Virtual Reality Graded Exposure Therapy (VRGET)

Source: Jennifer Bleyer

Virtual Reality Graded Exposure Therapy (VRGET): What it is and how it works

VRGET is a technology-based exposure therapy with important implications for the management of post-traumatic stress disorder (PTSD) as well as severe phobias that are difficult to treat using conventional psychological therapies and medications. VRGET combines advanced computer graphics, three-dimensional visual displays, and body-tracking technologies to create realistic virtual environments with the goal of simulating feared situations or objects. Virtual environments have been designed to provide visual, auditory, tactile, vibratory, vestibular, and olfactory stimuli to patients in highly controlled settings. During a virtual exposure session, the therapist closely tracks the patient’s state of arousal by monitoring physiological indicators of stress, including heart rate and respiration. Many individuals are ready to take the next step and engage in real life (i.e., in vivo) exposure to the feared object or situation after they have been desensitized to a virtual environment.

VRGET is more effective than conventional exposure therapy

VRGET is more effective than conventional imaginal exposure therapy and has comparable efficacy to in vivo exposure therapy for the treatment of specific phobias, agoraphobia, panic disorder, and PTSD. Like in vivo and imaginal exposure therapy, VRGET desensitizes the patient to a situation or object that would normally cause anxiety or panic. In a randomized controlled trial, VRGET and conventional cognitive behavioral therapy (CBT) were equally effective treatments for panic disorder with agoraphobia, and patients who underwent VRGET required 33 percent fewer sessions to achieve similar results. Studies also confirm that VRGET is an effective treatment of fear of flying, fear of heights, fear of small animals, fear of driving, and other phobias. VRGET is as effective as and more cost-effective than conventional exposure therapy for fear of flying because patient and therapist avoid the cost and inconvenience of airplanes. A virtual environment simulating the devastation of the 9/11 attacks on the World Trade Towers has been successfully used to treat individuals diagnosed with severe PTSD following the attacks.

VRGET reduced PTSD symptoms in combatants who do not respond to conventional exposure therapy

Findings of a study on combined multisensory exposure and VRGET reported significant reductions in severity of PTSD symptoms in active duty combatants who had failed to respond to other forms of exposure therapy. Several subjects reported significant improvement following only five VRGET sessions; however, there was considerable variability in the number of VRGET sessions needed to reduce symptom severity to the same level.

VRGET is being used to screen individuals at high risk of developing PTSD

Research studies are being aimed at developing virtual reality tools for assessing and preventing combat-related PTSD. STRIVE (Stress resilience in virtual environments) is a highly integrative “stress resilience training” program aimed at enhancing emotional coping strategies prior to active deployment. STRIVE employs an immersive VR environment to simulate combat situations that includes a “virtual mentor” who guides the combatant through a virtual experience while coaching him or her in relaxation and emotion self-regulation skills. The intensity of the virtual stimulus used is determined by the individual’s habituation based on HRV and other measures of autonomic arousal. Physiological biomarkers of stress response are measured before and after VRGET sessions. The STRIVE system permits users to be immersed in stressful combat scenarios and interact with virtual characters for training in a variety of coping strategies that may enhance resilience in the face of extreme stress. The STRIVE protocol may provide a useful tool for predicting the risk of developing PTSD or other psychiatric disorders in new recruits prior to actual combat exposure. Recruits who display high resilience and thus presumably at relatively lower risk of developing PTSD might be more suitable for direct combat roles while individuals who display low resilience might preferentially be assigned to noncombat roles.

Future innovations will integrate VRGET with biofeedback and broadband internet connections permitting in-home therapy

Future integrative approaches to phobias, panic attacks, and other severe anxiety disorders will combine VRGET with biofeedback in outpatient settings or in the patient’s home via broadband Internet connections, with CBT, relaxation, mind-body practices, and appropriate medications. Combining VR environments with real-time feedback based on neurophysiological responses to stress may permit each unique patient to optimize the level and type of VR exposure to enhance resiliency training and speed the rate of recovery from PTSD. Human-computer interface (HCI) systems based on CBT and biofeedback are being developed for resilience training in individuals at risk of developing PTSD following exposure to trauma. Larger studies on patient populations diagnosed with PTSD using head-mounted displays and other technologies that create more immersive virtual environments are needed to determine whether combining VRET and EEG biofeedback is practical in clinical settings and yields superior outcomes compared to either approach alone.

Few safety problems

Infrequent cases of disorientation, nausea, dizziness, headache, and blurred vision have been reported following VRGET. Intense sensory stimulation during VRGET can trigger migraine headaches, seizures, or gait abnormalities in individuals who have these disorders. Patients with schizophrenia should not use VRGET because immersion in a virtual environment can exacerbate delusions.

To learn more about VRGET and other non-pharmacologic treatments of PTSD check out my e-book "Post-traumatic stress disorder: the integrative solution."