What phobias can we treat with virtual reality?

Phobias of spiders, planes, tight spaces … many of us suffer from irrational fears to varying degrees. To treat them, more and more practitioners are using virtual reality headsets. A psychiatrist at La Pitié Salpêtrière in the service of Pr Fossati (head of a program on the subject at the Brain Institute), Fanny Levy explains how it works.

Why is virtual reality a suitable tool for treating phobias?

Fanny Levy: Virtual reality has several advantages. When you have a fear, you have to face it gradually according to a specific protocol. First we list and prioritize all of the problematic cases. For someone who is afraid of dogs, this can for example start with a baby chihuahua and end with a bulldog without a leash, passing through lots of intermediaries (labrador kept on a leash, labrador without leash, etc.) Same if you are afraid of the plane. Before arriving at the night flight with turbulence, there will be stages such as the journey to the airport, ticket control, etc. Once you’ve listed these steps, you don’t get exposed to them anyhow, you have to do it for a while until the anxiety goes down by half. These exercises usually last 15 to 20 minutes. Normally, patients do these exercises on their own. The advantage of virtual reality is that it allows me to be by their side during these exhibition periods. So I can guide them and help them follow the protocol. It’s also very handy if your phobia is about something that is not close to you on a daily basis. You are afraid of flying for example or you have a cliff phobia but do not live in Paris. The fun side of virtual reality also helps people take the plunge. It is not always easy to decide to make an appointment in a psychiatric department to treat your phobia. Virtual reality makes it all less intimidating.

What types of phobias work well for VR sessions?

FL: Virtual reality works very well on so-called “specific” phobias. This includes in particular fears related to an animal (dog, spider …) or a specific situation (confinement, emptiness …) and social phobias such as speaking in public. But it must be checked that the anxiety disorder to be treated is not linked to a deeper trauma. A person who is afraid of elevators because they have been raped in it may need to be exposed to this trauma in a framed way more than at this specific place. It’s the psychiatrist’s job to assess that.

What happens during a session ?

FL: In our department, we carry out an initial assessment to check that it is a phobia and that there are no co-morbidities, trauma or depression which could hamper the course of treatment. Then, we program a dozen sessions with various exposure exercises ranging from the easiest to the most delicate. For fear of emptiness, for example, we have a universe that immerses the patient in a 24-story tower with floor-to-ceiling windows and balconies. The patient will explore this environment by going gradually to higher and higher floors. The session lasts 45 minutes, but the exhibition exercise itself lasts only 20 minutes. And the price of the sessions is equivalent to that of a consultation at the hospital.

What is the success rate of treatments for phobias based on virtual reality?

FL: It allows a 70% reduction in symptoms. But you have to be careful with some firms that claim to offer virtual reality but actually only offer 360 ° video. 360 ° video is not at all as immersive. We can’t move around, we can just turn our heads. Not being active prevents exposure as gradually as in virtual reality. And above all you will not believe it as much so it will work less well. The effectiveness of 360 ° video has not been demonstrated at all in the treatment of phobias.

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