VR And Agoraphobia:
How Virtual Reality Is Transforming THE THERAPY

There are different types of fear (phobia), many of which can lead to medical conditions (e.g. depression and anxiety disorder). Fortunately, there are also several ways of managing/treating them. In this article, we will be taking a close look into one specific type of fear – agoraphobia, and how virtual reality can be used to overcome it.

It has been researched that agoraphobia often starts as a feeling of anxiety about certain events which develops over time into a generalized fear. While the actual cause of this condition is yet to be fully understood, several factors have been linked to its development. Examples of these risk factors are:

• Panic Attacks: People who have and respond to panic attacks with extreme fear and apprehension have a high chance of developing agoraphobia
• Genetic history of anxiety disorders
• Experience with other phobias
• Traumatic childhood experience
• Stressful events such as divorce or job loss
• Depression
• Being a victim of criminal events
• Excessive alcohol or drug abuse

A large number of individuals with agoraphobia have benefited from these treatment options in the cure or management of their condition. However, over time, there has been a discovery of some difficulties associated with some of them. Let’s take a look at them in detail:

Psychotherapy Challenges
Therapy treatment would involve an individual with agoraphobia making their way to the therapist to have a session. This is often difficult especially with people with severe agoraphobia, as they would have to leave their house and wade through a most populated area to reach their destination.
Furthermore, cognitive behavioral therapy as well as exposure therapy are known to take a considerable amount of time before changes are noticed. There are some patients who as a result of the wait might get discouraged when there are no immediate changes.
There is also the overwhelming feeling a lot of patients feel while undergoing exposure therapy which might cause some to drop out of the program without achieving any solid progress.

Medication Challenges
People with fear and anxiety often find it difficult to remain committed to lifestyle habits like exercise, diet changes, or relaxation techniques. And while this option might work with support from friends and family, there are cases of affected individuals who are without any support. Taking antidepressant drugs has its side effects.
Having talked about the traditional therapy issues of agoraphobia, let’s have a look at a more modern approach - virtual reality and how it works in treating this condition.

Virtual Reality (VR) is basically a form of therapy that helps people with agoraphobia face and overcome their fears by creating a digitally simulated world. It was designed to limit the distress of agoraphobia in a much shorter time than traditional approaches. With VR technology, it becomes possible to create different forms of reality/situations and immerse agoraphobic individuals in them for the purpose of interaction. By creating a virtual environment where people act out or revisit situations, VR therapy removes real-world risks and helps people with agoraphobia to:

• Learn interpersonal skills
• Improve their confidence
• Process an occurrence in the past

The primary aim is for agoraphobic individuals to gradually overcome and train their emotions after repeated exposure to virtual anxiety-inducing simulations. It is often used for people with extreme levels of anxiety who are unable to leave their homes.

The therapy is carried out using a virtual reality headset that is programmed with several simulations that are hard, too scary, or risky to recreate in the actual world. These simulations are generally recommended by a therapist or people who have experienced psychosis. With the VR headset, agoraphobic people are helped to explore an electronic version of an everyday situation that they find scary or disturbing (e.g. standing in a queue). The technology is completely automated and has a virtual character inserted in each simulation who delivers psychological advice and guides the subject throughout the duration of their stay in the e-simulated environment.

The integration of monitoring and feedback features in virtual therapy is vital in determining a positive outcome. They enable quick adjustments to the virtual setup by providing insights based on data evidence gathered during the virtual therapy sessions. This helps to improve the effectiveness and safety of the treatment method.

The integrated monitoring mechanism involves biosensors which are used to measure and keep track of the subject’s physiological responses such as heart rate, eye movement, stress levels, vocal changes, body movement, and posture during sessions. These measured responses help to provide information about the patient’s emotions and stress level during exposure to the event simulations generated by the virtual reality software.

The sensor devices are often placed directly on the subject’s skin or worn as a wristband and their primary function is to provide the managing therapist with real-time data. This refers to information that details the subject’s response to the virtual environments which helps the therapist modify the situation in accordance with the subject’s feedback. A practical example is when the agoraphobic subject begins to shiver as a result of being in the center of the large crowd simulation, the therapist can choose to end the session or make modifications to the simulation.

Another upside to having the monitoring features integrated is that it gets the subject acquainted with the visual metrics of their stress responses in anxiety/fear-inducing situations. This helps in improving their therapeutic process as they learn to understand and manage their psychological reactions over time with self-help techniques. For example, an agoraphobic individual who notices an elevation in his heart rate during a disturbing session can regulate his reaction through breathing. This way, a patient can actively learn how best to regulate their physiological reactions not only in virtual sessions but also in real-life situations.

Aside from the real-time monitoring features, there are several benefits that come along with the use of VR for agoraphobia treatment. Let’s take a look at some of them in detail:

Unlike conventional exposure therapy where agoraphobic individuals are introduced to unpredictable real-life situations to overcome their fear, VR provides a fully automated environment. All through the sessions, therapists are able to adjust factors like crowd size, noise level, and environment settings. They are also able to pause, modify, or repeat customized scenarios when needed, ensuring a safe and supportive experience for the patient. Virtual reality allows for a step-by-step exposure where individuals are helped to overcome their fears progressively from less disturbing scenarios to very challenging ones. A practical example is when an individual who is scared of being in public places is progressively run through the following simulations:

• Simulation that shows places you at the entrance of a shopping mall (low difficulty)
• Simulation of you walking inside the mall which is less crowded (moderately difficult)
• Simulation of you navigating a busy mall filled with people (highly difficult)

This gradual process helps individuals slowly build the confidence they need to overcome their fears.

With virtual reality, agoraphobic individuals can easily access treatment from their therapist’s office or even from the comfort of their homes. This makes it a perfect option for people with agoraphobia who are not able to leave their houses. Additionally, virtual reality makes it possible to create and recreate the specific environments that would be of therapeutic help to the patient which may be hard to set up in real life. It also saves time and removes the stress of having to plan and schedule these scenarios in real life, as some of them may be costly or difficult to create and repeat.

The use of virtual reality for agoraphobia treatment is very patient-engaging as it creates an immersive environment that feels very real. It removes the need of having to depend on imagination and captures the patient’s attention, making the session all the more engaging and interactive.
Furthermore, virtual reality helps in providing a safe space where agoraphobic individuals can become more willing to build confidence and overcome their fears. There are several game-like elements that can be integrated into the software like progress tracking, milestone achievements, and level increases, which help encourage patients to stay committed to the treatment.

Virtual reality therapy, while being a great option for agoraphobia, also comes with a few potential downsides. Therefore, it is essential that users fully understand the risks that may occur as a result of its usage.

The most common side effect of using VR or 3D videos is motion dizziness. This symptom is similar to what you might have experienced when watching a 3D movie in a cinema. If you experience such effects, you should stop using the equipment, take a break and try shorter VR sessions. 3D motion sickness varies from person to person—some individuals are more prone to dizziness than others when watching 3D movies. To enhance safety, PsyTechVR has minimized the use of flashing lights in its virtual experiences. If you experience any discomfort or adverse symptoms while using VR, inform your therapist immediately.

There is also the risk of added emotional distress when there is a lack of smooth transition from virtual environments to reality. This is the reason why it is admonished that VR therapy be viewed as a complementary treatment option to be used alongside traditional therapy, face-to-face interactions, and real-world coping strategies.

The value of having professional guidance involved in virtual therapy cannot be overestimated. Not only are they trained to ensure a safe, ethical, and effective treatment, but they also help to tailor the VR exposure to the needs of individual patients. Through their techniques, therapists make it possible for patients to successfully navigate their emotional responses and enable therapeutic exercises that bring about positive outcomes.

Furthermore, therapists help to monitor the progress of the treatment, adjust the treatment plans, and also arm the patient with real-coping strategies alongside the sessions. These professionals ensure the proper usage and enhance the overall effectiveness of the treatment approach.

At PsyTechVR, the VR therapy system is designed to sync perfectly with the efforts of mental health specialists. It makes provisions for therapists to conduct initial assessments and monitor their patient’s VR sessions in real time. PsyTechVR’s therapy system also provides a 30-day free trial for therapists interested in integrating VR into their practice while providing tools like automated CBT questionnaires and a Learning Management System (LMS).