The past two decades have witnessed the emergence of virtual reality (VR) as a major tool for the investigation, assessment, and management of medical and psychiatric disorders. The growing interest in medical applications of VR is highlighted by the fact that the number of scientific articles published in Medline every year on this topic increased from 45 in 1995 to 951 in 2003 to 3,203 in 2010.

There are many definitions of VR, one of which is given here: “Virtual reality refers to immersive, interactive, multi-sensory, viewer-centered, three-dimensional computer-generated environments and the combination of technologies required to build these environments.

Anxiety disorders are among the most common of mental disorders affecting nearly 18.1% of adults The estimated prevalence of anxiety disorders worldwide is 7.3%, and they cause a high proportion of the global burden of disease. Anxiety symptoms can cause significant distress, impair quality of life, and increase stress. Anxiety increases the risk for a range of co-occurring physical conditions, including chronic pain (4). Given the pervasiveness of anxiety and its impact on mental and physical health, effective treatment is clearly needed, yet a majority of affected individuals remain untreated. These data highlight the importance for individuals and for society at large of increasing access to effective treatment. This perspective paper presents the ways that incorporating virtual reality (VR) in therapy can improve treatment for anxiety.

VR consists of a fully immersive, 3-D environment that transports people to engaging, interactive environments that can promote new learning. VR technology also has the potential to assist in training, evaluation, delivery, and supervision of psychotherapy skills, and can provide patients with a physiologically and emotionally evocative experience which can make VR a valuable tool for mental health treatment. VR exposure therapy (VRET) permits individualized, gradual, controlled, immersive exposure that is easy for therapists to implement and often more acceptable to patients than in vivo or imaginal exposure (8). This can allow users to practice behavioral skills in a safe environment through the support of a therapist. VRET has been used for the treatment of a range of conditions including social anxiety, Post-Traumatic Stress Disorder (PTSD), and panic disorder (9). The authors present several methods for incorporating VR technology into the therapeutic process and review how VRET can improve the ease, acceptability, and effectiveness of treatments for anxiety.

A patient can encounter difficulties finding or completing evidence-based anxiety treatment. These barriers can include failure to recognize and diagnose anxiety disorders, lack of access to treatment, and less-than-optimal quality of care. Since anxiety causes somatic symptoms, anxious patients often seek treatment through their primary care doctor. Anxiety disorders may go under-recognized and untreated. Access to effective care is further hampered by a shortage of therapists trained in evidence-based anxiety treatment. Limited access to effective treatment results in a large treatment gap allowing millions to suffer from anxiety even though evidence-based treatment exists. Obstacles to effective therapy need to be addressed.

Exposure therapy for anxiety disorders has a strong evidence base, yet few therapists utilize this method and patient and therapist misconceptions limit its availability. Exposure therapy involves gradual and repeated exposure to feared stimuli with resultant changes in cognitions, behaviors, and emotional and physical responses. Feared stimuli can be almost anything: living organisms, inanimate objects, situations, activities, thoughts, mental images, physical symptoms, and/or affective experiences. Extensive research demonstrates the efficacy of exposure-based therapy for various anxiety disorders, especially phobias. Exposure facilitates extinction of the fear response and helps change dysfunctional assessments of threat and unhelpful responses, reducing the conditioned anxiety associated with feared stimuli. Gradual exposure allows habituation and re-evaluation of the threat to occur.

Unfortunately, although exposure therapy can relieve anxiety symptoms ranging from mild to severe, therapists may not offer it and patients may be reluctant to try it, contributing to the treatment gap for anxiety. What are some obstacles to offering this proven effective treatment and how might VR help overcome these obstacles?

This course takes you on a journey of how VR is being used in mental healthcare today.