Virtual world: Scientifically proven way of dealing with phobias

Fear of spiders, open spaces, fear of heights? Virtual reality comes to the rescue as a tool to treat phobias, prove researchers from SWPS University, Gdańsk University of Technology and Jagiellonian University.

Virtual reality (VR) increasingly permeates actual reality in our daily lives. It enhances the attractiveness of computer games, events, museum exhibitions. It is also used for educational and train purposes, for example, to improve doctors' social skills, or to visualise complex chemical compounds VR police training turns out to be just as effective as training conducted with traditional methods.[1]

Virtual reality techniques have also been used in therapy. Smokers who participate in sessions in a virtual bar, where they are exposed to known triggers, significantly cut down on the number of cigarettes they smoke daily[2]. Similarly, gambling addicts, subjected to therapy in a virtual casino, report a significant decrease in their urge to gamble[3].

Phobia, or the art of avoidance

Phobias are a sub-type of anxiety disorders. People who suffer from a phobia do not just experience fear in particular situations, they also avoid fear-inducing situations[4]. Interestingly, people who suffer from phobias are aware that their reactions and feelings are excessive and unfounded, yet they are unable to overcome their irrational fears.

The list of phobias is very long as they are induced by various objects and situations. People suffering from phobias may experience fear of certain colours, animals or situations (like riding a lift). Symptoms of phobias include recurring, persistent thoughts.

Another form of phobias are social phobias, which manifest themselves during interactions with other people, or in situations of social exposure. People suffering from them experience a strong fear of being judged; this condition often afflicts adolescents. The most complex of phobias is agoraphobia, the fear of open spaces, says Agnieszka Popławska, PhD, from the Faculty of Psychology in Sopot at SWPS University, co-author of the paper “Overcoming phobias. Harnessing the power of immersive virtual reality therapy”, published in the book Smart VR/AR/MR Systems for Professionals.

Methods of treating phobias

The most effective ways to treat phobias are the methods derived from behavioural therapy. They include flooding, implosive therapy, systematic desensitisation, and modelling.

The first method, flooding, consists in exposing the patient to an extremely strong fear-inducing stimulus, or gradually to stimuli that cause discomfort. Implosive therapy is very similar but only requires patients to vividly imagine stimuli, while systematic desensitisation works by exposing clients to the object of their fear gradually, over the course of several months. Modelling, in turn, involves observing others in a scenario that the patient finds fear-inducing.

VR also reduces fear

Persistent phobias, as well as anxiety disorders and obsessive-compulsive disorders (OCD) can also be treated by immersing the participant in a specially created virtual world. This type of therapy is referred to as exposure to virtual reality.

VR is a promising solution because it combines the advantages of traditional methods. The patients do not have to imagine anything, while being aware that they are not dealing with a real-life stimulus. In addition, unlike in the case of traditional methods, all interactions in virtual reality can be precisely controlled by therapists.

Studies show that virtual reality exposure can have a positive effect in the treatment of most phobias[5]. An experiment has proven that the results of therapies for people afraid of spiders were equally positive for both groups (one where the animals were presented live and the other - in virtual reality)[6].

One of the most effective and most emotionally engaging techniques is cave automatic virtual environment (CAVE) - literally a room where a VR environment is created in the form of a projection inside a cubic space. CAVE can be used, for example, to treat social phobia. Participants in an experiment were asked to make a speech and solve an arithmetic problem in front of a panel of judges. Blood pressure measurements taken inside the CAVE were similar to those in real-life social exposure - the researchers recorded a comparable increase in both conditions[7]. It also turns out that participants in the experiments experience stronger emotions when they are exposed to emotional stimuli within the CAVE than during a 3D presentation.

The authors of the paper emphasise that VR therapy can be an effective tool in the treatment of phobias, but it is necessary to design appropriate therapeutic scenarios and complementary applications, and test them in further studies.

[1] Bertram, J., Moskaliuk, J., Cress, U. (2015). Virtual training: Making reality work? Computers in Human Behavior 43, 284–292.

[2] Lee, J., Lim, Y., Graham, S. J., Kim, G., Wiederhold, B. K., Wiederhold, M. D., Kim, I. Y., Kim, S. I. (2004). Nicotine craving and cue exposure therapy by using virtual environments. CyberPsychology & Behavior 7(6), 705–713.

[3] Park, C.-B., Park, S. M., Gwak, A. R., Sohn, B. K., Lee, J.-Y., Jung, H. Y., Choi, S.-W., Kim, D. J., Choi, J.-S. (2015). The effect of repeated exposure to virtual gambling cues on the urge to gamble. Addictive Behaviors 41, 61–64.

[4] Moldovan, R., David, D. (2014). One session treatment of cognitive and behavioral therapy and virtual reality for social and specific phobias. Preliminary results from a randomized clinical trial. Journal of Cognitive and Behavioral Psychotherapies 14(1), 67–83.

[5] Freitas, J., Velosa, V., Abreu, L., Jardim, R. L., Santos, J., Peres, B., Campos, P. F. (2021). Virtual reality exposure treatment in phobias: A systematic review. The Psychiatric quarterly 92(4), 1685–1710

[6] Wiens, S., Eklund, R., Szychowska, M., Miloff, A., Cosme, D., Pierzchajlo, S., Carlbring, P. (2022). Electrophysiological correlates of in vivo and virtual reality exposure therapy in spider phobia. Psychophysiology 59(12), e14117. doi: 10.1111/psyp.14117

[7] Wallergård, M., Jönsson, P., Österberg, K., Johansson, G., Karlson, B. (2011). A virtual reality version of the Trier Social Stress Test: A pilot study. Presence 20(4),

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