morina, N. (2016). Exposure to Virtual Social Interactions in The Treatment of Social Anxiety Disorder: A Randomized Controlled Trial. Behaviour Research and Therapy, 77147-156.
- Marks, IM (1995). Advances in Behavoral-Cognitive Therapy of Social Phobia. Journal of Clinical Psychiatry, 5625-31.
- Marsigli, N. (edited by) (2018). Stop to social anxiety. Trento: Erickson.
