Using Virtual Reality
Exposure Therapy in the
Treatment of Phobia
Amy Dunn, Gemma Hunt,
Caroline Osborn and Phil Sequeira
Phobias
• Phobias are irrational fears of nonthreatening stimuli, involving physiological
and cognitive stress
• Phobias are traditionally treated using
exposure therapy or systematic
desensitisation (Wolpe, 1958)
• Repeated exposure to phobic stimulus +
relaxation techniques + components of
CBT = gradually minimised phobic anxiety
• BUT provision of exposure can present some
serious challenges…
Controversies
• Safety issues - confronting fear in real
situations (Newman and Adams, 2004)
• Ethical considerations/client
confidentiality issues resulting from realworld context (Davidson and Smith, 2003)
• VR exposure therapy attempts to
overcome these problems
VR Exposure Therapy
• Virtual reality exposure therapy (VRET)
relates to the use of virtual environments
(VEs) as a tool for the graded exposure
to a phobic stimulus
• VRET is not a new therapeutic system, but a
tool for use in established methods
•e.g. systematic desensitisation and
cognitive-behavioural therapies (CBTs)
• The use of VR in the treatment of phobia can
offer increased control and containment of
therapy (Klinger et al., 2005)
Controversies in VRET
• Cost
• Presence and immersion
– The “feeling of being in an environment even if one
is not physically present” (Robillard et al., 2003:468)
• Cyber-sickness
– “a kind of motion sickness induced by discrepancies
between visual, vestibular and proprioceptive
information” (Robillard et al., 2003:468)
• Transferability of skills
• Effectiveness in inducing enough anxiety to
treat phobias (Krijn et al., 2003)
The Virtual Reality Suite
• The VR theatre is designed to display
large stereoscopic virtual imagery to a
seated audience
• This is achieved using three separate
projected displays, which are blended
together to create one “seamless” image
• The projectors and a rack containing all
the image generators are located behind
the screen in the projection room
Case Study
• Anxiety and Presence during VR
Immersion: A Comparative Study of
the Reactions of Phobic and Nonphobic Participants in Therapeutic
Virtual Environments Derived From
Computer Games (TVEDGs)
• Robillard, Bouchard, Fournier and Renaud
(2003)
Aims and Rationale
• TVEDGS
• VEs created using standard computer games,
which cost less than $50 and are compatible
with PCs
• Can be modified by users with little
computing experience
• Graphic quality is often superior
• Aims
• Do TVEDGs evoke appropriate phobic reaction?
• To assess the impact of simulator-sickness and
sense of presence
Method
• Sample
– 13 phobic participants and 13 non-phobic participants,
matched for age and gender
– Phobias were arachnophobia, acrophobia and
claustrophobia
• Procedure
– 5 minutes to familiarise with VE and equipment (HMD,
tracker and game-pad) without phobic stimuli
– 20 minute session with phobic stimuli: both phobic and
non-phobic participants experience the same phobic
cues and are encouraged to interact with them
– Verbal reports regarding anxiety, immersion and cybersickness given throughout and assessed by
questionnaire at the end
The Virtual Environments
• Virtual environment for phobia of spiders Version 2 (developed from Max Payne™)
The Virtual Environments
• Virtual environment for phobia of heights Version 2 (developed from Max Payne™)
The Virtual Environments
• Virtual environment for claustrophobia Version 1 (developed from Unreal
Tournament™)
Results
• Pre-exposure:
• Phobic participants had significantly higher levels of
anxiety and a higher propensity to immerse
• During exposure:
• All participants except one reported low anxiety in
neutral VEs
• Post-immersion:
• Phobic participants reported greater anxiety and
sense of presence
• Phobic participants reported greater simulator
sickness (though not significant)
Discussion
• Aim 1 – Can TVEDGs produce phobogenic
stimuli?
• Results show that anxiety was the product of VE
stimuli and not VR equipment
• Using TVEDGs, for a quarter of the cost of
commercial VRTs, therapists can provide an
equivalent level of treatment
• Aim 2 – What is the impact of simulatorsickness?
• Results suggest that simulator-sickness has no
impact on phobogenic efficacy
• Adaptation effects – Regan, 1995
Discussion
• Aim 2 – What is the impact of presence?
• Anxiety was importantly related to sense of
presence
• Group differences show that it was phobic
participants who had a greater tendency to
immerse
• Correlations and regressions show that anxiety
and presence were the most highly correlated
variables and most predictive of each other
• These findings support a synergistic relationship
but the underlying reasons remain unclear
Conclusions of the Study
• Firstly, phobogenic effectiveness of the
inexpensive software used, shows that VR
technology is now sufficiently advanced for
VRET to move into the clinical mainstream
• Secondly, the findings demonstrate that highcosts, issues relating to immersion, and sideeffects such as cyber-sickness, need not remain
barriers to effectiveness in the use of VEs to treat
phobia
Remaining Issues
• Verbal reports
• Impact on immersion
• Demand characteristics
• Retrospective questionnaire
• Accuracy of recall
• Transferability of skills
• Standardised environments – Individual
differences?
• Testing software efficacy/testing
therapeutic efficacy
Thank you for listening
Any Questions?
References
• Davidson, J., and Smith, M. (2003). Biophobias/technophilias:
Virtual reality exposure as treatment for phobias of nature.
Sociology of Health and Illness, 25(6), 644-661.
• King, N.J., Muris, P., and Ollendick, T.H. (2005). Childhood
fears and phobias: Assessment and treatment. Child and
Adolescent Mental Health, 10(2), 50-56.
• Klinger, E., Bouchard, S., Legeron, P., Roy, S., Lauer, F.,
Chemin, I., and Nugues, P. (2005). Virtual reality therapy Vs
cognitive behaviour therapy for social phobia: A preliminary
controlled study. Cyberpsychology and Behaviour, 8(1), 7688.
• Krijn, M., Emmelkamp, P.M.G., Biemond, R., de Wilde de
Ligny, C., Shuemie, M.J., and van der Mast, C.A.P.G. (2003).
Treatment of acrophobia in virtual reality: The role of
immersion and presence. Behaviour Research and Therapy,
42, 229-239.
References
• Newman, C., and Adams, K. (2004). Dog gone good:
Managing dog phobia in a teenage boy with a learning
disability. British Journal of Learning Disabilities, 32, 35-38.
• Regan, E.C. (1995). Some evidence of adaptation to
immersion in virtual reality. Displays, 16(3), 135-139.
• Robillard, G., Bouchard, S., Fournier, T., and Renaud, P.
(2003). Anxiety and presence during VR immersion: A
comparative study of the reactions of phobic and nonphobic participants in therapeutic virtual environments
derived from computer games. Cyberpsychology and
Behaviour, 6(5), 467-476.
• Virtual environments. Retrieved May 13th 2005, from:
http://www.uqo.ca/cyberpsy/index-en.html
References
• Davidson, J., and Smith, M. (2003). Biophobias/technophilias:
Virtual reality exposure as treatment for phobias of nature.
Sociology of Health and Illness, 25(6), 644-661.
• King, N.J., Muris, P., and Ollendick, T.H. (2005). Childhood
fears and phobias: Assessment and treatment. Child and
Adolescent Mental Health, 10(2), 50-56.
• Klinger, E., Bouchard, S., Legeron, P., Roy, S., Lauer, F.,
Chemin, I., and Nugues, P. (2005). Virtual reality therapy Vs
cognitive behaviour therapy for social phobia: A preliminary
controlled study. Cyberpsychology and Behaviour, 8(1), 7688.
• Krijn, M., Emmelkamp, P.M.G., Biemond, R., de Wilde de
Ligny, C., Shuemie, M.J., and van der Mast, C.A.P.G. (2003).
Treatment of acrophobia in virtual reality: The role of
immersion and presence. Behaviour Research and Therapy,
42, 229-239.
References
• Newman, C., and Adams, K. (2004). Dog gone good:
Managing dog phobia in a teenage boy with a learning
disability. British Journal of Learning Disabilities, 32, 35-38.
• Regan, E.C. (1995). Some evidence of adaptation to
immersion in virtual reality. Displays, 16(3), 135-139.
• Robillard, G., Bouchard, S., Fournier, T., and Renaud, P.
(2003). Anxiety and presence during VR immersion: A
comparative study of the reactions of phobic and nonphobic participants in therapeutic virtual environments
derived from computer games. Cyberpsychology and
Behaviour, 6(5), 467-476.
• Virtual environments. Retrieved May 13th 2005, from:
http://www.uqo.ca/cyberpsy/index-en.html
References
• Davidson, J., and Smith, M. (2003). Biophobias/technophilias:
Virtual reality exposure as treatment for phobias of nature.
Sociology of Health and Illness, 25(6), 644-661.
• King, N.J., Muris, P., and Ollendick, T.H. (2005). Childhood
fears and phobias: Assessment and treatment. Child and
Adolescent Mental Health, 10(2), 50-56.
• Klinger, E., Bouchard, S., Legeron, P., Roy, S., Lauer, F.,
Chemin, I., and Nugues, P. (2005). Virtual reality therapy Vs
cognitive behaviour therapy for social phobia: A preliminary
controlled study. Cyberpsychology and Behaviour, 8(1), 7688.
• Krijn, M., Emmelkamp, P.M.G., Biemond, R., de Wilde de
Ligny, C., Shuemie, M.J., and van der Mast, C.A.P.G. (2003).
Treatment of acrophobia in virtual reality: The role of
immersion and presence. Behaviour Research and Therapy,
42, 229-239.
References
• Newman, C., and Adams, K. (2004). Dog gone good:
Managing dog phobia in a teenage boy with a learning
disability. British Journal of Learning Disabilities, 32, 35-38.
• Regan, E.C. (1995). Some evidence of adaptation to
immersion in virtual reality. Displays, 16(3), 135-139.
• Robillard, G., Bouchard, S., Fournier, T., and Renaud, P.
(2003). Anxiety and presence during VR immersion: A
comparative study of the reactions of phobic and nonphobic participants in therapeutic virtual environments
derived from computer games. Cyberpsychology and
Behaviour, 6(5), 467-476.
• Virtual environments. Retrieved May 13th 2005, from:
http://www.uqo.ca/cyberpsy/index-en.html
References
• Davidson, J., and Smith, M. (2003). Biophobias/technophilias:
Virtual reality exposure as treatment for phobias of nature.
Sociology of Health and Illness, 25(6), 644-661.
• King, N.J., Muris, P., and Ollendick, T.H. (2005). Childhood
fears and phobias: Assessment and treatment. Child and
Adolescent Mental Health, 10(2), 50-56.
• Klinger, E., Bouchard, S., Legeron, P., Roy, S., Lauer, F.,
Chemin, I., and Nugues, P. (2005). Virtual reality therapy Vs
cognitive behaviour therapy for social phobia: A preliminary
controlled study. Cyberpsychology and Behaviour, 8(1), 7688.
• Krijn, M., Emmelkamp, P.M.G., Biemond, R., de Wilde de
Ligny, C., Shuemie, M.J., and van der Mast, C.A.P.G. (2003).
Treatment of acrophobia in virtual reality: The role of
immersion and presence. Behaviour Research and Therapy,
42, 229-239.
References
• Newman, C., and Adams, K. (2004). Dog gone good:
Managing dog phobia in a teenage boy with a learning
disability. British Journal of Learning Disabilities, 32, 35-38.
• Regan, E.C. (1995). Some evidence of adaptation to
immersion in virtual reality. Displays, 16(3), 135-139.
• Robillard, G., Bouchard, S., Fournier, T., and Renaud, P.
(2003). Anxiety and presence during VR immersion: A
comparative study of the reactions of phobic and nonphobic participants in therapeutic virtual environments
derived from computer games. Cyberpsychology and
Behaviour, 6(5), 467-476.
• Virtual environments. Retrieved May 13th 2005, from:
http://www.uqo.ca/cyberpsy/index-en.html
References
• Davidson, J., and Smith, M. (2003). Biophobias/technophilias:
Virtual reality exposure as treatment for phobias of nature.
Sociology of Health and Illness, 25(6), 644-661.
• King, N.J., Muris, P., and Ollendick, T.H. (2005). Childhood
fears and phobias: Assessment and treatment. Child and
Adolescent Mental Health, 10(2), 50-56.
• Klinger, E., Bouchard, S., Legeron, P., Roy, S., Lauer, F.,
Chemin, I., and Nugues, P. (2005). Virtual reality therapy Vs
cognitive behaviour therapy for social phobia: A preliminary
controlled study. Cyberpsychology and Behaviour, 8(1), 7688.
• Krijn, M., Emmelkamp, P.M.G., Biemond, R., de Wilde de
Ligny, C., Shuemie, M.J., and van der Mast, C.A.P.G. (2003).
Treatment of acrophobia in virtual reality: The role of
immersion and presence. Behaviour Research and Therapy,
42, 229-239.
References
• Newman, C., and Adams, K. (2004). Dog gone good:
Managing dog phobia in a teenage boy with a learning
disability. British Journal of Learning Disabilities, 32, 35-38.
• Regan, E.C. (1995). Some evidence of adaptation to
immersion in virtual reality. Displays, 16(3), 135-139.
• Robillard, G., Bouchard, S., Fournier, T., and Renaud, P.
(2003). Anxiety and presence during VR immersion: A
comparative study of the reactions of phobic and nonphobic participants in therapeutic virtual environments
derived from computer games. Cyberpsychology and
Behaviour, 6(5), 467-476.
• Virtual environments. Retrieved May 13th 2005, from:
http://www.uqo.ca/cyberpsy/index-en.html
References
• Davidson, J., and Smith, M. (2003). Biophobias/technophilias:
Virtual reality exposure as treatment for phobias of nature.
Sociology of Health and Illness, 25(6), 644-661.
• King, N.J., Muris, P., and Ollendick, T.H. (2005). Childhood
fears and phobias: Assessment and treatment. Child and
Adolescent Mental Health, 10(2), 50-56.
• Klinger, E., Bouchard, S., Legeron, P., Roy, S., Lauer, F.,
Chemin, I., and Nugues, P. (2005). Virtual reality therapy Vs
cognitive behaviour therapy for social phobia: A preliminary
controlled study. Cyberpsychology and Behaviour, 8(1), 7688.
• Krijn, M., Emmelkamp, P.M.G., Biemond, R., de Wilde de
Ligny, C., Shuemie, M.J., and van der Mast, C.A.P.G. (2003).
Treatment of acrophobia in virtual reality: The role of
immersion and presence. Behaviour Research and Therapy,
42, 229-239.
References
• Newman, C., and Adams, K. (2004). Dog gone good:
Managing dog phobia in a teenage boy with a learning
disability. British Journal of Learning Disabilities, 32, 35-38.
• Regan, E.C. (1995). Some evidence of adaptation to
immersion in virtual reality. Displays, 16(3), 135-139.
• Robillard, G., Bouchard, S., Fournier, T., and Renaud, P.
(2003). Anxiety and presence during VR immersion: A
comparative study of the reactions of phobic and nonphobic participants in therapeutic virtual environments
derived from computer games. Cyberpsychology and
Behaviour, 6(5), 467-476.
• Virtual environments. Retrieved May 13th 2005, from:
http://www.uqo.ca/cyberpsy/index-en.html