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How an NHS Study Uses Virtual Reality to Address Patients’ Worst Phobias

There is only a handrail between me and a 120 ft drop on huge granite boulders and crashing ocean waves below.

I can clearly see the swirling, thundering water through openings in the ramps of the vibrating platform I am standing on – but miraculously, I am not afraid.

This is a revelation. I’ve been afraid of heights for as long as I can remember – and it’s gotten worse over the years.

Indeed, just two years ago, wild horses would not have dragged me to this swaying platform over the ocean in Torndirrup National Park, Western Australia, where I recently vacationed with my family.

The virtual reality therapy, which was conducted in 2018 as part of a trial at Oxford University, is now being rolled out on the NHS. (Stock image)

The virtual reality therapy, which was conducted in 2018 as part of a trial at Oxford University, is now being rolled out on the NHS. (Stock image)

Yet I was here. I think the transformation is due to a new approach to virtual reality therapy, which I tried as part of a trial at Oxford University in 2018.

This therapy is now being rolled out on the NHS, including in Oxfordshire, Buckinghamshire, Berkshire, Cambridge and Peterborough.

Some experts call virtual reality therapy an important new treatment for mental illness, from phobias to depression, schizophrenia and even pain – and studies are ongoing.

It uses a specially designed computer program to create an environment that mimics a real situation. This is passed on through small projectors that patients see through a headset.

The idea is that by desensitizing patients gradually and in a safe and controlled manner to the thing causing their symptoms – for example, standing on a ladder for people like me with a fear of heights.

Fear of heights – acrophobia – affects about one in three people in the UK and, as I experienced, there is some evidence that it can worsen as we age.

One theory, says Kevin Gournay, professor emeritus at the Institute of Psychiatry at King’s College London, is that “as you age, your brain’s balance system deteriorates and you become more physically frail.”

Daniel Freeman, professor of clinical psychology at Oxford University, who led the virtual reality trial, says, “Phobias, such as fear of heights, have a negative effect on many people’s lives.

Virtual reality puts someone in a situation that would normally scare them, but it is bearable because they are not real.

“This provides an essential element of detachment. The user learns that while heights can feel uncomfortable, they do no harm. Over time, this new learning lifts old, anxious memories. ‘

Virtual reality puts a patient in a situation that would normally frighten them, but is bearable because she is not real. (Stock image)

Virtual reality puts a patient in a situation that would normally frighten them, but is bearable because she is not real. (Stock image)

Virtual reality puts a patient in a situation that would normally frighten them, but is bearable because she is not real. (Stock image)

It seemed like a good idea to me when I heard about the Oxford trial on local radio. I wanted to address my anxiety, which was becoming a real nuisance on family outings, preventing me from participating in activities such as climbing castle towers or cliff walks.

My legs would turn into jelly, I would feel breathless, my palms would sweat. I’d be terrified of the thought that if I slipped just a little bit, I’d walk over the edge.

I had nothing to lose by trying the virtual reality program. For four 30-minute sessions, I wore a headset over my eyes and held controllers in each hand to allow me to “touch” items in the virtual reality world.

After putting on the headset, I was dropped into another world: a large multi-storey mall but one with trees and fruit growing – a clear sign to me that this was a fantasy world and not really, which eased my anxiety.

I was asked to perform tasks through an earpiece. I used the hand control to pick up virtual items such as fruit or, in the later sessions, a cat stuck in the branches.

By the last session, I continued to walk along a rope path suspended about 70 feet above the central void.

It felt really strange everywhere: I knew the mall was artificial, but still felt that familiar swaying feeling in my stomach, shallow breathing, and tingling palms when I found myself standing on the third floor balcony with only a low barrier between me and the drop.

The worst thing was when the barrier was removed for my first task – I couldn’t help jumping physically several steps back.

I felt more confident as the sessions progressed, but remained skeptical about whether it would have a long-lasting effect on me.

But for the Oxford researchers, there was generally good news. The two-week trial, involving 100 adults with vertigo who were randomly assigned to receive virtual reality therapy, or nothing, was a success.

Participants were given a questionnaire before and after the trial to assess their phobias. We got scenarios that would normally cause our phobia – like imagining looking down on a balcony on the 15th floor – and asked how scared we felt.

Results published in the journal The Lancet Psychiatry in June 2018 showed that all those who received virtual reality therapy reported a significant reduction in their fear of heights – by an average of 68 percent.

Traditional phobia treatment includes talk therapies and “habituation” – putting the person in a situation that gradually startles, so they get used to it. Both include encouraging the person to handle situations that are bothering him.

There are potential benefits of virtual reality over traditional techniques, as patients are exposed to situations that would be too frightening or risky in real life, Professor Freeman says.

“A virtual reality gives them time to live with the situation and learn new ways to deal with it.”

Dr. Warren Mansell, a clinical psychologist at the University of Manchester, says, “Virtual reality is also effective because it puts the patient behind the wheel – they can choose the level of discomfort and challenge they feel is appropriate.”

He adds that virtual reality has been shown to help other psychological problems, such as paranoia, an irrational belief that others want to harm you, where the program can introduce people to spending time in public places and the level of human contact they experience one they feel comfortable with.

Research is also being conducted into the possibility of using virtual reality to treat schizophrenia and social anxiety by helping people face the situation they fear in a controlled, safe environment and changing their thinking processes.

When the trial ended, I wasn’t convinced I would see a permanent benefit, but a few months later I found myself climbing a high ladder at home without thinking, to my family’s surprise – and me!

As time goes by, I find myself surprisingly open to trying out heights – including standing on the ocean platform in Australia. So how did I really feel?

Vulnerable, yes, but – crucially – not afraid. I cheer quietly and yet I am so used to being afraid of heights that it seems more like something is missing than anything else. What it is indeed.

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