Considerations in Using Virtual Reality for Mental Health Therapy

Virtual reality (VR) “experiences” have been around since the mid 20th century, and VR has been dubbed the “technology of the future” but has yet to gain traction among mental health clinicians. Even industry titans, such as Google, have failed with ventures in virtual reality and augmented reality. Yet, since the standard of care for obsessive compulsive disorder is exposure therapy, and there is a need for clients seeking virtual care, virtual reality remains in the periphery as a potential suitable option for treatment. Given the known advantages of virtual reality, why hasn’t it caught on?
 
Why isn’t virtual reality more popular?

The novelty of virtual reality, lack of standardization, and the incentive to create new technology rather than validate existing technology have all contributed to the lack of traction. Virtual reality has preliminary research supporting its use in treating anxiety, OCD, depression, and as of 2020, has amassed more than 53 systematic reviews and meta-analyses to support its use which supports the generalization of VR to the real-world.  Even still, the rough graphics may make patients consider the VR environment to not be very believable, and therefore worry that their experience will not carry over into the real-world. Some patients will make this assumption before trying the environment, or they may be treated by a clinician who is unfamiliar and unable to describe the experience.
 
Despite the growing data in support of virtual reality, the majority of clinicians still do not incorporate virtual reality into their practice. Much comes down to a lack of familiarity with the technology and evidence, and a lack of desire to change. The cost is often unknown because many companies will not reveal the cost on their website and instead want customers to speak to their sales agents and schedule a demo – introducing yet another obstacle unless one is highly motivated. Patients may fear that virtual reality might be more uncomfortable, not as effective, or difficult to get set up. Patients who are more sensitive to motion sickness may worry about the nausea or disorientation they experience afterward.
 
How does virtual reality affect anxiety and ocd?

The underlying reason why exposure therapy treats anxiety is because the activation of emotions via the element of surprise or fear impacts learning, neuroplasticity, and relates to positive treatment effects. Emotional activation needs to be controlled very precisely because if a client feels overly activated, they will reject engaging in the exposure therapy and consider it too intense. Therefore the ability to modulate the type of exposure, and thereby the intensity of the emotional activation, is crucial.
 
What are the benefits of using virtual reality?

With virtual reality, the environment can be manipulated in real time. Virtual airplanes can sit on the tarmac or they can take off on demand, in a digital environment. You can also repeat scenes but adding/removing elements, or focus on a different component of the scene, allowing an individual to more completely absorb the experience. There is also a reduction in interference, and uncontrolled variables, reducing the chances of having to reschedule an appointment. Virtual reality studies therefore show much lower dropout rates than in vivo exposure therapy.
 
Virtual reality has a lot of potential in the treatment of anxiety disorders and is an under-recognized tool among mental health clinicians that has very few physical side effects associated with it. There are many barriers associated with implementing virtual reality more quickly, such as lack of transparent pricing, high startup logistics, and lack of familiarity or discomfort with using technology. Much of the resistance to utilizing VR is due to a lack of familiarity with the technology, the experience, and the effectiveness.