Virtual Reality Experience: Effects of VR Therapies to Treat Social Anxiety Disorders

Virtual Reality Experience: Effects of VR Therapies to Treat Social Anxiety Disorders

Abstract

There have been evolving discussions and research done on the effectiveness and usage of Virtual Reality Therapy or a VR experience to treat social anxiety disorders. Recent advancements in digital technologies have enhanced the outlook and generosity that a virtual reality experience or exposure offers while creating a debate on how feasible and practical the future of VR experience can be in treating social anxiety disorders and depression in people. However, there is enough evidence to support and argue the positive effects of a virtual reality experience in treating a plethora of mental conditions and illnesses. This paper shall discuss the positive and negative impact of VR therapies for treating and preventing mental conditions like social anxiety. Arguments are presented in a neutral tone to help readers justify both sides of such cognitive therapies in treating complex mental disorders. However, with challenges and limitations that can be counted on one’s fingertips, it can safely be assumed that virtual reality experience has and will continue to produce great outcomes in the field of advanced and engineered health care services. Especially for mental disorders, scientists have highlighted better and ever-evolving results that can serve as a strong foundation in treating and preventative care methods for mental disorders. In the end, virtual reality experiences and therapies show a promising future, where its efficiency and reliability can be proven to generate maximum results for patients suffering from mental conditions like a social anxiety disorder.

Introduction

Mental health disorders have been a popular area for experimental therapies, especially when it comes to three-dimensional visual reality experience. When it comes to social anxiety disorders, scientists and psychiatrists have introduced newer and more advanced cognitive methods to help patients overcome their fear and anxiety problems with great ease and comfort. While there are debates on the feasibility, accessibility and technological challenge that virtual reality therapies create, the later sections of this paper will convince the reader of the efficiency of such therapies and how these benefits outweigh the negligent challenges that it poses.

Though the effectiveness of virtual reality exposure is still at an infant stage in the treatments for mental conditions, the same shows a huge scope and bright prospects in the field of e-health and interventions for advanced medical psychology treatments. Virtual reality is a way of creating a real-like environment for patients to face their fears and social phobia in a confined space, with the belief that over time, patients will outgrow their fears and overcome their social phobia and/or anxiety fears.

The reason for the topic of virtual reality exposure on treating social anxiety disorder being controversial is due to the adverse psychological, mental or physical effects it could have on the heat of an individual (Rothbaum 2009). Over years of conducting researches and determining the implementation of VR therapy on treating mental disorders and social phobia, the best assumption to make is the ever-growing and increasing effectiveness of such cognitive behavioral therapies as compared to other traditional forms of treatments.

As such, this paper will not only focus about the realms and practicalities of using virtual reality experiences to help people overcome phobias and social fears, but will also discuss the limitations that come with such therapies and how positive their future actually looks in mental and depression treatments (McLay et al. 2010). Evidence-based studies and reports will support the arguments and statements made in this report, with a clear conclusion as to what the writer thinks and feels, and thus draw inferences from his critical thinking and review of relative studies.

Using virtual reality experience to treat social anxiety disorder

This section will focus on the history and evolution of virtual reality exposure and therapies in treating and preventing mental conditions and social phobias.

2.1 Social Anxiety Disorder

According to the study of Powers(2008), the fear of being involved in or facing social situations is what triggers social anxiety disorder. People suffering from a social anxiety disorder may feel like they are constantly being watched, monitored or tracked, making them uncomfortable and distressed in social situations and experiences. They are usually very worried, stressed or anxious during social settings and thus, may also tend to avoid meeting people and getting out of their homes and confined spaces due to heightened anxiety and social phobia. A person suffering from a social anxiety disorder may find it extremely challenging to deal with social situations, and this is the reason why virtual reality experiences are considered the best methods that can help them come face-to-face with their daily social life. It offers an environment that can help stressed and anxious individuals become slowly and gradually acquainted with real-life situations and worries, and thus, overcome their challenge with social lives and situations in a healthy and effective manner.

2.2 History and present scenario of VR exposure in cognitive therapy

The history and implementation of virtual reality-based technologies can be dated back to the 1950s and 60s when Morton Heilig invented the Sensorama to help viewers with a real-life experience on screen. It used components that defined different senses of the mind and body, such as touch, sight, smell, etc. and later started being used in dual monitor displays, tracking facilities and to train military personnel in real tests and environments. Maller and Reiss (1992) discovered that over the years, virtual reality therapy has been used in mental health treatments based on relevant clinical research and support studies. Modern virtual reality therapy is designed and customized based on the emotional processing theory that can stimulate the right response, stimuli, feedback, and reaction in patients suffering from mental disorders and conditions.

2.3 Current work implementation of VR therapy in social anxiety disorder treatment

Vieira et al. (2017) suggest that Virtual Reality Experience or VRE follows a standard reality exposure and practices segment, to make an individual stand face to face with his/her challenges and phobias. VRE treatments are also available to help social anxiety disorder patients relax and cope with difficult and challenging strategies that affect their mental abilities and well-being. Patients can also undergo personalized VRE treatments for better productivity, accessibility, and results. Based on therapeutical observation and mental cognitive capacities, virtual reality experiences can count as a major part of the mental transformation that could take place in an individual. It has seen to help patients overcome their biggest fears and face situations that they were otherwise hesitant about in the past.

For example, the study of Brewin et al. (1996) revealed that a person suffering from a fear of heights is usually involved with a real-like environment which is usually selected before during the VR exposure event. The individual can make to feel like he is jumping off a tall building, the repetition of which is considered to help that individual overcome any fears or phobias that he may have of heights. Another instance could be of a person suffering from the fear of crowded places, where a crowded real environment can be created with delusional properties for the individual to face experience and thus, overcome.

2.4How VR Therapies can help treat social anxiety

Based on the above examples, it can be inferred that virtual reality exposure is nothing but an artificial yet real-like environment for people with social phobias and anxiety issues. Freeman (2007) suggests that virtual reality therapy is a high-tech method that uses a kind of simulation program to create an environment that the individual dreads or fears (Freeman 2008). During a typical virtual reality therapy session, virtual reality headsets are required to be worn that can help an individual look at the real environment created on an artificial platform. A person is engaged with environments and situations that make them feel uncomfortable, thus helping them gain a better position and better mental and emotional condition to help them face real-life situations post their VR therapy.

A low-grade anxiety stimulus initially forms the base of a virtual reality experience therapy (VRET). However, the intensity is gradually increased to toughen up the level of challenge and to help individuals overcome more complex anxiety disorders and social fears. Alsina-Jurnet et al. (2007) stated that as a person’s coping and cognitive skills improve, environments are changed and altered to keep at pace with the patient’s mental development. A therapist is involved who coaches, trains, and monitors the entire VRET of a patient. Medications along with a combination of emotional mental and relaxation techniques are used to get the best out of social anxiety disorder patients and help those overcome fears and anxiety issues in the shortest period of time.

Gorini and Riva (2008) discuss that virtual reality therapy allows one to be a part of and experience a setting that they would otherwise not prefer. With concerns about an aggravated emotional outburst or other severe mental impacts, a therapist can also choose to stop a VRET in case a patient becomes too uncomfortable or controllable during rare situations. Emotional responses may get triggered despite using an artificially-created real-time environment. However, studies state that almost 85% to 90% of people who have undergone a virtual reality experience have overcome their social fears and anxiety disorders with minimal or no mental and health effects at all.

The resulting effectiveness of Virtual Reality Experience on social anxiety disorder patients

A study involving the critical analysis of 404 potentially reviewed papers on the effects of VRET for treating social anxiety disorder highlights inevitable opportunities and a bunch of limitations its way.

Methods used: Electronicdatabasewas used for information research and strategies involved with the virtual reality experience in treating mental conditions. Search related items were ‘virtual reality’, ‘mental health’, ‘mental disorders’, ‘anxiety’ or ‘depression’. The eligibility criteria were strictly based on the quantities measurements and analysis of human participants dealing with anxiety and depression related disorders. Peer-reviewed study papers of Ready et al. (2006) were analyzed to gauge the concluding results with relevant arguments and evidence. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) established a set of guidelines and methodological details to follows that led to reviewers come to evident conclusions, based on professional research of the positive ratings related to VRT studies and mental anxiety disorder treatments.

Eligibility criteria: Powers and Emmelkamp (2008) recommend the removal of duplicates, abstracts and titles, 407 potential articles were reviewed to critically analyze the arguments present in different papers. An additional study was undertaken through reference list verification. Other crucial eligibility criteria were analyzing the non-immersive VR therapies and exercises, measuring anxiety and depression conditions and establishing a correlation between virtual reality settings and preventive measures for social anxiety disorders.

Key findings: It was observed that a number of authors laid their focus on the five essential ways in which virtual reality experiences can help improve mental and cognitive behavior (Savović et al. 2014). At the end of reviews, authors discussed direct outcomes in patients such as reduced tiredness and increased energy levels, less stress and more enjoyment.

Falconer et al. (2016) state that experiments have also shown the positive psychological effects VR exercise can have on patients suffering from other medical conditions as well. Two experimental groups with participants suffering from spinal cord injuries were involved in the experiment, with only one group given VR exercise equipment. Also, Meyerbröker and Emmelkamp (2010) produced evidence of drastic improvement was seen in patients involved with virtual reality exercise than those who were not. There was a striking difference in the way both the groups balanced their stress and calmness levels while going through medical conditions that directly or indirectly affect then psychological and mental well-being of individuals.

Assessments included administration of self-reported measures for patients dealing with anxiety, social phobias, and mental disorders. Most critiques conducted telephone screenings, in-person, and pre-treatment assessment (Leichsenring and Steinert 2018).

McCann et al. (2014) suggest other VRE treatments with long-term and powerful impacts were displayed in people with social anxiety, self-focused attention, negative perceptions, lack of emotional control, and unrealistic goal settings. A lot of sessions included in the major part of the studies rely on cognitive restructuring and videotape feedback exercise to assess and analyze the exposure of patients towards virtual environments. VR instruments used during the sessions were primarily headphones, goggles, and a tracker that could provide a three-dimensional exposure of the relevant circumstance/environment and thus, therapists could manipulate the scenarios as per the progress and/or failure of the treatment. Audience reactions were also manipulated during the experiments to determine the reaction of those suffering from social phobias and anxiety problems and help them reach their treatment goals.

3.1 Current Protocols in the VR paradigm

A few inventions, mainly three, are offered by the set protocol of virtual reality experience based on a clinical setting. Such is the current protocol and work culture in the field of VR therapy for treating social anxiety disorders.

Including biosensors and behavioral analysis for better and more accurate objective and quality assessment: A patient’s behavior can be assessed and analyzed by determining their general symptoms and emotional/mental status. This is further done in the process of a feedback method that takes into account critical evolutions of the time, timely feedback activation, assessing a patient’s psychological status and following a closed-loop mechanism to come at the right conclusions (Bouchard et al. 2016).

Implementations required in the planning of treatments: Making therapeutic decisions by planning and strategizing virtual reality treatments and programs for patients. This is done to monitor the responses of patients and to check their feedback and reaction to the VR treatments included. (Ágata et al. 2018).

Shah et al., 2015 suggest that to enhance the quality of outcomes and conclusions with a constant warning and feedback process: The advantage of this approach mainly revolves around self-regulation training that improves the behavioral, emotional and physiological senses and practical in patients.

Effects of VRET on physical and mental health

There have been a few negative impacts that are potential with the use of virtual reality therapy. Despite newer and better innovations in virtual reality technologies, the same does not mean that it can be a hundred percent effective and harmless in helping patients dealing with and overcome social anxiety disorder problems. A lot of evidence suggests that the use of heavy, head-mounted displays such as gadgets, goggles, etc. can result in a number of health issues and psychological problems for patients (Difede et al. 2002). Seizures, dizziness, head heaviness, sweating, fatigue, motion sickness, disorientation (both mentally and physically) are a few challenges that people, especially women, may still face when it comes to using virtual reality instruments and undergoing the experiences to treat social anxiety disorders. Eye strain, headache, stomach problems are another set of common health issues that woman and men may face, due to the over-exposure and handling of virtual reality exposure machines and equipment. People may also suffer from muscle problems and joint aches due to the additional responsibility of carrying and using virtual reality experience instruments.

In addition to this, Botella et al. (2004) compare the old and traditional style of treating social anxiety disorders by stating that virtual reality experience therapy may turn out to be an expensive affair, as many studies suggest. The current challenge in using and incorporating virtual reality experience for treating social anxiety disorders is mainly because of the lax and carefree approach of stakeholders in realizing the outcomes and potential benefits of virtual reality exercise. Due to this different and careless approach, the implementation of virtual reality technology still needs a lot of effort and research, and the positive effects of which have to be closely and clearly associated with social anxiety treatments and prevention. Firth et al. (2018) back up this argument stating that effective exercises still have quite a lot of room to see their presence and implementation in social anxiety disorder care methods. All machines and virtual reality instruments are still at the beginning of their development stages, thus not clearly and accurately specifying the risks and hazards of VRET. As with any other mental and psychological treatment, studies have also discussed a similar change of experiencing obsession and/or dependence on virtual reality experience environments (Parsons and Rizzo, 2008).

Conclusion

The main goal of this discussion was to assess the efforts and transitions that have taken place in the field of virtual reality experience for treating social anxiety disorders and how effective or unsuccessful these treatments actually are. Main studies included the critical review literature of more than 22 papers that also discuss the current and future efforts of practitioners and health professional/therapists into incorporating virtual reality exposure into various mental and psychological disorder treatments. None of the studies found any negative counts or downsides of using virtual reality experience therapy in treating social anxiety disorders. Most of the articles that have been included in this literature review study focus on the potential benefits of virtual reality experience, despite discussing the minor negative downfalls that can come with treatments like these, such as feasibility, expenditure, accessibility, and more. However, virtual reality experience or exposure comes with mostly positive effects for the society. However, the writer feels that the topic of virtual reality experience is still at a very infant and generalized level, due to which optimum results have still been narrowed down in the studies. The type, duration, frequency, and intensity of virtual reality therapies and exercises need to be increased and focused on better to treat anxiety and depression in patients (Shiban et al. 2015).

Price et al. (2011) discusses the benefits of outdated virtual reality experience systems that have worked out well in the past. Nut newer virtual reality technologies have successfully replaced and taken over the older and traditional VR forms, thus increasing the efficiency and efficacy of VRET in treating social anxiety disorders. However, after doing a careful reading of all the available literature on the effects of virtual reality on anxiety and depression treatments, the same has been found very encouraging and motivating for patients that are looking for better and alternative methods to transform their minds and fears by experiencing a computerized virtual environment (Krijn et al. 2003). Also, considered extremely safe and effective, it was also seen that the old virtual reality systems hardly had any detrimental effects on the patient and most participants showed positive, reliable and long-term effects on virtual reality experience in social anxiety disorder treatment and prevention.

5.1 Future research on VRET for treating social anxiety disorder

Over the past decade, virtual reality technology has experienced a drastic increase in treatment applications for those suffering from mental and social anxiety disorders. Virtual reality experience and technologies have had a favorable impact on those dealing with and trying to cope with social anxiety disorder and other mental illness over the last few years. There have been a plethora of innovations and technologies introduced, the potential benefits and risks of which were available in a number of literature papers. This helped me to critically assess literature produced by professionals, practitioners, and authors. It can be gathered that virtual reality experience is nothing but an emotionally processing therapy that can intensify and highlight the mental and emotional challenges of a person with the right fear responses, stimuli, and feedback. A virtual environment that can facilitate and trigger the mental and emotional awakening of patients has been proven to be one of the most experienced and effective treatments for social anxiety disorders and depression. Yet, the same potential benefits and risks are rarely investigated due to lack of efforts and the need for improved research that can highlight better inquiry details of a virtual reality experience.

References

Vieira, Á., Melo, C., Machado, J. and Gabriel, J. (2017). Virtual reality exercise on a home-based phase III cardiac rehabilitation program, effect on executive function, quality of life and depression, anxiety and stress: a randomized controlled trial. Disability and Rehabilitation: Assistive Technology, 13(2), pp.112-123.

Alsina-Jurnet, I., Carvallo-Beciu, C. and Gutiérrez-Maldonado, J. (2007). Validity of virtual reality as a method of exposure in the treatment of test anxiety. Behavior Research Methods, 39(4), pp.844-851.

Botella, C., Osma, J., Garcia-Palacios, A., Quero, S. and Baños, R. (2004). Treatment of flying phobia using virtual reality: data from a 1-year follow-up using a multiple baseline design. Clinical Psychology & Psychotherapy, 11(5), pp.311-323.

Bouchard, S., Dumoulin, S., Robillard, G., Guitard, T., Klinger, É., Forget, H., Loranger, C. and Roucaut, F. (2017). Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: A three-arm randomised controlled trial. British Journal of Psychiatry, 210(04), pp.276-283.

Difede, J., Hoffman, H. and Jaysinghe, N. (2002). Multimedia Reviews: Innovative Use of Virtual Reality Technology in the Treatment of PTSD in the Aftermath of September 11. Psychiatric Services, 53(9), pp.1083-1085.

Falconer, C., Rovira, A., King, J., Gilbert, P., Antley, A., Fearon, P., Ralph, N., Slater, M. and Brewin, C. (2016). Embodying self-compassion within virtual reality and its effects on patients with depression. BJPsych Open, 2(01), pp.74-80.

Leichsenring, F. and Steinert, C. (2018). The Evidence for Cognitive Behavioral Therapy—Reply. JAMA, 319(8), p.832.

Freeman, D. (2007). Studying and Treating Schizophrenia Using Virtual Reality: A New Paradigm. Schizophrenia Bulletin, 34(4), pp.605-610.

Firth, J., Torous, J., Carney, R., Newby, J., Cosco, T., Christensen, H. and Sarris, J. (2018). Digital Technologies in the Treatment of Anxiety: Recent Innovations and Future Directions. Current Psychiatry Reports, 20(6).

Gorini, A. and Riva, G. (2008). Virtual reality in anxiety disorders: the past and the future. Expert Review of Neurotherapeutics, 8(2), pp.215-233.

Savović, J., Weeks, L., Sterne, J., Turner, L., Altman, D., Moher, D. and Higgins, J. (2014). Evaluation of the Cochrane Collaboration’s tool for assessing the risk of bias in randomized trials: focus groups, online survey, proposed recommendations and their implementation. Systematic Reviews, 3(1).

Meyerbröker, K. and Emmelkamp, P. (2010). Virtual reality exposure therapy in anxiety disorders: a systematic review of process-and-outcome studies. Depression and Anxiety, 27(10), pp.933-944.

McCann, R., Armstrong, C., Skopp, N., Edwards-Stewart, A., Smolenski, D., June, J., Metzger-Abamukong, M. and Reger, G. (2014). Virtual reality exposure therapy for the treatment of anxiety disorders: An evaluation of research quality. Journal of Anxiety Disorders, 28(6), pp.625-631.

McLay, R., McBrien, C., Wiederhold, M. and Wiederhold, B. (2010). Exposure Therapy with and without Virtual Reality to Treat PTSD while in the Combat Theater: A Parallel Case Series. Cyberpsychology, Behavior, and Social Networking, 13(1), pp.37-42.

Parsons, T. and Rizzo, A. (2008). Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: A meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry, 39(3), pp.250-261.

Price, M., Mehta, N., Tone, E. and Anderson, P. (2011). Does engagement with exposure yield better outcomes? Components of presence as a predictor of treatment response for virtual reality exposure therapy for social phobia. Journal of Anxiety Disorders, 25(6), pp.763-770.

Powers, M. and Emmelkamp, P. (2008). Virtual reality exposure therapy for anxiety disorders: A meta-analysis. Journal of Anxiety Disorders, 22(3), pp.561-569.

Maller, R. and Reiss, S. (1992). Anxiety sensitivity in 1984 and panic attacks in 1987. Journal of Anxiety Disorders, 6(3), pp.241-247.

Ready, D., Pollack, S., Rothbaum, B. and Alarcon, R. (2006). Virtual Reality Exposure for Veterans with Posttraumatic Stress Disorder. Journal of Aggression, Maltreatment & Trauma, 12(1-2), pp.199-220.

Rothbaum, B. (2009). Using virtual reality to help our patients in the real world. Depression and Anxiety, 26(3), pp.209-211.

Shah, L., Torres, S., Kannusamy, P., Chng, C., He, H. and Klainin-Yobas, P. (2015). Efficacy of the Virtual Reality-Based Stress Management Program on Stress-Related Variables in People With Mood Disorders: The Feasibility Study. Archives of Psychiatric Nursing, 29(1), pp.6-13.

Shiban, Y., Schelhorn, I., Pauli, P. and Mühlberger, A. (2015). Effect of combined multiple contexts and multiple stimuli exposure in spider phobia: A randomized clinical trial in virtual reality. Behaviour Research and Therapy, 71, pp.45-53.