Virtual reality may help cure fear of heights

(Reuters Health) - A virtual reality program may work at least as well as one-on-one therapy to help people overcome a fear of heights, a UK study suggests.

Over four weeks of sessions, scores measuring fear of heights dropped by an average of two-thirds for volunteers who wore a virtual reality headset in anxiety-provoking situations, such as walking out on a platform over a large drop-off or rescuing a cat stuck in a tree, researchers said.

“In virtual reality, people can repeatedly enter simulations of the everyday situations that trouble them and be guided in the very best ways to think, feel and behave,” said the study’s lead author, Daniel Freeman of the University of Oxford. “The beauty is that the conscious awareness that these are simulations allows people to try things that they would be wary of in real life.”

While the method might apply to other phobias as well, Freeman and his colleagues chose to experiment with fear of heights because it is the most common phobia, with one in five people saying they’ve experienced it at some point.

The novel aspect of the new study is that no actual therapist was present during the sessions, just a “virtual coach” who walked each participant through the exercises, Freeman said. The animated coach asked questions that required yes/no answers or a rating of fear level, and then responded with suggestions.

One hundred people participated in the study, with 49 randomly assigned to get the virtual reality therapy in six 30-minute sessions and the others to receive no therapy for their fear of heights during the study period. (They were offered the VR treatment after the study was done).

On average, participants had experienced fear of heights for 30 years. To be included, they had to score between 30 and 55 on an acrophobia questionnaire, indicating a moderate fear of heights, or between 56 and 80, indicating severe fear.

As reported in The Lancet Psychiatry, at the end of the treatment period, half of the volunteers who got the VR treatment had scores at least 25 points lower than at the outset, while the group that didn’t get the treatment had little change in their scores.

“Afterwards, people even found they could go to places they wouldn’t have imagined possible, such as a walk up a steep mountain, going with their children on a rope bridge, or simply using an escalator in a shopping center without fear,” Freeman said.

Past research on the effectiveness of in-person treatment with a therapist has shown comparable benefits, but the current study did not compare VR treatment to any other therapy. Another limitation, the authors note, is that they can’t tell what aspects of the VR treatment were most effective.

Freeman and several other study authors are affiliated with Oxford VR, a company that partially funded the study.

Freeman doesn’t see virtual reality replacing real therapists. But it may fill a void caused by the shortage of therapists and also might help reduce the cost of treatment for people with phobias.

Programs like this might work well as a first step to getting people over their phobias, said Dr. Robert Hudak, a psychiatrist at the University of Pittsburgh Medical Center in Pennsylvania. “I could conceive of someone with fear of flying using virtual reality to get to the point where they could actually fly on a plane,” said Hudak, who was not involved in the study.

“I don’t think anyone is advocating this in place of a therapist, but it could be used as a step in many people’s treatment. With any kind of therapy patients are supposed to do homework. If they were doing a virtual reality program, then they’d be doing their homework,” Hudak said.

“When you’re working with an individual with anxiety you want to help them face the things they’re afraid of: that’s called exposure therapy,” said Lynne Bufka, a clinical psychologist and associate executive director for practice, research and policy at the American Psychological Association in Washington, DC.

Virtual reality therapy is not yet widely available, said Bufka, who wasn’t involved in the study. But with advances in technology making the programs more and more realistic, she can see it expanding. “It could help a lot of people,” she said.

SOURCE: and The Lancet Psychiatry, online July 11, 2018.