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Virtual reality therapy for anxiety disorders

You may have noticed that more and more people you know have been feeling a bit on edge. The ‘cog in a wheel’ feeling in the modern workplace and the expectation to ‘go go go’ to meet those KPIs (key performance indicators) or tight deadlines is hard enough. And going home to the nuclear family with pressures to keep the kids fed, clean, educated, and enriched sure doesn’t help — especially when you have to factor in heavy traffic to get from point A to point B. Then there were the infamous lockdowns of 2020.

It’s no wonder that stress and anxiety are among the most common reasons people seek mental health treatment.

Did you know?

  • There was a 49% rise in mental stress in April 2020 with an average increase of approximately 20% monthly until January 2021. (Statista, 2021)
  • Anxiety disorders are the most common mental health disorders in the United States, which affects approximately 18.1% of the population (AADA, 2021)
  • Anxiety disorders are incredibly treatable, yet only a little over ¼ of people suffering from the debilitating symptoms seek treatment (AADA, 2021)

Sure, stress is a completely normal (and necessary) function of your body—a helpful fight-or-flight artifact from our ancestors’ cave-dwelling days. Your body is a complex machine ‘designed’ to protect, defend, and nourish itself for survival. In the face of stress, your cortisol levels rise adrenaline production increases blood vessels constrict muscles tense heart rate speeds up digestion slows down blood sugar spikes.

All of this gives you the extra energy, stamina, and strength to outrun a Saber-toothed tiger or catch your dinner. But you don’t exactly need to do that these days, do you?

All of this gives you the extra energy, stamina, and strength to outrun a Saber-toothed tiger or catch your dinner. But you don’t exactly need to do that these days, do you?

‘In modernity, ‘good stress’ helps you get things done and stay of danger. It warns you to get out of the way of a fast-moving bike. It prompts you to prepare for your big test or presentation. It helps you get excited about a big date…

But prolonged stress does the exact opposite. It is like your brain is your car stuck in 4th gear even when you’re trying to park to give your engine a rest.

Chronic stress and anxiety can wreak havoc on the nervous system leading to a trickle-down effect to multiple systems in the body, ultimately taking a heavy toll on your mental and physical health.

Luckily, you can reverse most (if not all) of your symptoms with a little workout for the brain with new easy-to-use technologies you can use at home. Before we explore your options, let’s take a brief look at stress and anxiety symptoms to help you understand if you would benefit from treatment.

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VR Therapy is a high-tech method that helps people learn effective ways to cope with situations they dread. During a VRET session, the person wears a virtual reality headset similar to the kind used in video games or to watch movies on the phone. A simulation program plays and one or more avatars are displayed. The person engages with these avatars in a variety of common social situations in order to become better prepared for interactions in real-life situations.

Virtual reality exposure therapy allows you to feel as if you are in a setting, but the therapist can stop the program if you become truly upset. Even if a person knows the virtual reality program isn’t real, what they experience is enough to trigger an emotional response to their phobia. By working through their reactions, nearly 83 percent of people who have tried virtual reality therapy have managed to put their fears behind them.

 Andrea Piacquadio/Pexels

Source: Andrea Piacquadio/Pexels

New research published in JMIR Mental Health has found that virtual reality (VR) can be useful in the treatment of anxiety and depression. Virtual reality can be used effectively to augment and enhance traditional treatment methods, such as cognitive behavioral therapy and exposure therapy.

The recent study reviewed articles published between 2017 to 2021 related to virtual reality in the treatment of mental health issues and found 369 articles in this subject area, which were narrowed down to 34 clinical studies. Most of these studies combined cognitive behavioral therapy, a standard method of treating anxiety, with virtual reality immersive environments and simulations. Based on this recent review of research, VR research has primarily focused on anxiety, and there is less research on the effectiveness and use of VR in depression.

Virtual reality uses computer modeling and simulation so that people can interact with realistic 3D visual environments as well as other senses through interfaces like sensory gloves. Virtual reality in health care entered the scene in the early 2000s with the use of a VR gaming system SnowWorld which was found to be able to reduce pain levels in burn wound care.

Virtual reality combined with cognitive behavioral therapy has been effective in the treatment of social anxiety disorder, generalized anxiety disorder, as well as treatment for specific fears such as public speaking anxiety, exam anxiety, and driving-related anxiety. However, most research in this area has small participant sample sizes, ranging from 2 to 115. All the studies used head-mounted displays, as opposed to projection-based displays, to provide simulated environments.

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The most common VR intervention was VR exposure therapy (VRET). Virtual reality exposure therapy is a behavioral method in which participants are deliberately shown a feared object or anxiety-provoking experience in a simulated environment. VRET has been useful to treat social anxiety and public speaking anxiety. The theory is that gradual and repeated exposure to this triggering simulated environment can reduce anxiety over time. Virtual reality provides a useful way for participants to experience safely and confidentially a simulated environment and gives people a chance to work directly with therapists in real time. For example, people with social anxiety were placed in a virtual workplace or job interview or people with a fear of public speaking were placed in a virtual classroom or conference room.

Virtual reality technology can also enhance the possibilities of music therapy. One study placed participants in a virtual performance hall where they could sing and perform. Another study used VR to enhance art therapy by using a virtual painting program. VR has also been used to conduct healthy games and exercises and as a way to provide neurofeedback and biofeedback.

As virtual reality technology continues to expand and develop, it will hopefully become more accessible to everyone. Virtual reality is a useful and novel way to enhance and make more efficient traditional forms of treatment for of anxiety and depression.

Marlynn Wei, MD, PLLC © Copyright 2021

In an experiment published in JMIR Mental Health, people with social anxiety disorder showed reduced social anxiety and less negative rumination following a virtual reality based exposure therapy. Moreover, this reduction in symptoms was associated with changes in brain activity when participants judged whether positive words were self-relevant.

People with social anxiety disorder (SAD) experience an intense fear of negative evaluation during social situations that greatly interferes with their quality of life. In investigating potential treatments for the disorder, psychology scholars have pinpointed virtual reality (VR) therapy as an effective intervention for teaching coping skills to individuals with SAD.

A team of researchers led by Ji-Won Hur devised a study to explore the efficacy of VR therapy in targeting a particular aspect of SAD that is believed to be key to the development and maintenance of the disorder. Self-referential processing — which refers to the processing of information related to oneself — appears to be biased among people with social anxiety. Using neuroimaging, the researchers tested whether VR therapy would affect areas of the brain responsible for self-referential processing.

First, a sample of 25 individuals diagnosed with SAD and 22 healthy control subjects took part in a baseline assessment. All participants completed a self-referential processing task while undergoing functional magnetic resonance imaging (fMRI). During the task, the subjects were presented with a series of words that were either neutral, positive, or negative and were asked to select whether each word was relevant to them, somewhat relevant to them, or not relevant to them.

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Next, 21 of the participants with SAD took part in six VR sessions over several lab visits. The VR situations varied in difficulty, but each one depicted a social anxiety scenario where participants had to introduce themselves to strangers. After completing the treatment, the participants with SAD underwent another fMRI while again partaking in a self-referential processing task.

When the researchers analyzed the baseline data, they found that people with SAD showed increased activation in certain parts of the brain during the self-referential processing task when compared to the controls.

Following the VR therapy, the participants with SAD showed increased activity in various parts of the brain, including the frontal, temporal, and occipital lobes. In addition, they showed robust decreases in negative rumination and lower scores on the Social Phobia Scale (SPS). In fact, SPS scores actually dropped below severity levels.

Moreover, the more participants showed changes in activity in the lingual gyrus during positive word processing, the lower their social anxiety and the less they partook in negative rumination following the VR therapy. Hur and colleagues note that, according to previous research, the lingual gyrus may be implicated in self-referential processing. They say that the VR therapy may have assisted the SAD patients in accepting the positive words as self-relevant.

The participants also showed increased activity in brain areas implicated in processing autobiographical memories, constructing self-image, and integrating sensory information.

“To our knowledge,” the researchers report, “this is the first neuroimaging study to specify the changes in the psychophysiological responses to self-referential information in social anxiety disorder in response to VR therapy. We believe that our findings may contribute to a better understanding of the therapeutic effects of VR-based interventions, which could be included in the routine treatment of social anxiety disorder.”

Since the control group did not partake in the VR sessions, it is uncertain whether the neural changes observed in patients with SAD were directly caused by the therapy treatment. However, the study authors emphasize that the SAD participants did show significant changes in brain activity during self-referential processing after completing the therapy.

The study, “Virtual Reality–Based Psychotherapy in Social Anxiety Disorder: fMRI Study Using a Self-Referential Task”, was authored by Ji-Won Hur, Hyemin Shin, Dooyoung Jung, Heon-Jeong Lee, Sungkil Lee, Gerard J Kim, Chung-Yean Cho, Seungmoon Choi, Seung-Moo Lee, and Chul-Hyun Cho.