Virtual Therapy

When should a person consider the fear of heights a problem?

Fear of heights would be a problem for a person if they restricted their lifestyle and avoided situations that are objectively harmless.

What kind of situations? Could you give us an example?

A number of people may not drive their cars across a bridge, that could be important in the Bay Area because they might not get to work. Or standing in and elevator, that might prevent them from taking a job that they might otherwise want. Or going to a restaurant.

When people are afraid of heights do they research where they might go?

What participants in this study have told is that they consciously avoid places where they believe they will be fearful.

How serious is a fear of heights?

If people could get over phobias then they would just go into places they were avoiding and that would be that and I would probably be out of a job. However, one of the things that characterizes a phobia is an irrational fear and a compelling desire to avoid the situation that elicits the fear. So people are not just able to go and do that by willpower.

They just can’t overcome it?

Not by themselves.

What is the current treatment if you didn’t have virtual therapy?

A standard kind of treatment for acrophobia would be a combination of psychotherapy and/or medication. The psychotherapy would generally be some kind of cognitive behavioral therapy where the clinician would use with the patient something called in vivo desensitization and a graduated hierarchy. That’s a way of saying that together the patient would visualize the environment that they are fearful of in a relaxed physiological state. The hope would be by pairing relaxation with the visualization or imagination of being in the fearful state that they then would be able to approach that place in the real world.

How long does that therapy take?

Normally I think six to ten sessions.

We talked about a ten step program to get to a high place. Can you explain that?

That would be part of the therapy where a person with the therapist would construct what is called a graduated hierarchy. This hierarchy would consist of steps ranging from the least fearful to the most fearful step that the patient would take in order to approach the thing that they are fearful of. For example, they may be sitting at home on the couch thinking of driving across the Golden Gate Bridge. Let’s say the least fearful step is sitting on the couch thinking about going to the Golden Gate Bridge and the most fearful step would be driving their car across the Golden Gate Bridge. What the patient would do with the therapist is get themselves into a relaxed state and then visualize each step one through ten until they are able to do that through their imagination in a relaxed kind of way. The hope would be that they then would be able to go into the real world and actually go across the Golden Gate Bridge with a tolerable level of anxiety.

Now the virtual therapy does the imagination for you?

Exactly, in a virtual environment which is a computer generated environment the person would encounter the thing that they are fearful of and in this study that would be the perception of height and depth.

How does the virtual therapy work? What takes place?

The virtual therapy occurs when a person puts a helmet on and inside of the helmet they perceive a computer generated environment and it has various things in that environment. For people who are fearful of heights there are various opportunities for them to encounter perceptions of height and depth. They move about in the environment with a hand held grip, they push a button and they can go forward. So it is under their control, the degree and amount of exposure to the virtual environment is under their control.

Is that important?

For the patient it is important so that they can feel comfortable while they are in the virtual environment. That they can give themselves as little or as much exposure to the thing that they are fearful of.

Did they seem to become less fearful as time went on in the environment?

Yes. We called that habituation and habituation is a term used to basically say that the arousal, the physiological arousal that the person experiences reduces with time in the virtual environment.

What were the results of your study?

The results were that ninety percent of the virtual therapy participants were able to ascend to heights within the first week after treatment. And, ninety percent of the patients were able to complete a criteria task at the end of three months. That task was to ascend fifteen stories in a glass enclosed elevator. They had to look out and down as they were going up and as they were going down in that elevator.

Actually they had one session with the virtual therapy and then they saw you a couple of times. So, even though it was three months a lot of that was homework.

That’s correct. The one session that they had of virtual therapy consisted of immersion in a virtual environment for approximately forty minutes and ten minutes of talking. There were two thirty minute follow up talk sessions with no treatment. Those were basically check in sessions as well as discussions about learning principles that would help people to utilize the virtual environment experience.

How did they seem after they had completed the virtual therapy experience?

Some people took the helmet off and were ecstatic afterwards and felt as if they had accomplished something very terrific in their lives. Other people were a little shaky when they took the helmet off afterward because it was a little scary for them to go and encounter the thing that they were fearful of. In all cases of those who were successful in achieving their goals they reported increased self-confidence and self-satisfaction from the treatment.

Who is a good candidate for this therapy?

A good candidate for this therapy is anyone who would describe themselves as fearful of heights and if they experienced anywhere from mild anxiety to panic or phobia of heights they would be a good candidate for this treatment.

Who wouldn’t be a good candidate?

People who may be psychotic, people who may have potential for brain seizures, people who have eye problems that would not allow them to perceive things three-dimensionally would not be candidates for this type of treatment.

When and where will this be available?

Virtual therapy has been offered at Kaiser-Permanente San Rafael from 1993 up until the present time as an experimental form of treatment. Virtual Therapy, Incorporated, which is seeking funds to advance research in the treatment of psychiatric disorders, has been formed to produce virtual environments for the enhancement of mental health.

Tell us how you thought to look at virtual reality for this problem.

I had a discussion with a friend about patients who would come in and see myself or other therapists individually or in groups and my complaint was that patients don’t actually get to encounter the things that they are fearful of or the things that they are having struggles with. I said wouldn’t it be great if we could actually surround them or give them something that they could encounter their struggle. He said, I think that’s virtual reality. The next thing I knew I went to a conference and put on a headset.

Don’t you have a fear of heights yourself?

I had a phobia of heights and I found myself several times in situations where I would break out into a sweat and my legs would feel rubbery, it’s really quite fearful so I know what that fear feels like.

And then you tried the virtual therapy yourself?

I went to a virtual reality conference and at that conference I put on a helmet and I did what the demonstrator suggested I do which was to reach out and push a button and by doing that I immediately found myself in the top of a building which was my own worst fear. I thought to myself, my God what am I going to do, should I take the helmet off or should I go further. I explored further and got close to a panoramic view of windows and I looked out and down and around and immediately all the fear and stress in my body drained from my body and I knew that I was going to be O.K. I knew that I was not in danger and I thought to myself, if this works with me perhaps it will work with other people. That was the beginning of this research project.

Since you did the trip to the building have you been afraid to go to the top of buildings at all?

Not at all, actually within two weeks after I had accidentally been in the virtual environment I went to visit a colleague on the twenty-second floor of a building. Outside his office was a balcony and I went out into the balcony and I looked over and out and down and I was O.K. I was just totally surprised that I wasn’t fearful like I used to be fearful. So that really solidified in my mind that perhaps this was the technology that could be used in psychiatry when integrated with learning principles to help people, and these are the initial steps to see if, in fact, that is true. It is showing, so far, that it is helpful.