Edwin adjusted his headset and gripped the game controller in both hands. He swallowed hard. The man had good rea- son to be nervous. He was about to enter a
virtual environment tailor-made to get his heart
pumping way more than any action-packed video
game: a coffee shop full of people.
Determined to overcome his persistent fear
that other people want to hurt him, Edwin had
enrolled in a study of a new virtual reality therapy.
The research aimed to help people with paranoia
become more comfortable in public places. In
this program, described in March in the Lancet
Psychiatry, Edwin could visit a store or board a
Virtual strangers can be scary, just like real people. Edwin, who had been diagnosed with paranoid
schizophrenia, often found simple errands like
grocery shopping overwhelming and exhausting.
But facing simulated crowds came with perks.
At a nearby computer sat clinical psychologist
Roos Pot-Kolder of VU University Amsterdam.
She could customize the number of avatars and
set their friendliness levels in each scene. That
way, Edwin could progress at his own pace.
During one session, Pot-Kolder coached Edwin
to challenge his own paranoid assumptions. If
he saw an angry-looking avatar, she
asked, “What could be other reasons
for looking mad, besides wanting to
hurt you?” Edwin offered: The person could be tired or having personal
After three months of VR treatment, public outings were easier,
said Edwin, who asked that his last
name not be used. “I felt more freedom, more
relaxed.” He even performed a poem for 500 people at a talent show, which he “would not have
Researchers have been developing virtual reality systems that help people overcome specific
phobias since the 1990s. VR therapy has since
expanded to address more complex anxiety disorders, such as social anxiety and post-traumatic
stress, and even the anxiety associated with paranoid schizophrenia for people like Edwin.
“The key ingredient to an effective treat-
ment for anxiety disorders is … you need to face
your fears,” says Stéphane Bouchard, a clinical
cyberpsychologist at the University of Quebec in
Outaouais, Canada. He’s referring to what’s known
as exposure therapy. With emotional support from
a therapist, exposure therapy helps desensitize
the patient to whatever the fear is. Patients typi-
cally face their fears in real life or, if their fear is a
traumatic memory, repeatedly relive the event in
But confronting fears can be easier in a virtual
setting. A flight-phobic patient can take off and land
many times in a single VR session without the cost
and hassle of actual flights. Veterans with post-traumatic stress who can’t remember a traumatic
memory in great detail can reenact a close proxy in
VR for a more potent therapeutic experience. The
same goes for those who repress painful memories.
Until recently, the price and complexity of VR
equipment, which could run tens of thousands
of dollars, limited VR therapy to a
few research labs and clinics. Now,
there are computer-based headsets
like the Oculus Rift that cost only a
few hundred dollars, as well headsets such as the Samsung Gear VR
that turn smartphones into virtual
reality displays for about 100 bucks.
With cheaper, more user-friendly
systems poised to make virtual reality therapy
available to many more patients, researchers are
testing the bounds of VR’s therapeutic powers
to treat a broader range of disorders or, in some
cases, replace the therapist altogether.
The power of VR therapy comes from the fact that
people automatically react to fear cues, even in
an environment they consciously know isn’t real.
That’s because the brain’s emotional command
center, or limbic system, responds to stressors in
a matter of milliseconds — way faster than logic
can kick in (SN: 2/26/11, p. 22).
As a result, patients who confront their fears in
VR have shown increased levels of the stress hormone cortisol, higher heart rate and higher skin
conductivity, says Barbara Rothbaum, a clinical
U.S. adults who experience
an anxiety disorder
at some point in life
SOURCE: NATIONAL INSTITUTE
OF MEN TAL HEALTH
A VR system that helps
people with paranoia
get more comfortable
in public places, such as
a café or grocery store
(shown), uses avatars
that can be made to
look friendlier or more
hostile, depending on a