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Fear of Heights? An Avatar Can Help

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Do you break into a cold sweat on bridges…hug the walls on upper levels of malls…avoid ladders and balconies…never, ever ride a ferris wheel? Fear of heights is one of the most common phobias and one that far too many people just live with. The standard treatment, exposure therapy—in which a therapist coaches a patient through increasing levels of exposure to what he/she fears in a real-world environment—is time-consuming and can be expensive. But virtual reality could help you lose your fear of heights quickly and inexpensively.

Though it’s new as a consumer plaything, virtual reality (VR) has been used to treat some mental health issues for about 20 years. It’s been used as a kind of exposure therapy to treat phobias, anxiety disorders and PTSD and to help recovery from substance abuse. VR has several advantages—treatment can easily be targeted to specific situations…patients are more willing to go into troubling virtual situations because they know they’re just simulations…and although VR still relies on a therapist present to provide guidance and psychological support, it is cheaper than, say, taking an actual flight to get over fear of flying. But what patients feel and learn is still transferable to the real world.

Researchers from the University of Oxford in England wanted to see whether VR could be automated so that a therapist would not need to be present. They had 100 adults diagnosed with fear of heights fill out an 80-point questionnaire to determine their levels of fear. Then about half of them were given six 30-minute VR sessions over a two-week period, while the other half carried on as normal.

VR intervention: Participants used an app designed by the researchers along with commercially available VR headsets and hand-held controls. Although a researcher was present during the therapy sessions for safety, the app was designed to be used without a therapist. Participants did each session while standing up—their virtual selves (an avatar they saw on their headset screens if they looked down at themselves) progressed from level to level in a 10-story building overlooking a ground-floor atrium. They were guided by a virtual coach who directed them to perform increasingly difficult tasks at each level—such as standing in front of a barrier that gradually lowered (relatively easy)…or walking out on a platform that went into the atrium space (difficult). The goal was for the participants to test—and learn—whether their fears really meant that they were in actual danger.

Results: After two weeks of VR therapy, participants had dropped an average of about 25 points in their fear scores—a 68% reduction—compared with no change in the participants who had carried on as normal. These results were better than hoped. In fact, the researchers speculate that the results were so good because the participants performed much harder tasks than would have been possible in the real world…so facing their real-world challenges seemed that much easier.

Although the automated VR app used in the UK study is not commercially available in the US, VR therapy with a therapist is offered at many hospitals, mental health centers and university centers. For instance, Duke University offers a 45-50-minute therapist-guided VR session for $140. The apps that offer virtual experiences of heights—such as being at the top of a high building—available online that you can use on your own with a VR headset do not have the therapy component and have not been clinically tested to show that they are effective.

VR is not meant to replace a live therapist for every patient or in every situation calling for exposure therapy. But if fear of heights is causing you unnecessary misery, VR therapy might open whole new vistas for you!

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Source: Daniel Freeman, PhD, professor of clinical psychology, University of Oxford, consultant clinical psychologist, Oxford Health NHS Foundation Trust and chief clinical officer, Oxford VR, all in the UK. He is lead investigator of the study titled “Automated psychological therapy using immersive virtual reality for treatment of fear of heights: a single-blind, parallel-group, randomised trial,” published in The Lancet Psychiatry. Date: November 6, 2018 Publication: Bottom Line Health
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