“This is life changing. Thank you!”
Helping Christine and similar clients has made me a passionate advocate for VR therapy. I am not alone; many other therapists have similar examples of using VR in creative ways to help clients.
VR is a technological breakthrough for therapy—especially for anxiety. This guide is written by clinicians for clinicians so that you—and your clients—can experience the benefits of VRT based on clinical experience, research findings, and case examples.
Although I have specialized in treating anxiety disorders for 40 years, I would have never predicted that I might become an expert in using VR. In 2008, I read an article that changed my life: Parsons and Rizzo (2008) said that exposure in VR was as effective as in vivo exposure—the gold standard for anxiety treatment. That got my attention and a literature review in 2009 cemented my interest. I started using VR with clients in 2010 and seeing great success. In the intervening years, I have taught continuing education workshops, spoken at conferences, consulted with therapists about adding VR to their practices, and written about VR.
My collaborator, Debra Boeldt, PhD, is a licensed psychologist, Deputy Director of the National Mental Health Innovation Center, and another advocate for VR. She has peer-reviewed publications to her name, speaks at conferences nationwide about VR, and supports the Tech Innovation Network.
Practical
This book provides a practical guide to integrating VR for anxiety into your practice in ways that are easy to understand and apply. It explains VR’s benefits and uses, reviews key research, answers common questions, and addresses common concerns. It covers using VR in person, for teletherapy, and for client homework.
Recommendations are informed by clinical experience as well as research. Case examples and quotations illustrate ways to use VR in clinical settings. Names and identifying details have been changed to protect client privacy and confidentiality, but all are based on actual people who sought help for anxiety.
Chapter 2 presents a general model of anxiety and its treatment. Chapters 3 and 4 describe therapeutic uses of VR followed by a VR anxiety treatment protocol and case example in Chapter 5. Chapter 6 provides an overview of VRT for specific phobias. VRT for blood-injection-injury phobia, claustrophobia, driving phobia, flying phobia, height phobia, and insect and animal phobias is discussed in Chapters 7 through 12. VRT for panic disorder and agoraphobia is covered in Chapter 13, social anxiety disorder in Chapter 14, stress, tension, and insomnia in Chapter 15, posttraumatic stress disorder (PTSD) in Chapter 16, and for generalized anxiety disorder, obsessive-compulsive disorder, and illness anxiety disorder in Chapter 17. Chapters 18 through 20 discuss how VR can be used with non-CBT therapies, provide answers to frequently asked questions, and discuss likely future developments. Appendix A explains types of VR equipment and content and Appendix B is a Virtual Reality Therapy Checklist.
Anxiety Focus
Anxiety is used as an umbrella term embracing all its clinical and subclinical manifestations ranging from tension, insomnia, or stress through panic attacks, phobias, intrusive worries, obsessions and/or compulsions, and post-trauma symptoms. VR can also be used for issues outside the scope of this book such as eating disorders, body image, social skills, increasing empathy, etc.
VR can be used for multiple purposes at different stages of anxiety treatment. Client responses to virtual stimuli can help confirm a diagnosis or evaluate treatment effectiveness. VR can facilitate relaxation, skills training, and skills practice, as well as be used for exposure, reinforcement, relapse prevention, and homework.
Integrative Approach
I use an integrative approach to treatment grounded in a comprehensive model of anxiety (Chapter 2). My background includes training in (listed alphabetically) assertiveness training, behavior therapy, client-centered therapy, cognitive therapy, cognitive-behavioral therapy, dialectical behavior therapy, ego state therapy, existential therapy, exposure therapy, eye movement desensitization and reprocessing, family systems therapy, gestalt therapy, guided imagery, hypnosis (directive and Ericksonian nondirective), mindfulness, motivational interviewing, positive psychology, psychodynamic therapy, rational-emotive therapy, relaxation techniques, solution-focused brief therapy, stress management, stress inoculation training, and other approaches.
I believe in treating the whole person. I have seen skilled professionals get good clinical results using many different techniques. In my experience, the most successful therapists use a combination of approaches flexibly adapted to each individual client.
Research Support
I also believe in research-informed practice. Quality research advances our knowledge. Incorporating new knowledge into practice increases efficacy. Human beings are complex, and it helps to be able to view clients through different theoretical lenses and to have as many tools in your toolkit as possible. VR is a flexible, research-tested tool deserving a place in your clinical armamentarium.
Interested readers can learn more about the relevant research by exploring the studies cited in the “Evidence Base” section of most chapters.