Supporting her clients’ journey toward healing from trauma, Cynthia Fecchia LSCSW wanted additional tools in her arsenal to aid with recovery. As a psychotherapist in Lawrence, Kansas, Fecchia felt that social situations overwhelmed anxious clients. There must be another tool she could use, she reasoned. The answer came when she purchased a VR headset for her own amusement. Could her patients socialize virtually, in safe, controlled spaces, with extended reality devices? The answer, she learned, was, yes, XR in psychotherapy is a research-supported tool!
Extended Reality (XR) is the common term for the three immersive digital experiences, Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR). A user wears a VR headset over the eyes and holds it in place with headbands. The user experiences a blend of the physical and virtual worlds, depending on the application. A broad spectrum of fields now utilizes XR after springboarding from gaming and entertainment according to the Interaction Design Foundation. Experts from education to healthcare found that it enhances learning and leads to healthy outcomes. There is certainly a role for XR in psychotherapy, according to research. Traditional therapy has limitations, XR has direct application to psychotherapy, but it also has accessibility and ethical considerations.
Limitations of Traditional Psychotherapy
Psychotherapy serves to help patients understand and manage their mental health issues. Usually the issues revolve around emotions, perceptions, behaviors, relationships and social functioning. Sometimes patients suffer from a psychological disorder such as anxiety or depression, that medication alone cannot treat. Therapists like Fecchia use all the tools in their toolbox to help patients improve their quality of life. Therapy typically takes place in an office setting. Yet at times, it’s more beneficial to assist patients within their community, in environments where they face challenges. Even as progress is made in reducing stigma and improving access and affordability of therapy, obstacles still impede treatment continuity. A significant barrier, according to Fecchia, is the gap between talk therapy in an office and applied behavioral therapy in real-world settings. How can a patient with extreme social anxiety slowly introduce themselves to social situations?
Mental health patients also benefit from learning and practicing calming techniques including breathing and meditation. Research shows that meditation, mindfulness and acceptance (MMA) methods are promising in easing anxiety symptoms. Patients learn the process of meditation with their therapist; however, they need to meditate outside of therapy. Without structure, patients may find it difficult to follow through. After all, they have years of faulty coping mechanisms to undo. The introduction of XR to mental health therapy addresses both limitations by using a virtual reality app. Suddenly, patients can socialize virtually, or experience immersive guided meditation.
The Introduction of XR in Psychotherapy
Modern psychotherapies can use XR technologies to transform their clients’ journeys by using appropriate apps to facilitate their healing. Therapists are using VR and XR for three main therapy methods. These include reproducing situations in a controlled environment, supporting meditation and calming techniques, and for virtual reality exposure therapy (VRET).
Social Anxiety
Patients who avoid social situations can now use VR to socialize on their terms. Being in a virtual world eliminates the cause of anxiety. Patients can meet in groups in some of the social apps, or even a game like poker. Clients are relieved of their concern with body image issues because they set up their avatar. Clients nervous about talking can use the chat feature or just participate. Fecchia says that removing barriers with which the client struggles allow for slow and controlled acclimation to socializing in real life. With XR, patients experience fewer anxiety symptoms compared to those who do not. The results were comparable to those achieved through other therapeutic methods, as reported by Fernandez-Alvarez in 2019.
Therapeutic Meditation
Patients can use VR apps to practice meditation and calming techniques outside of therapy. Many VR meditation apps are available for this purpose. Some offer feedback so patients can work toward goals. For instance, a study published in 2023 used a mindful meditation (MM) application, TRIPP. Results showed that the immersive VR-based MM approach showed significant reduction in negative emotions over the computer-based MM sessions. Fecchia mentioned that in the future, MM apps may offer biofeedback to patients while using the VR app. That feedback would help them work toward calming themselves.
Phobias and Fears
A fascinating development in this field is the use of VRET. Imagine being afraid of flying. You can talk to your therapist, look at photos of planes, watch videos and talk to pilots. But the next step is to go to the airport. Prior to VRET, it was difficult to make that leap without buying an airline ticket. This is true for many specific fears or anxieties including PTSD, social anxiety, and phobias.
With VRET, patients are gradually introduced to anxiety-provoking settings in a safe, controlled setting. Patients control the speed and degree to which they engage in their fear. This immersive experience comes as close to real as possible. A study in 2020 used VRET to address fear of COVID-19. The VRET reduced symptoms above traditional exposure therapy. It was also practical with remote use or for patients in isolated settings. The introduction of VRET greatly enhances modern mental health treatment.
Accessibility and Ethical Considerations
The use of Virtual Reality (VR) in mental health does have some challenges in terms of accessibility and ethics. VR technology is expensive. It is therefore less available to lower-income populations and those in rural areas with limited mental health service. Additionally, the technology requires digital literacy, which may exclude older adults or those unfamiliar with digital tools. These issues with accessibility are shared with mental health services in general.
The primary ethical consideration of using VR in virtual social settings is that the metaverse is not HIPAA compliant. Names and places must be protected. In many cases, patients prefer the anonymity anyway, so this drawback can be overcome. Furthermore, there is the risk of over-reliance on VR, potentially leading to the neglect of traditional, proven therapeutic methods. As VR continues to integrate into mental health treatment, addressing accessibility and ethical issues will ensure equitable and responsible use of the technology.
Integration of XR into Mental Health Therapy
Introducing Extended Reality XR in psychotherapy offers a new and creative way to address anxiety, phobias, PTSD and other disorders by creating safe, controlled environments. Patients can confront their fears and practice calming techniques using VR apps and practicing in the metaverse. Technologies like Virtual Reality Exposure Therapy (VRET) allow for gradual exposure, enhancing patient confidence and therapeutic outcomes. However, accessibility challenges, such as the high cost of VR equipment and the need for digital literacy, may limit its reach. Ethical considerations, including ensuring patient privacy and avoiding over-reliance on VR at the expense of traditional methods, are crucial as the technology becomes more widespread. Using it in combination with proven techniques and continuing with research, XR holds significant potential to provide innovative and effective solutions for those who need them most.
