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TRADITIONAL VERSUS VIRTUAL TREATHMENT OF SPECIFIC PHOBIAS:
The most effective traditional technique to treat specific phobias is gradual exposure to the phobogenic stimulus, according to a list of anxious situations determined by the phobic person. Exposure is conducted in real situations (in vivo exposure) or with imagination tehniques and can be held in the therapist office (e.g. insect phobia) or outside the office (e.g. in a ublic building for fear of elevators).
 

Inherent limits to the desensitization technique
Virtual therapy
Advantages of virtual therapy
INHERENT LIMITS TO THE DESENSITIZATION TECHNIQUE IN THE TREATMENT:
Although “in vivo” exposure has been deemed as the most effective technique in the treatment of phobias, it is important to note that this technique holds certain disadvantages for both the client and the therapist. Indeed, in using this type of therapy once is confronted with certain limitations such as the breach of confidentiality during exposure in a public place, the care of the animals and insects (and their replacement as needed), the possibility of unforeseen problems (e.g. elevator jamming or malfunctioning), the climate (e.g. fear of thunderstorms), monetary costs (e.g. fear of flying). In this sense, the advantages related to the use of virtual reality offer a therapeutic potential that is particularly interesting for the treatment of phobias.
VIRTUAL REALITY IN THE TREATMENT OF PHOBIAS:

Virtual reality, when applied to the treatment of phobias, allows individuals to be exposed to fear stimuli (in the same manner as when performing traditional therapy) within a computer-generated situation. The use of a helmet that has been integrated into a screen, the individuals perceive themselves in a virtual environment where they are gradually exposed to their fears (in virtuo exposure).

With the aim of facilitating the task for clinicians employing virtual therapy with individuals suffering from anxiety disorders (such as specific phobias), many types of software have been developed that are designed to treat certain types of psychopathological states such as: agoraphobia, post-traumatic stress disorder, specific phobias (e.g. heights, plane travel, enclosed spaces, public speaking, etc.), attention deficit disorder assessment, etc. Since these softwares are often very expensive, the Cyberpsychology Lab uses modified computer games to create its own virtual environments. The option of adapting computer games for use in virtual therapy offers numerous advantages, including cost reduction as well as the possibility to modify a multitude of virtual environments in terms of the particular needs of the patient.
ADVANTAGES THAT VR THERAPY PRESENT:

Virtual reality treatment offers many advantages comparing to traditional exposure techniques for phobias (North, North, & Coble, 1996; Riva, Wierderhold, & Molinari, 1998; Rothbaum & Hodges, 2002). Here are some examples :

  1. Increased control and security : the virtual environment allows for the control of unexpected occurrences that may come up during exposure to the real world (jammed elevator, plane turbulence, traffic jams). In addition, the virtual environment allows the client to be exposed to certain fears that may be difficult to reproduce in reality (fear of flying in an airplane) within a secure environment.
  2. Reduction of breaching confidentiality : Using gradual traditional exposure techniques, the therapist must accompany the client into different locations in order to allow the client to conquer their fear. However, these techniques require outings into the world outside of the office, often into a public place (e.g. fear of heights) and this may hold certain risks for the client. Virtual therapy takes place in the privacy of the therapist’s office, thus preserving client confidentiality.
  3. Minimization of avoidance : Avoidance is the most commonly observed behaviour among phobic individuals. It may also manifest itself in the course of therapy, during exposure. In virtual therapy, is more difficult for clients to avoid the phobic stimulus given that they are confronted with the stimulus under the therapist’s supervision. The therapist can see on the screen of their computer the image that has been projected into the virtual helmet and onto the movement encoders. In this manner, the therapist can guide the client back to the feared stimulus if the client demonstrates avoidance tendencies.
  4. Respecting the client’s rhythm : the therapist can see and hear what the client is experiencing within the virtual environment. Should the client’s anxiety levels become too elevated, the client can easily return to a lower level of anxiety during the course of treatment or may simply remove the virtual helmet. It is also possible to repeat the sate of exposure as often as is necessary as well as to permit the therapist to pace the sessions according to the client’s needs.
  5. Reassuring context : virtual reality offers clients having difficulty imagining feared situations or clients having difficulty entering real life situations, the possibility of conquering a fear stimulus or object in a secure context.
  6. Elimination of animal care : for persons suffering from animal or insect phobias, traditional « in vivo » therapy can become complicated and expensive, because the therapist has to house and feed these living creatures.
  7. Reduction of costs : Virtual therapy allows for the reduction of costs often encountered with traditional therapy (plane tickets, travel). In addition, many insurance companies do not cover sessions running longer than the standard period of time (e.g. when leaving the office). This is not problematic in virtual therapy given that all of the treatment components can take place within the confines of an office during the course of one-hour sessions. The adaptation of video or computer games for use in virtual reality offers many advantages in terms of the considerable reduction of consists, the possibility of creating a multitude of different virtual environments as a function of the client’s needs and in terms of the implementation of efficient treatment programs for treating various types of phobia.
  8. Increased accessibility to services : The prevalence of specific phobia in the general population is high in North America, yet few people seek treatment. This type of therapy appears to offer security for potential patients, which in itself may motivate them to seek help. For the therapist, this technology allows for diminished travel time (for exposure outside of the office) thereby freeing them and making them more available to their clients in the office.
  9. Transfer of gains into the real world : Virtual reality has the potential of becoming an asset for exposure to fear stimuli in a secure context. Studies conducted by means of virtual reality have demonstrated its efficacy longitudinally in the treatment of acrophobia (Bouchard, St-Jacques, Robillard, Côté, & Renaud, 2004; Emmelkamp, Bruynzeel, Drost, & van der Mast, 2001; Rothbaum & al., 1995; Schuemie & al., 2000), claustrophobia (Botella & al., 1998; Botella, Banos, Villa, Perpina, & Garcia-Palacios, 2000; Bouchard, St-Jacques, Côté, Robillard, & Renaud, 2004) arachnophobia (Bouchard, Côté, Robillard, St-Jacques, & Renaud, submitted ; Carlin, Hoffman, & Weghorst, 1997).
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