Virtual Reality is the latest consumer technology to reach a critical mass in the public eye. Well-known media and retail institutions from the Today Show to IKEA have embraced VR. What many people might not know is that the technology has been in use for quite some time in a more noble pursuit. Virtual reality therapy was one of the first applications of VR, and it’s only becoming more effective as technology advances.
Virtual Reality Therapy Definition and History
The term Virtual Reality Therapy was first coined in 1992, in a doctoral dissertation by computer scientist Max M. North. Dr. North posited that virtual reality could be used to treat a number of psychological ailments through safe, controlled exposure.
The US Army funded research and development of North’s ideas, and today uses virtual reality exposure therapy to treat PTSD (post-traumatic stress disorder) and other anxiety disorders. The private sector, as it is wont to do, has taken the idea and run with it. Today, virtual reality therapy is an effective tool of psychology, used as a treatment for phobias, disorders, and even some of the symptoms of autism.
Virtual reality therapy is still a new and developing field, and there are a great many opportunities to expand its horizons. For the mental health professional, it is an exciting time to find new ways to help patients. Here are some of the best examples of virtual reality software being used as a treatment for psychological problems. They can serve as inspiration to expand the field into new directions.
6 Examples of Virtual Reality Therapy Solutions
The work started by Dr. North has evolved into Bravemind, an ongoing research project into virtual reality treatment of PTSD. Research is currently underway at several universities and is funded by the US Army Simulation and Training Technology Center.
One of Bravemind’s earliest successes was Virtual Iraq, a program launched all the way back in 2007 to help veterans returning from the Middle East deal with the traumas of war. Soldiers receiving treatment wear a head-mounted display (a VR headset) and are virtually transported to the streets of Fallujah. Virtual Iraq incorporates a number of other technologies to complete the immersion, which are introduced gradually over a number of sessions.
By the end of a course of therapy, physical elements such as vibration and even the smells of smoke and dust have been added into the equation. Patients are even given a mock rifle to hold, to complete the illusion. Virtual Iraq has allowed numerous veterans to process their experiences overseas, sleep without medication, and reduce episodes of anxiety and panic.
The Virtual Reality Medical Center
The Virtual Reality Medical Center (VRMC) is a private psychology practice that has built a very extensive and elaborate system for treating the fear of flying using virtual reality exposure therapy. Patients undergoing the VR Flight treatment are seated in an actual commercial airline seat. The patient wears a head-mounted, motion tracking display, and is immersed in the experience of a flight from takeoff to landing.
VRMC has added powerful speakers and motors to their airline seats, allowing them to rumble and bounce to simulate engine noises, storms, and turbulence. The program progresses from simply sitting in a grounded aircraft, to waiting on a runway for takeoff, to flying through the air complete with a view out the window. Therapists can then add flight problems such as inclement weather to desensitize the patient to the stresses of travel.
In addition to the airplane seat, VRMC has developed a health monitoring device that gives therapists awareness of the patient’s heart rate, skin temperature, EEG, and ECG. Therapists can therefore keep an accurate picture of the patient’s stress levels as they undergo treatment, and can increase or reduce the intensity of the simulation as needed for maximum efficacy.
Virtual Reality Treatment Program at Duke Faculty Practice
A program offered at the Duke University School of Medicine uses virtual reality therapy to treat a number of different phobias and anxiety disorders. Therapists at the program have VR simulations to aid in treatment of acrophobia (fear of heights), astraphobia (fear of thunderstorms), speech anxiety (fear of public speaking), and the fear of flying.
Researchers and therapists at Duke are advocates of virtual reality exposure therapy for a number of reasons, including its lower cost and greater efficiency compared to traditional exposure therapy. Taking a virtual trip to the top of a mountain to desensitize a patient to heights is much more economically feasible and less time-consuming than what they call visiting a mountain “in-vivo” (in life).
Duke University is a frontrunner in the field of virtual reality research, and has been lauded for its multiple programs advancing the industry. Duke is frequently represented at the IEEE Virtual Reality Conference, and their DiVE (Duke immersive Virtual Environment, capitalization theirs) room-scale VR installation is a fine example of the furthest reaches of the technology.
VR Treatment of Autism at Newcastle University
Researchers at the Newcastle University Institute of Neuroscience have explored virtual reality therapy in the treatment of autism. The study involved nine children aged 7-13 who have been diagnosed as high functioning autistics. Their autism had caused them to suffer anxieties around situations such as shopping, riding public transportation, and speaking in class. The study focused on children with specific triggers to their fears, rather than general anxiety disorder.
Technically speaking, the Newcastle University project was unusual in that it did not rely on traditional virtual reality therapy equipment. Rather than wearing a head-mounted display or holding a controller, the study participants entered the “Blue Room”. This was an enclosed room with bluescreens on all surfaces, onto which were projected images of the desired virtual environment. Although simple, the Blue Room could produce a very convincing virtual simulation of a high bridge, a busy road, or a classroom full of expectant students and teachers.
The children could interact with the room using iPads when needed, or simply by walking around under the guidance of a therapist.
The project was considered a success, and further research is currently underway. Of the nine study participants, eight of them were determined to have achieved significant progress in overcoming their fears. After completing virtual reality exposure therapy in the Blue Room, the children could face their triggers in the real world without shutting down from anxiety or debilitating fear.
The study was heavily documented in the scientific journal PLOS ONE.
Medical technology firm Virtually Better has developed several virtual reality solutions to treat substance abuse disorders, PTSD, several phobias, and stress management. They also have a software program intended to assist children who suffer from social anxiety.
Some of the solutions offered by Virtually Better use relatively commonplace, consumer-grade technology such as smartphones and commercially available VR headsets. However, the company is also a participant in the US Army-funded Bravemind program detailed above, which uses advanced tools and props to enhance virtual reality therapy technology for treatment of PTSD.
Other VR applications developed by Virtually Better include Calm Craft, which simulates a relaxing underwater environment in the service of teaching calm breathing techniques, and an Alcohol and Tobacco suite for patients prone to addiction to practice self-control and distraction from temptation.
HITLab VR Therapy for Spider Phobia
At the University of Washington’s Human Interface Technology Laboratory (HITLab), researchers have developed a very specific program to treat arachnophobia (fear of spiders) using virtual reality exposure therapy.
HITLab pioneered the use of VR for the treatment of arachnophobia. In the program, called SpiderWorld, patients wear a head-mounted display and explore a virtual world filled with the eight-legged critters. Over the course of 12 one-hour sessions, the simulation progresses by increasing the quantity and activity level of the spiders.
A therapist can help direct the session by controlling the spiders either with a mouse and keyboard, or by physically holding a toy spider up to the patient’s face. The toy is wired into the simulation, and the its position in relation to the patient’s headset corresponds to the virtual spider’s proximity in the virtual world. The patient is encouraged to reach out and touch the toy spider, which appears realistic and animated in the simulation.
Combining the visuals provided by the head-mounted display with the sense of touch offered by the physical toy is a potent combination, and SpiderWorld has been very effective in treatment of the phobia.
Virtual Reality Therapy Equipment
There is a wide range of equipment used in VR applications, some of it specific to mental health settings like virtual reality exposure therapy. For VR to be effective as a means of psychological treatment, the hardware and software must combine to create an immersive illusion, even more so that in entertainment or shopping applications.
To that end, virtual reality developers have created a number of specialized pieces of equipment that are unique to VR as a treatment for mental disorders.
Dedicated head-mounted display
A head-mounted display, or VR headset, is the core of most virtual reality experiences. The device is worn on the patient’s head and presents high-resolution displays directly in front of their eyes. Most headsets also incorporate motion trackers or gyroscopes to allow the user to pan and tilt their view of the virtual environment by simply moving their head. The ability to control the view through such a natural motion is a hallmark of virtual reality, and is key to its effectiveness in mental health treatments.
The purpose of a head-mounted display is to completely block out all vision of the real world and replace it with computer generated imagery. Dedicated consumer-grade equipment like the Oculus Rift and the HTC Vive are gaining popularity, along with custom-built solutions for VR therapy and other applications.
Mobile phone based head-mounted display
As a more economical alternative to dedicated head-mounted displays, there are several solutions to use an ordinary smartphone as a VR headset. These can be especially useful for home-based virtual reality therapy, since it is often not practical to send a patient expensive and specialized equipment. Almost everyone owns a smartphone these days, and any relatively recent iOS or Android device can be made into a head-mounted display with the right enclosure.
By far, the most common such enclosure is Google Cardboard. A number of manufacturers sell Cardboard enclosures to work with almost any smartphone, and the Cardboard uses a pair of lenses and some clever engineering to turn the phone into a virtual reality device. The phone’s own gyroscope is co-opted for VR motion tracking, and the high resolution displays of modern devices give them the graphical fidelity needed for immersive virtual experiences.
Beyond turning one’s head to rotate the view, the most common way to interact with a virtual reality environment is by using a controller. The Oculus Rift and HTC Vive both use their own custom-designed controllers, as do VR systems intended for exposure therapy. Commonly available video game controllers like the Xbox Controller for Windows may also be used.
Depending on the intended patient, these controllers can be an advantage or disadvantage. Young people are often very familiar indeed with the use of game controllers, but for those who did not grow up with them, they can be difficult to use and distract from the effectiveness of the treatment.
Our sense of smell is just as important as sight or hearing, and many effective VR therapy programs incorporate smells using a scent machine. These are similar to commercial air fresheners or aromatherapy devices, and use specially formulated sprays to expose the patient to the scents relevant to their treatment.
A program such as Bravemind for treatment of PTSD uses smoke and other smells of combat to enhance the illusion, while substance abuse therapy programs like those offered by Virtually Better can use tobacco and alcohol scents to trigger the reward centers of the brain so patients can learn to ignore them without risk of a relapse.
Also called a wired glove, a data glove allows for very instinctive and natural manipulation of a virtual world. The glove typically integrates a motion tracking device to translate hand position into the simulation, and utilizes sensors in each finger to allow the software to respond as the user grasps and gestures. Some gloves even include haptic feedback, using vibrations to give the user the feeling of physical touch in the computer-generated environment.
Data gloves are high-end, specialized equipment, and are not typically available in the consumer market. That said, they can be extremely effective in virtual reality exposure therapy, as the sense of immersion they provide cannot be equaled by game controllers.
Custom simulacra related to specific experiences
Depending on the nature of the situation being simulated, physical props and sets can be helpful in treatment of phobias and disorders. Most notably, the Bravemind project has participants hold a mock rifle in its treatment of PTSD. In the civilian world, the Virtual Reality Medical Center’s program to treat fear of flying has patients sit in actual airplane seats while engaging in the VR experience.
The goal of any VR simulation, whether for therapy or entertainment, is to create the sensations and feeling of being in another place. The addition of a physical object into the virtual world provides a familiar tactile sensation to the user. This simple trick can be the tipping point that fools the brain to the degree necessary for effective treatment.
How AppReal can help with VR development
Mental health clinic managers and other medical professionals hoping to integrate virtual reality therapy into their treatment plans face some unique challenges. In almost all cases, a medical practice does not have the in-house programming and development expertise needed to successfully create and deploy a virtual reality solution.
Therefore, it is necessary to select and employ a virtual reality company to create the software. A good virtual reality development house is also able to assist in the design and specification of the therapy, including sourcing and integrating hardware and equipment.
AppReal is one such company. The firm is reputable and very experienced in all aspects of VR production, mobile app development, and custom development of virtual reality. AppReal prides itself on its individualized, bespoke solutions to suit the needs of each client, and maintains close collaboration with the client throughout the development process.
AppReal utilizes an Agile workflow. In the world of software development, to be agile means that collaboration is prioritized and adaptation is embraced. At AppReal, agile also means that an executable version of the software is available at every stage of development. In a sense, the software is treated like a living, growing organism, and it can be examined and interacted with as it evolves over time.
AppReal has experience developing for commercially available virtual reality hardware and smartphone-based solutions like Google Glass, as well as with custom-designed equipment for a number of industries. The carefully constructed project teams at AppReal can assist with every phase of a virtual reality therapy development project, from the initial specifications to the final deployment.