Anxiety Treatment with Virtual Reality Exposure (cont.)
I think it's important that when we began, no one knew that if you were afraid of heights in the real world, that you would also be afraid in VR. That was an open question. No one knew whether or not if you got anxious in a VR and habituated and got better, whether or not that would carry over to the real world, so when we began we had no idea if this would be effective at all. But as it turned out, all of these things were true. People got anxious in the Virtual environment, they got better, and it carried over to the real world.
Moderator: Please give us an outline of how you create a virtual environment (VE).
Dr. Rothbaum: I met with Dr. Hodges and his brilliant computer scientist graduate student, and explained what were some of the important aspects of a therapeutic exposure. So for example, with the fear of heights, we discussed what high places I would take people to in Atlanta, and they went back and built them in VR.
Grapp: I think you have to look at what is being done clinically presently, and then look for commonalities in the virtual world. The idea is you have to create an environment that will work for a lot of people
smersh_WebMD: This might be a geek questions -- but what OS/hardware are you using to do the VR rendering?
Dr. Hodges: This is completely pc based, using Windows 98. The software that's used to develop VE is two aspects. The software used is 3d Studio Max, which is a commercial CAD program. And then for all of the software support for realtime VR, we use something called Simple Virtual Environment toolkit, which was developed at Georgia Tech. The environments are all presented in head mounted displays, and currently we use something called 3D-fx. It's from IIS.
Moderator: Plenty of people suffer from "fear of flying" or can't face the prospect of public speaking. Can you outline the major anxieties or phobias and the extent of the problem.
Dr. Rothbaum: The number one phobia is fear of public speaking. For fear of flying, it's estimated that approximately 25 million people in the US are sufferers.
Grapp: The fear of public speaking, there are estimates that there are between 26 and 57 million people could be affected by fear of public speaking.
Dr. Rothbaum: The difference between fears and phobias, is that everyone has fears. For it to be a real phobia, it has to cause excessive anxiety, it has to lead to avoidance, and it has to interfere with the person's life. That's when they seek treatment.
Grapp: For post traumatic stress, the estimates are about 830,000 Vietnam Era veterans who are diagnosed with PTSD (post traumatic stress disorder). There are some estimates that up to 20 percent of people who fly on a daily basis may be using alcohol or sedatives in order to cope with the anxiety associated with flying.
Moderator: How prevalent is fear of heights?
jgers01_WebMD: What kind of anxiety disorders can you treat with virtual reality?
Dr. Rothbaum: Right now, we have applications for the fear of flying, the fear of public speaking, the fear of heights, fear of thunderstorms, a virtual mall for agorophobia, virtual Vietnam for veterans with PTSD, and we are planning more. If anyone has a good idea, they should feel free to contact us, and we may build their environment.
Dr. Hodges: VR has been used for other phobias. IF we can build a VE that contains the feared stimulus, then we can do therapy with it. Fear of animals is something that can be done; fear of spiders has been done successfully, driving phobias, and so we are probably only limited by imagination and time to create the VE.
Moderator: Has it been used for claustrophobia?
Dr. Hodges: Yes, there have been reports in literature that it has been, but we haven't done that yet.
tenuli_WebMD: What is the success rate for treating different kinds of phobias with virtual reality?
Dr. Rothbaum: With the fear of heights, all of the people who received the VR exposure therapy improved more than the controls, and seven out of ten reported exposing themselves to real life height situations by the end of treatment. For the fear of flying, the VR treatment works as well as standard exposure therapy, and at six months following treatment, 90 percent of people had flown.
Moderator: What are the advantages to using VR instead of reality?
Grapp: One of the advantage are that you have a lot more control over the situation in VR. You also can schedule more efficiently because you are not meeting people outside of your office . You protect the confidentiality of your patients as a therapist because you don't leave your office.
marzel2_WebMD: Are there effective ways of getting over the fear of flying without therapy, especially for longer trips? It doesn't leave me incapacitated, but it does make me extremely nervous and agitated during the ride.
Dr. Rothbaum: You may want to try some anxiety management techniques, for example, slow breathing. You probably want to make sure that you are not scaring yourself, and acting or feeling as if you are facing death, and being thankful each time the plane lands that you narrowly escaped death. So watch your thinking.