Conquering phobias with virtual reality

Little Miss Muffet almost certainly never tried virtual reality to cure her of her arachnophobia. When the spider sat down beside her, she simply abandoned the curds and whey in fright and ran away. Had she previously been introduced to spiders via a VR headset, at least she might have learnt to live with the hairy-legged creatures, if not love them.

For years now, therapists have been using behavioural therapy to tackle fear of spiders and other phobias. The sufferer is gradually exposed to the cause of their fear, first by using pictures of spiders (or whatever stimuli produces anxiety), until finally, when ready, they may be confronted with a real spider. But these methods can be time-consuming, expensive and do not always work.

Now, doctors and therapists are using a new tool to fight phobias and other psychological problems - virtual reality. They are having impressive results. "Traditionally, the goal in therapy has been to change the patient to better fit reality. What we are doing is changing reality to better fit the patient," says Dr Suzanne Weghorst, a leading VR specialist at Washington University in St Louis, Missouri.

In the UK, the first clinical trial using virtual reality images to combat fear of spiders has been completed by the Institute of Psychiatry at the Maudsley Hospital, London, whose report is expected to be published in the Lancet later this year. Dr Alex Lewis, a clinical lecturer at King's College Hospital, London, and a researcher at the Maudsley, and Dr Tony David, a consultant psychiatrist, have been working with a group of 40 patients, exposing them to VR images of a moving spider that can, at the flick of a button, grow gradually nearer until the patient feels it is inches away.

"Patients are exposed to an animated spider of various sizes, depending on the level of fear," says Dr Lewis. "We use a three-dimensional spider created by the computer department at Nottingham University and it is extremely realistic." In virtual reality, imaginary worlds are created using 3D films or computer graphic programmes. These worlds can be entered and visually explored as if they really existed. By wearing a helmet or special headgear with TV sets in front of each eye and stereo speakers over each ear, the patient is dissociated from the real world and immersed in the virtual world, moving or flying around at the turn of the head or the movement of a foot. By wearing a special glove, the patient can also appear to touch things in the virtual world.

Originally, VR was seen as a leisure toy, but mental health specialists and researchers are now using it as a therapeutic tool. So real is the virtual world to the wearer of the helmet that they can suffer panic symptoms when confronted with the cause of the phobia.

In the United States, for instance, people suffering from acrophobia (fear of heights) are immersed in a virtual world where they have to walk over high bridges and travel in lifts. The edge of the small wooden platform on which they are actually standing becomes the side of a narrow footbridge 80 metres above a fast-flowing river.

Dr Barbara Rothbaum, of Emory University School of Medicine in Atlanta, Georgia, where VR is used to combat acrophobia, says: "We found that people who used the virtual reality had the same sensations and anxiety as they did in real life. They were sweating, weak at the knees and had butterflies in the stomach."

The theory of the treatment of phobia is that by gradually exposing the patient to the cause of their fear, the anxiety will go away. "It is a bit like going to the seaside and jumping in the water. At first it's very cold, but over time you get used to it," says Dr Lewis.

The first phobia tackled with virtual reality was fear of flying, using a virtual aeroplane, a technique that is now widely used.

Max North, who carried out work in the psychology department at Clark University in Worcester, Massachusetts, says fears of heights, dark places and open spaces are all now being successfully treated using VR images, and suggests the possibilities for further areas of treatment are immense. He and his team are now drawing up trials using VR to deal with fear of public speaking.

But this new world of virtual reality in medicine does not stop with the treatment of phobias. In Italy, Dr Giuseppe Riva, co-ordinator of the Virtual Reality for Psycho-Neuro-Physiological Assessment Programme, is pioneering a new treatment for anorexic, bulimic and obese patients.

Eating disorders, he points out, can be a result of people having a distorted image of their bodies. If patients can be shown their true size and shape, they may be able to curb anorexic or bulimic behaviour.

In his work in Milan, head-mounted VR helmets are being used to correct these distorted body images. In one scene, the wearer travels down corridors lined with male and female models. At the end of one corridor, the patient then enters a room furnished only with a mirror. As the wearer moves across the room, they see moving pictures of themselves standing next to the mirror. The pictures weretaken earlier using a camcorder and then superimposed on the virtual world, so the patient sees themselves as others would see them. The patient then moves into another room from which there are four exits, each with doors of different sizes. The only way out is to go through the door that corresponds closest to real body size.

"We have found that even five minutes' exposure to VR is enough to reduce body dissatisfaction. The procedure may be helpful in getting patients to break through the resistance-to-treatment barrier," Dr Riva says.

Dr Weghorst says that virtual reality may not only replace traditional phobia therapy but could also be an alternative to some drug treatments for phobias. A third application, she says, is in Parkinson's disease, where sufferers tend to drag their feet or shuffle along rather than take steps. "We know they can lift their feet because if there is an obstacle in the way they will do so. We have now found that they will also step over artificial obstacles created in a virtual world. By providing artificial cues on a daily basis, we would enable walking in these patients," she says.

More than a dozen teams around the world are currently working on major medical applications for virtual reality in health care. At the New York Hospital, Dr Ian Alger, clinical professor of psychiatry, is drawing up plans to use VR in marital counselling." The idea is that rather than simply sitting in an office and discussing their problems, the partners and their counsellor would all wear helmets that would put them in the virtual world of the real home, where tensions would be more easily re- created.

If Dr Alger's research is successful, dysfunctional couples in future might be able to have "virtual" rows and arguments. Before a couple could start throwing cutlery at each other in the kitchen, the therapist would be able to step in.