Global Courant
Tapestry53:52Virtual therapy made reality
Fay Nugent’s fear of escalators had become so debilitating that it began to interfere with her daily life.
The British project manager, 52, recalls that the phobia began as a fear of heights. She remembers being in her early thirties and going away for the weekend with some friends.
“We decided to do some adventure activities as part of this weekend where we had to climb a pole and then walk out over ropes at different heights,” she told CBC Radio’s Tapestry.
However, when it came time to walk the rope, Nugent couldn’t. She froze in fear. After that, whenever she was in a situation involving heights, she would begin to feel dizzy and this “overwhelming sense of anxiety” would engulf her.
For the next 20 years, she avoided heights as much as possible, especially escalators. Her breaking point came in 2018 when she was at an airport in the Netherlands with some colleagues.
“(They) were on their way to an escalator with luggage to go down and check in,” she said. Nugent was supposed to follow them, but was terrified.
Companies including Facebook owner Meta – which produces the Quest 2 virtual reality headset, pictured here – have been pushing VR technology in recent years. (Josep Lago/AFP/Getty Images)
Not long after, she heard an ad on Oxford University radio. Researchers were looking for people with a fear of heights to participate in a new clinical trial. The trial involved testing a new virtual reality technology as a therapeutic tool.
“I thought, ‘Well, this is it,'” Nugent said. “This is something I can try to get back to some sort of normalcy in my everyday life.”
Virtual reality-based (VR) therapy combines other forms of therapy, including talking, with technology, enabling patients to immerse themselves in their fears in a groundbreaking way. It has been used to treat post-traumatic stress disorder, anxiety, and other mental health diagnoses.
In Nugent’s case, a form of virtual exposure therapy presented her with challenging situations in a controlled setting.
A VR headset allows a patient to pause or distance himself from an experience if it feels too overwhelming, says John Francis Leader, a psychologist and cognitive scientist specializing in psychology and technology at University College, Dublin.
The researcher describes the approach as ‘theme park meets therapy’. He said VR therapy is still an emerging field and its core is a combination of the physical, the virtual and the imaginary.
Virtual scenarios to challenge phobia
The imagination in itself can be a very powerful driver of fear, Leader said.
“Very often someone does some form of mental rehearsal using imagination,” he said.
“And the problem is whether or not they’ve had real experiences of challenge. They’ve imagined it so many times that it feels like they’ve had thousands of challenging experiences.”
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VR-based therapy is believed to treat phobias by activating the amygdala — a part of the brain that triggers a fear response — and triggering an emotional response, said study researcher Stéphane Bouchard. With support from a therapist, a patient can then respond to that reaction in a logical way, which helps to reframe the phobia.
“You compare the gold standard treatment, which is exposure in vivo, and then you compare it to VR…. Most studies suggest it’s just as effective,” said the University of Quebec en Outaouais professor, who has been studying cyberpsychology since the 90’s.
During Nugent’s treatment, she was taken to a shopping center in Oxford and asked to go down an escalator while being filmed by an investigator. She couldn’t. “I was scared for myself,” she said.
She was then given a VR headset to put on and entered a world she describes as “very cartoonish, very blocky”. She said it didn’t feel real at all, yet the tasks she was given in this virtual space evoked a sense of dread in her.
At first, the challenges were easy, like leaning over a balcony, but they got progressively more difficult and “terrifying,” she said.
“I had to do things like save a cat from a tree,” she said. Another challenge was that she was “walking on a rickety railroad track.”
The last task, which Nugent says was the most terrifying, was her standing in the mall while it was full of water when suddenly “an orca came by and I had to stand on its nose as it swam around,” she said.
Although it was virtual and she knew she was safe in an office, Nugent said she experienced the same fears and physical reactions as in real life.
“My heart was racing, I felt anxious, I felt a little sweaty,” she recalls. Eventually those feelings disappeared.
VR an alternative to real world experiences
Leader said this kind of inconvenience can be helpful.
“When someone is afraid of something, often encountering or dealing with that particular thing is a really important part of the therapeutic process,” he said.
This kind of exposure therapy is common, but VR allows doctors to use it in a new way, especially when setting up a scenario can be difficult.
Nugent, pictured standing on a staircase while hiking in the United Kingdom, had a fear of heights that affected her life. (Submitted by Fay Nugent)
Exposure therapy for someone living with social anxiety is an example. It would be helpful to help that person interact with other people, but it can be difficult to do this organically because of their anxiety.
“That’s where the virtual can be really helpful,” he said, “because you can create a scene with other characters, other people, and the person can put on the virtual reality headset and they can practice.”
Bouchard said that virtual reality in itself is not therapeutic. On the contrary, VR can be a tool in a therapist’s toolkit when combined with traditional therapy.
“You can buy a VR system. It won’t treat you. You can buy a VR system (for) spiders or a fear of flying. It won’t treat you,” he said.
“Therapy is much, much more complex and VR is just one detail in the whole story.”
As technology — and patient comfort with VR — advances, he said such systems could be useful in teletherapy, which pairs people with remote therapists. Advances in artificial intelligence may also provide better options for self-guided VR-based therapy, but such options are currently moving closer to a self-help book, he noted.
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For Nugent, virtual exercise helped reset her perception of risk. After spending the morning doing tasks in a VR environment, the Oxford researchers took her back to the mall and asked her to go down the escalator again.
“I just went into it without thinking about it,” she said.
Nugent was surprised by her new reaction to heights. “I just thought, I don’t understand what happened here. My feelings from this morning or the fears are just completely gone,” she said.
While she said it hasn’t completely eradicated her fear of heights, Nugent says the impact of VR therapy on her life has “been huge.”
At the age of 51 she took her first ski lesson – something she never thought possible before.
“I can go shopping with my daughter and not worry about escalators in the malls,” she said.
