Introduction
With the advent of case-reports of various mental illnesses, there remains an immediate need for cognisance on the subject. Such awareness may stem from two fronts: increased awareness regarding the identification of such illnesses and increased awareness over plausible treatment options.
Whilst the former front isn’t limited to being propagated via academia, the latter is more bound to the scientific community; its members are uniquely positioned to test, validate, and accredit treatment options — both conventional and novel. Virtual Reality Exposure Therapy (VRET) is one such novel method and this blogpost aims to investigate said method’s efficacy in patients suffering from anxiety disorders and Post-traumatic Stress Disorders (PTSD).
Background
Within exposure therapy are two oft-used forms, both utilised in treating anxiety disorders and PTSD: real (in vivo) exposure and imaginary (imaginal) exposure. Through a supervised subjection to anxiety-inducing stimuli, people suffering from such disorders learn to manage their emotional responses (Hooley et al., 2020, p. 582).
Specifically targeted at treating PTSD, Prolonged Exposure (PE) therapy aims to continuously present people with details pertaining to their respective traumatic events until the intensity of their emotional responses lessens (Hooley et al., 2020, p. 180). Such subjection can either be gradually done over a period of time (systematic desensitisation) or all at once (flooding).
VRET represent a new medium through which such forms of therapy can take place. it can be used as a substitute for either form of exposure, and has been the subject to myriads of studies — those studies being subsequently meta-analysed to produce more thorough claims regarding its efficacy.
Evaluation
VRET has been noted for its inherently greater range of flexibility; VR’s individual-driven foundation has led it to be more personalised than other forms of imaginal exposure (Dellazizzo et al., 2020). This level of customisability is prised over the sporadic cases of cybersickness — akin to experiencing motion sickness — with the latter seeming to be an acceptable caveat.
VRET’s ability to mimic a scenario yields objectively more benefits as some individuals could be inherently avoiding any recall of their traumatic memories (Dellazizzo et al., 2020). VR could not only allow such individuals to overcome their avoidance, but also do so at a gradual and controlled rate — via slowly introducing virtual elements into one’s field of view — thereby minimising chances of setbacks to treatment (Kothgassner et al., 2019).
Overall, evidence for VRET being a beneficial treatment whilst compared with wait-listed controls showcases a significant decrease in one’s symptoms, even possessing stable long-term effects (Cieślik et al., 2020). However, it does not seem to significantly differ from more conventional, evidence-backed treatments — save for treatments of aviophobia (fear of flying in aeroplanes) — (Dellazizzo et al., 2020). This discrepancy could be attributed to the greater control in repeatedly presenting relevant exposure content, such as turbulence. This example reifies VRET’s capabilities of safely simulating non-replicable environments — enhancing its ecological validity.
However, the lack of standardisation of VRET’s hardware and software specification opens the door to numerous confounding variables — potentially altering VRET’s true efficacy (Cieślik et al., 2020). Not only is the standardisation necessary for comparison, the creation of certification programmes for those clinicians who provide VRET is crucial to mitigate potential harm; currently, no such certification exists (Kothgassner et al., 2019).
Nevertheless, studies on VRET have more predicaments which prevent any definitive claim from being made on VRET’s efficacy. The evidence for VRET is “quite variable”, making the process of sieving through studies’ results’ implications arduous (Dellazizzo et al., 2020). Moreover, some studies’ methodology may be flawed; be it the absence of a well-defined control group or the highly skewed samples (Kothgassner et al. 2019 calculated an average ratio of 22:3 (males to females) across numerous studies), the number of single-blinded randomised control trials is insufficient for clear inference.
That age might also play a factor in the extent to which one could be immersed in a virtual environment — an essential criterion to facilitate imaginal exposure — and it being mentioned in only a few studies further highlights the necessity for more research in this field (Kothgassner et al., 2019).
Future
Apart from the conduction of further research, Augmented Reality (AR) technology could also permeate into the field of exposure therapy — giving rise to Augmented Reality Exposure Therapy (ARET).
ARET differes from VRET in a few ways (Baus & Bouchard, 2014). Firstly, ARET’s ability to overlay elements onto the ‘real world’ renders its ecological validity higher than that of VRET as people are better able to perceive themselves as a part of the ‘world’ which they are viewing.
Secondly, given that ARET does not attempt to render one’s entire field of view, it consumes much lower energy than VRET. Finally, ARET allows for a less isolated feeling of one’s surroundings — grounding them more so than VRET would allow. These differences result in ARET being a potentially viable candidate for anything where VRET is currently used (Baus & Bouchard, 2014).
Conclusion
A common theme throughout the literature presented above — apart from a call for more rigorous research — is that VRET (and, potentially, ARET) is best utilised as a tool to aid in the treatments of anxiety disorders and PTSD. Anxiety — and especially PTSD — treatment is complex and multi-faceted; claiming VRET as being a replacement is premature — even if no study has shown it to be ineffective (Cieślik et al., 2020).
In fine, VRET shows a lot of promise in its ability to ameliorate symptoms across a variety of disorders. However, it is still in its infancy; whilst its abilities need not be undermined, unless more research came to light, the scientific community will continue to broach the topic with cautious optimism.
References
Baus, O., & Bouchard, S. Ã. (2014). Moving From Virtual Reality Exposure-based Therapy to Augmented Reality Exposure-based Therapy: A Review. Frontiers in Human Neuroscience, 8. https://doi.org/10.3389/fnhum.2014.00112
Cieślik, B., Mazurek, J., Rutkowski, S., Kiper, P., Turolla, A., & Szczepańska-Gieracha, J. (2020). Virtual Reality in Psychiatric Disorders: A Systematic Review of Reviews. Complementary Therapies in Medicine, 52. https://doi.org/10.1016/j.ctim.2020.102480
Dellazizzo, L., Potvin, S., Luigi, M., & Dumais, A. (2020). Evidence on Virtual Reality–Based Therapies for Psychiatric Disorders: Meta-review of Meta-analyses. Journal of Medical Internet Research, 22(8). https://doi.org/10.2196/20889
Hooley, J. M., Nock, M. K., & Butcher, J. N. (2020). Abnormal Psychology (Global Edition) (18th ed.). Pearson Education.
Kothgassner, O. D., Goreis, A., Kafka, J. X., Van Eickels, R. L., Plener, P. L., & Felnhofer, A. (2019). Virtual Reality Exposure Therapy for Posttraumatic Stress Disorder (PTSD): A Meta-analysis. European Journal of Psychotraumatology, 10(1). https://doi.org/10.1080/20008198.2019.1654782
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