Have virtual therapeutic interventions been proven safe?Posted on: October 5, 2023
by Ben Nancholas
It’s no secret that the state of public mental health in the UK – as well as globally – is in crisis.
The COVID-19 pandemic not only highlighted the rocketing rates of anxiety, stress and burnout, but likely also contributed to them. A large proportion of this population will find it difficult, if not impossible, to access proper treatment – due to factors including insufficient funding in mental health services, an overburdened healthcare system more broadly, and a lack of means to seek help privately.
Is it time to look at other evidence-based modalities of mental health treatment delivery? Could virtual reality (VR) interventions transform the way that therapy is delivered – and the ways in which we can think, feel and behave?? Most importantly, is the use of VR safe for patients?
What is virtual reality therapy?
As a concept, using immersive VR technology to treat certain mental health conditions and disorders isn’t new. First studied in the 1990s, virtual reality-based therapeutic treatments have long been proposed to help overcome phobias, alleviate anxieties and treat specific disorders.
Virtual reality therapy (VRT) involves using computer-generated, virtual reality technologies – such as headsets, haptic gloves or full-body suits – to place patients in safe, controlled and realistic situations that can accurately recreate settings that stimulate their fears, anxieties and other complex feelings and experiences. For example, with informed consent, a soldier suffering from post-traumatic stress disorder (PTSD) could receive treatment in an immersive warzone, or a patient with a phobia of social anxiety and crowded spaces could be transported to a crowded city centre. Every aspect of the virtual world – and, crucially, the degree to which it exposes patients to various stimuli – can be controlled by the therapist.
What conditions can it help to treat?
- Pain management
- Eating disorders
- Grief and loss
- Substance use disorders
- Compulsive behaviour disorders.
Using VR modalities in mental health treatment can provide some huge advantages. As it can be delivered remotely, it could make therapy more accessible for some patients who are unable to attend in-person sessions. Its potential to simulate VR environments, scenarios and interactions is also limitless, meaning it can be tailored to any number of patients and the specifics of their mental health issues.
How effective is virtual reality therapy?
For clinicians, therapists and practitioners, virtual environments and technologies can be combined with traditional mental health interventions to provide patients with a holistic, ‘real-world’ approach to treatment. Interestingly, research by Edith Cowan University found that 30% of people are more open about themselves in VR settings than in real life, preferring to share negative experiences with an avatar than with another person.
There is strong evidence that points to the effectiveness of VR:
- A pilot study that explored whether virtual reality exposure therapy (VRET) could help reduce acrophobia (fear of heights) also reported success.
- Patients with social anxiety disorder (SAD) reported positive outcomes via the Likert scale questionnaire when undergoing cognitive behavioural therapy (CBT) with adaptive VR exposure
- Randomised control trials (RCTs) into the treatment of PTSD using VR also indicated positive results, but concluded that further clinical trials and research are required with larger sample sizes.
Systematic review of factors such as control groups, follow-up measures, study designs, inclusion criteria, observed and self-reported side effects, and primary outcome measures must also be explored in greater depth. Further open access studies are available via sources such as the British Medical Journal (BMJ), Google Scholar, PubMed and Creative Commons.
Any therapy, in large part, relies on the efficacy of the therapist – they play a critical role in any treatment’s success – and the same is true of VR interventions.
Is VRT safe for patients?
Recreating realistic situations could, potentially, re-traumatise some patients – particularly under the guidance of a therapist who isn’t sufficiently experienced or skilled to handle these issues. Problems may occur in situations where therapists are unable to reach patients – for example, geographically or due to anonymity – in the event that immersive VR-related problems arise. Keeping patients safe in such instances is not only challenging but also raises ethical concerns.
There must also be stringent eligibility criteria regarding who can offer immersive virtual reality as part of treatment: practitioners must be fully trained in delivering VRT, taking sufficient time to understand how it works and how it can be applied safely to meet patient needs.
Additionally, virtual reality interventions are not recommended for all types of mental health conditions – such as bipolar disorder, severe depression, or patients experiencing suicidal thoughts.
What are the barriers to using VR interventions on a wider scale?
Virtual reality therapy is yet to gain mainstream adoption – and it’s not due to limitations of technological development. It’s an expensive option, simply beyond the reach of mental health service providers who are already struggling to keep their operations afloat – and that’s without factoring in the time it takes to train therapists to use VR tech safely and correctly.
There also exists a profound lack of awareness about VRT in the first place, meaning that patients who might be interested aren’t seeking it out. Even for those who are aware of it, VR’s slow adoption more broadly can make it difficult to find providers who offer it. VR therapy feasibility also requires a certain level of technical ability on the part of the patient, as well as a smart phone, computer and reliable Internet connection, which not everyone has access to.
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