Interreality: Virtual Reality Simulations Make Stress Therapies More Effective
The idea of "facing your fears" has long been a cornerstone of cognitive behavior therapy, but now psychotherapists in Italy want to take it one step further. In a recent study, they had patients undergoing therapy for stress engage in virtual reality simulations of stressful situations in order to literally face their worst fears, much like the fear simulations in the recent film Divergent.
"Psychological stress has reached pandemic proportions in industrialized countries. Exposure to prolonged stress is known to increase the risk of physical and mental health problems, including depression and disabling anxiety conditions," said Dr. Andrea Gaggioli from the Istituto Auxologico Italiano, who led the study.
The study particularly focused on occupational stress: "In particular, work-related stress is responsible for around one fifth of staff turnover, with negative implications for the productivity of organizations. Identifying more effective strategies to help people dealing with stress is an important research challenge," said Gaggioli.
The researchers aimed to create a therapeutic approach that was more tailored to the individual's needs: "The trouble with stress is that it is so very personal. Stress-related disorders depend a great deal on how the person experiencing a stressor is put together - psychologically and physically." So they used biosensors, smartphones, and virtual reality technology to create virtual reality scenarios in which therapists could observe how each patient dealt with stressful situations and identify exactly where their coping mechanisms had room for improvement.
For the study, 121 nurses and teachers filled out questionnaires to gauge their pre-treatment stress levels, and then were randomly assigned to the interreality treatment, traditional cognitive behavioral therapy, or a control group that received no therapy. The interreality group would be placed in virtual situations such as "coping with a student's parents' criticism" or "managing a medical emergency situation," and then receive psychotherapy based on their performance in the simulations. The cognitive behavioral therapy group would be told to imagine the same situations and receive therapy accordingly.
Both groups reported improvement in stress levels, but the interreality group showed a statistically significant higher level of improvement over those receiving traditional therapy. Patients in the interreality group showed a 12% decrease in general anxiety levels and a 14% increase in emotional coping skills. By contrast, the cognitive therapy group members showed only a 0.5% decrease in general anxiety and a 0.3% increase in coping skills.
"A real strength here is the mix of technology, practitioners and real-life use – which seems like a potentially powerful therapeutic mix," said Chris Williams, a professor and psychiatrist at the University of Glasgow, who was not part of the study.
However, Williams doubted whether the population studied was comprehensive enough for the treatment to have clinical applications: "The results show early encouraging results, however a key issue is that the people involved in this early stage study were stressed rather than facing the level of clinical anxiety normally seen by mental health workers. In fact, people with definite diagnoses such as generalized anxiety disorders or phobias were ruled out of the study. That means that it's still too early to quite know whether that group of people can benefit. That's important because at the moment CBT is almost entirely focused on people with mental health disorders. I'm afraid as with lots of early stage research I'd have to say it shows promise, but for use clinically there need to be more studies."
In their publication, the researchers acknowledge that more research needs to be done, as their study has several limitations. In addition to Williams' concerns, they also have not had the opportunity for long-term follow-up (although they plan to observe the participants at 6 and 12 months), and the equipment needed for these cutting-edge treatments is expensive. But they also observed during the study that traditional therapy seemed to be less effective because it could not occur in real time, while the stress is actually happening. They asserted that, at the very least, the study is grounds for potentially reconsidering traditional cognitive behavioral therapy as the "gold standard" for treatment of psychological stress.