Technology is becoming more accessible to individuals of all ages and is developing into an inseparable part of modern culture. While it makes many of our lives easier with its convenience it is also important to think about how it can help clients in a therapeutic sense. However, psychological therapy’s methods have not advanced nearly as much as other areas of science in terms of adopting technology and incorporating it into therapeutic practice, still maintaining the (perceived) ever-important but basic components of two people, two chairs and a comfortable room. That’s not to say that no progress has been made as Virtual Reality (VR) is becoming an increasingly useful tool within the therapy room and in the education of professionals to better improve their practice.
The most commonly accepted form of VR in psychological therapy is in using it as an addition to well-known exposure therapy (Parsons, & Rizzo, 2008). People confront their fears within a virtual landscape in order to adjust to them and learn that they are not necessarily the danger their minds had built things up to be. All the while the client has the safe grounding factor of the therapist a few feet away controlling the simulation, to support them if things get too ‘real’. This has a number of benefits over it’s non-technological counterpart as, for starters, it allows clients to challenge nearly any fear that can be visually created on a computer with far greater ease than their real-world counterparts. The most iconic one would be fear of flying whereby it would be ludicrously expensive and time-consuming for a client to expose themselves to on a regular basis. However, in the safe therapy room with VR, a client can be anywhere from flying high above the seas to Spain to enclosed in an uncomfortable and claustrophobic elevator shaft and be able to stop at a moment’s notice.
Other interesting uses of VR in psychological therapy incorporate the recreation of the client’s world or their life experiences. As new VR software is developed such as Tilt Brush (Google, 2017) or Quill (Facebook, 2016), allowing us to create art in a three-dimensional space with boundless materials, there is room for established practices of art therapy to experiment with the use of VR in its work. The client could recreate their experiences and world as guided by the tech-savvy therapist and then, with the therapist, walk through a scene from their past and reflect on their lives from a new perspective.
Ultimately, VR in therapy serves to help therapists and clients cross the imaginal bridge. Where it is hard for the client or therapist to visualise a part of the client’s experience, VR therapy has the opportunity to make it real. Allowing clients to visualise their fears, their past, their experiences and better communicate these to the therapist where previously the client would have to rely on their own imagination and descriptive ability to portray these. Early research using new technology by ProReal is taking steps to explore the client’s world this way (Van Rijn, Cooper, Jackson, & Wild, 2017) although more research is needed to refine this therapeutic process.
However, as VR therapy has gained traction and recognition, research is mostly dedicated to randomised clinical trials which show that, yes, VR exposure therapy is a useful and effective measure of treating clients on par with its traditional, non-technological equivalents (Turner, & Casey, 2014). While there is always room for more research and evidence showing that something is effective in terms of symptom reduction (especially as the call for empirical-evidence is extremely important), in striving to prove its worthiness of a place amongst the pantheon of other therapeutic practices, this obsession with outcomes justifying the practice has tended to ignore the source of all those numbers: the client.
A couple of studies (Garcia-Palacios, Hoffman, & Fabregat, 2007; Opriş, Pintea, García-Palacios, Botella, Szamosközi, & David, 2012) have examined parts of the client’s experience of VR therapy: is it more appealing because it’s technically avoiding directly confronting their fears in real life? Is the experience even real enough for the client to be affected in the real world? Does not being able to see the therapist because of the headset make things difficult? Yet studies have not explored these questions on a deep qualitative level.
It’s not hard to find several glowing recommendations from clients about VR therapy in news (Hattenstone, 2017; Temming, 2018) with several articles lauding the process of VR therapy normally accompanied by comments from clients talking about how wonderful their experience of VR therapy was and how it changed their life. However, this still tells us little more other than what the outcome-focused evidence has already indicated: that VR therapy tends to be effective. As such there is a need for a more scientific and critical examination of VR therapy from the client’s perspective. While therapists providing VR therapy will obviously be able to see what the client sees, only the client can tell us how they are truly experiencing the virtual world and future research needs to attempt to examine and understand just what this is. In doing this, therapists could understand the client’s voice in VR therapy and further refine and enhance the experience of VR therapy so that perhaps in the future more therapists will be willing to accept and practice this therapy and make it more widely available, in better quality to our clients.
Facebook (2016). Quill [Computer Software]. Available from: https://www.oculus.com/experiences/rift/1118609381580656/
Garcia-Palacios, A., Botella, C., Hoffman, H., & Fabregat, S., (2007). Comparing acceptance and refusal rates of virtual reality exposure vs. in vivo exposure by patients with specific phobias. CyberPsychology & Behavior, 10(5), 722-72
Google (2017). Tilt Brush [Computer Software]. Available from: https://www.tiltbrush.com/
Hattenstone, S. (2017). ‘After, I feel ecstatic and emotional’: Could virtual reality replace therapy? The Guardian. Available from: https://www.theguardian.com/technology/2017/oct/07/virtual-reality-acrophobia-paranoia-fear-of-flying-ptsd-depression-mental-health
Opris, D., Pintea, S., Garcia-Palacios, A., Botella, C., Szamoskozi, S., & David, D. (2012). Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis. Depression and Anxiety, 29(2), 85-92
Parsons, T.D., & Rizzo, A.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), 250-61.
Temming, M. (2018). Scared of heights? This new VR therapy could help. Science News. Available from: https://www.sciencenews.org/article/scared-heights-new-vr-therapy-could-help
Turner, W. A., & Casey, L. M. (2014). Outcomes associated with virtual reality in psychological interventions: Where are we now? Clinical Psychology Review, 34(8), 634-644. doi:10.1016/j.cpr.2014.10.003
Van Rijn, B., Cooper, M., Jackson, A., & Wild, C. (2017). Avatar-based therapy within prison settings: Pilot evaluation. British Journal of Guidance & Counselling, 45(3), 268-16. doi:10.1080/03069885.2015.1068273
Peter Taggart is a Counselling Psychology trainee studying at Glasgow Caledonian University in Scotland. He is currently practicing as a counsellor in multiple organisations and he has a longstanding interest in using technology to improve people’s wellbeing and quality of life.
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