A small study of children with specific phobias showed that a single virtual reality exposure session helped reduce their anxiety symptoms. The participants also showed signs of physiological habituation to virtual reality exposures. The paper was recently published in Child Psychiatry & Human Development.
Exposure therapy is a psychological treatment for anxiety disorders that involves gradually and systematically exposing the patient to the feared object, situation, or internal experience, in a controlled and safe environment. This therapy is based on the principles of habituation and cognitive restructuring, where repeated exposure helps reduce the fear response and alters negative thought patterns associated with the object or situation that provokes anxiety. By facing their fears instead of avoiding them, patients learn that their anxiety and fear diminish over time, enabling them to develop coping strategies for their emotional responses.
Anxiety disorders are one of the most common psychiatric conditions among children and adolescents. It is estimated that up to 30% of youth have some form of anxiety condition. If these childhood anxiety conditions are left untreated, they increase the risk of the development of severe psychopathology later in adulthood.
However, one important difficulty with exposure therapy is that in classical psychotherapy settings it is often difficult to recreate situations that cause anxiety in the patient. For example, if a child fears storms, the best that a traditional psychotherapist can do is ask the child to imagine being in a storm. This seriously limits the effectiveness of this approach. New developments in immersive virtual reality (VR) offer a potential way to change that as these systems allow practically any imaginable condition or situation to be created and a person immersed in it just using regular VR equipment.
In their new study, Kelsey A. Ramsey of Johns Hopkins University School of Medicine and her colleagues aimed to explore the use of VR exposure therapy for treating anxiety disorders in youth. They assessed the feasibility, acceptability, and clinical benefits of this approach, including its ability to induce physiological arousal and distress comparable to real-world exposures.
The study involved three children, two girls and a boy, all around 12 years old, with fears of storms, spiders, and dogs, respectively. The latter also had generalized anxiety disorder and a fear of storms. These phobias were of moderate clinical severity.
The treatment involved a single VR exposure session using an HTC Vive headset, headphones, and the Virtually Better exposure phobia suite. The treatment started with the therapist explaining what anxiety, exposure therapy, and coping techniques are, as well as why they are using VR exposure. They then made a plan for the VR exposure procedure.
Next, the child would receive a brief orientation to using the VR headset and controllers. The exposure session followed, where the therapist guided the child to progress up the exposure treatment hierarchy. When the child mastered the current level of exposure to the feared situation/object, the treatment would progress to the next step representing a more intensive exposure.
Before and after the VR exposure treatment, children underwent clinical assessments for anxiety symptom severity. Satisfaction with the treatment was reported by both the children and their parents. The researchers measured skin conductance changes to assess distress and monitored for VR-related adverse effects, such as eye strain, nausea, and fatigue, using the Simulator Sickness Questionnaire.
All three children were able to complete multiple VR exposures within the single treatment. On average, they needed 50 minutes for that. However, the first two children completed the full VR exposure treatment protocol consisting of 13 and 19 situations. Meanwhile, the third child (the one with a fear of dogs) discontinued after 5 VR exposures due to an intense anxiety response.
Children reported some mild adverse effects of VR use, but these did not persist till the end of the treatment. Both children and parents reported being satisfied with the help they or the child received. Anxiety assessments showed that symptoms were reduced after the treatment.
As expected, VR exposure lead to subjective distress and also produced the expected physiological responses. The participants showed signs of physiological habituation to virtual reality exposures.
“Our findings provide preliminary support that VR exposures are feasible, acceptable, and demonstrate initial evidence of the potential therapeutic effects for youth with anxiety. Indeed, albeit on a smaller scale, the positive treatment effect of VR exposures parallels the findings and clinical trajectory of symptom improvement observed in other OST [one session treatment] protocols for childhood anxiety,” the study authors concluded.
“Moreover, VR exposures elicited similar subjective and physiological responses to parallel in vivo exposures. Collectively, this suggests that VR exposures show therapeutic potential for the treatment of childhood anxiety disorders, and overcome many of the traditional barriers confronting in vivo exposures (e.g., access and availability of exposure stimuli).”
Despite its promising results, the study’s small scale and the single-session format limit its conclusions. Further research with larger participant groups and extended treatment durations is necessary to fully understand VR exposure therapy’s efficacy and scope.
The paper, “Immersive Virtual Reality Exposures for the Treatment of Childhood Anxiety”, was authored by Kesley A. Ramsey, Joey Ka-Yee Essoe, Nathan Boyle, Ainsley K. Patrick, and Joseph F. McGuire.
