Virtual reality therapy

Virtual reality therapy (VRT), also known as virtual reality immersion therapy" (VRIT), virtual reality exposure therapy''' (VRET), and as Computerised CBT or CCBT is a method of psychotherapy that uses virtual reality technology to treat patients with anxiety disorders and phobias where it has proven very effective. It is now one of the primary treatments for PTSD.  New technology also allows for the treatment of addictions and other conditions.(Lamson, ext. ref. 2, pp108–111)

Description
Virtual Reality Immersion Therapy (VRIT) uses specially programmed computers, visual immersion devices and artificially created environments to give the patient a simulated experience that can be used to diagnose and treat psychological conditions that cause patients difficulty. Since reaction to the hazards of the environment, such as heights, speaking in public, flying, close spaces, and the like are usually triggered by visual and auditory stimuli, VRIT is a means to reproduce or simulate such stimuli so the psychologist or psychiatrist can observe and measure the patient's reaction, and provide appropriate treatment. Unlike traditional discussion sessions with psychologists and/or psychiatrists, called cognitive behavior therapy, such treatment may involve adjusting the virtual environment, such as for example adding controlled intensity smells or adding and adjusting vibrations, and allow the clinician to determine the triggers and triggering levels for each patient's reaction. VRIT allows replaying virtual scenes, with or without adjustment, to habituate the patient to such environments. VRIT has the great advantage that while the patient experiences the perceived "dangerous" stimuli, the patient knows he or she is actually quite safe in a VRIT lab. This allows the patient to confront situations and achieve virtual victories that build self efficacy and the confidence that comes from mastering situations that the patient previously could not confront in real life, and through therapy learn to change behavior so as to eventually confront such situations in real life more successfully. VRIT has great promise since it historically produces a "cure" about 90% of the time at about half the cost of traditional cognitive behavior therapy, and is especially promising as a treatment for PTSD where there are simply not enough psychologists and psychiatrists to treat all the veterans with anxiety disorders diagnosed as related to their military service.

History
VRIT was developed by Dr. Ralph Lamson a USC graduate and now retired clinical psychologist then at Kaiser Permanente Psychiatry Group, San Rafael, CA in the early 1990s as a means to solve his own acrophobia or fear of heights. Dr.Lamson began actual testing, and soon began publishing his work in 1993. As a psychologist, he was most concerned with the medical and therapeutic aspects, that is, how to treat people using the technology, and found that the environment did not have to be totally realistic, only realistic enough to replicate the condition. Psychology Today reports that the treatment was successful in about 90% of Dr. Lamson's virtual psychotherapy patients. Dr. Lamson wrote in 1993 a book entitled "Virtual Therapy" which was published in 1997 directed primarily to the detailed explanation of the anatomical, medical and therapeutic basis for the success of VRIT. Dr Lamson who still continues his development and use of VRIT, eventually obtained US Patent 6,425,764 for his interactive immersion VRT and now markets his approach under the service marks VIRTIGO and VIRTUAL THERAPY and is still achieving over 90% success in treatments. Dr. Max North, a computer scientist originally from Iran currently teaching MIS at Southern Polytechnic State University in Marietta, GA, claims to have also independently pioneered the same technology, following observation in 1992 of anomalous responses in an individual in a flight simulation video game, which lessened upon repeated exposure to the game environment. Dr. North attributed this to an unknown phobic response he later, after consultation with others, concluded was perhaps Agoraphobia (fear of situations where there is no easy escape). In 1994-6, Dr. North ran further tests to determine if VR might be used therapeutically to lessen Agoraphobia, and after seeing a high success rate of over 70%, published a book "Virtual Reality Therapy" in September 1996 concerned with the virtualization technology, that is, how to make the computer create the environments useful in VRIT. Dr North claims to have done this independently of Dr. Lamson, although his 1996 book refers to the prior work of Dr. Lamson in 1994 (actually 1993) Dr. Lamson received the 1994 CyberEdge Journal award for product application of the year: Virtual Therapy of Anxiety Disorders. (ext. ref. 2, page v.) After Dr. Lamson's results were published in 1993-4, Dr. Larry Hodges at Ga. Tech in Atlanta, GA began work on VRT after consultation with Dr. North and Dr. Lamson, and engaged Dr. Barbara Rothbaum of Emory University, in Atlanta, GA. Dr. Hodges and Dr. Rothbaum established a company Virtually Better, Inc. ("VBI") and subsequently filed patent applications in 1995 claiming to be the original inventors of VRT. Dr. Lamson subsequently filed for patent in 1997 and after proving his prior invention of VRT was awarded US Patent 6,425,764 for VRIT. Dr. Skip Rizzo of USC's Institute for Creative Technologies, who had created a war simulation called Full Spectrum Warrior, created what he termed a Wizard of Oz (magical)adaptation of that game in 2005-2006 for the treatment of Posttraumatic Stress Disorder ("PTSD"), with funding from the Office of Naval Research ("ONR"), to environments simulating the Iraq War to produce in 2006 a VRIT system and method called Virtual Iraq which, was subsequently developed under ONR funding and is sold commercially by VBI. VBI applications of VRIT currently include Virtual Iraq, Virtual Afghanistan, Virtual Airplane, Virtual Audiences, Virtual Heights, Virtual Storm, and Virtual Vietnam. Virtual Iraq proved successful in normalization of over 70% of PTSD sufferers, and that has now become a standard accepted treatment by the Anxiety Disorders Association of America. Military labs have subsequently set up dozens of VRIT labs and treatment centers for treating both PTSD and a variety of other medical conditions. The use of VRIT has thus become a mainstream psychiatric treatment for anxiety disorders and is finding increasing use in the treatment of other cognitive disorders associated with various medical conditions such as addiction, depression and insomnia much as Dr. Lamson predicted back in 1993.

Efficacy
Randomized, tightly controlled, acrophobia treatment trials by Lamson at Kaiser Permanente provided >90% effectiveness, conducted in 1993-4. (Ext. Ref. 2, pg. 71) Of 40 patients treated by Dr. Lamson, 38 showed marked reduction in phobic reaction to heights and self-reported reaching their goals. Dr. Lamson found that VRIT allows patients to achieve victory over virtual height situations they could not confront in real life, and that gradually increasing the height and danger in a virtual environment produced increasing victories and greater self-confidence in the patient that they could actually confront the situation in real life. "Virtual therapy interventions empower people. The simulation technology of virtual reality lends itself to mastery oriented treatment...Rather than coping with threats, phobics manage progressively more threatening aspects in a computer generated environment...The range of applications can be extended by enhancing the realness and interactivity so that actions elicit reactions from the environments in which individuals immerse themselves"(Ext. Ref. 3, pg331-332)

Continued Development
Larry Hodges, formerly of Ga. Tech and now Clemson and Barbara Rothbaum of Emory Univ., both in the Atlanta, GA area, have done extensive work in VRET, and also have several patents and established a business entitled Virtually Better. In the United States 9.5% of the population annually suffer from depression with 18.1% of the population suffering from anxiety. However, both depression and anxiety can be successfully treated in many cases, and with Cognitive Behavioral Therapy proving to be as effective as medication (Watkins & Williams, 1998) and a popular choice for sufferers any provision of CBT on a wider basis is desirable. Hence, Computerised CBT programs may offer a unique opportunity to dramatically improve the lives of millions of people.

Current Applications
There are VRT or Computerised CBT (CCBT)sessions, some immersive and some not, in which the user interacts with computer software (either on a PC, or sometimes via a voice-activated phone service), instead of face to face with a therapist. For people who are embarrassed by their phobias or feeling depressed and withdrawn, the prospect of having to speak to someone about their innermost problems can be unpleasant. In this respect, VIRT/CCBT either in a VR lab or online, is an option.

The use of VRIT continues to expand due to this effectiveness. In February 2006 the UK's National Institute of Health and Clinical Excellence (NICE) recommended that VRIT be made available for use within the NHS across England and Wales, for patients presenting with mild/moderate depression, rather than immediately opting for antidepressant medication. Some areas have developed, or are trialing.

One of the more prominent uses of VRIT is for treatment of PTSD, due to the increasing use of the program Virtual Iraq developed by A.A. "Skip"Rizzo of USC from the video game Full Spectrum Warrior.

These days there are a number of providers offering VERT. Some offer interactive communication with therapists and live feedback has shown to improve the result of online VIRT/CCBT.

At Auckland University in New Zealand, a team led by Dr. Sally Merry have been developing a computerised CBT fantasy 'serious' game to help tackle depression amongst adolescences. The game is currently undergoing testing and the results are thought to be released in 2011. The game has a number of features to help combat depression, where the user takes on a role of a character who travels through a fantasy world, combating 'literal' negative thoughts and learning techniques to manage their depression.

External References
1. North, Max, et al., Virtual Reality Therapy - An Innovative Paradigm, 221 pages, (IPI Press 1996) 2. Lamson, Ralph J, Virtual Therapy, Virtual Therapy - Prevention and Treatment of Psychiatric Conditions by Immersion in Virtual Reality Environments, 172 pages, (Polytechnic International Press(Ecole Polytechnique de Montreal)1997) 3. Bandura, A. "Self-Efficacy:the exercise of control" (W.H.Freeman & Co., NYC, NY 1997:331-332)