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Book Forum: Anxiety Disorders   |    
Virtual Reality Therapy for Anxiety Disorders: Advances in Evaluation and Treatment
PAUL E. RUSKIN, M.D.
Am J Psychiatry 2005;162:1772-1772. doi:10.1176/appi.ajp.162.9.1772
View Author and Article Information
Baltimore, Md.

By Brenda K. Wiederhold, Ph.D., and Mark D. Wiederhold, Ph.D. Washington, D.C., American Psychological Association, 2004, 225 pp., $39.95.

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All of us have experienced virtual reality to one extent or another. When we become engrossed in a movie or a video game, we enter into a virtual world. For a brief period of time, we lose awareness of the world outside and our consciousness becomes focused on the sounds and images presented on the screen. The authors of this book suggest that virtual reality can be used effectively in the treatment of anxiety disorders. The book documents their efforts and the efforts of other investigators to do so.

Anxiety disorders are among the most common psychiatric disorders encountered in clinical practice, if not the most common. Standard treatment consists of psychotropic medication and psychotherapeutic interventions. A key psychotherapeutic intervention is exposure therapy. Exposure can be either imaginal, by having the patient imagine a particular scene (for instance, a traumatic war experience), or in vivo (for instance, having a patient who is afraid of flying go to an airport, watch planes take off, sit in an airplane seat, etc.). As the authors of this book point out, virtual exposure may have advantages over both imaginal and in vivo exposure. It may be superior to imaginal exposure in that it is much more life-like and therefore might be more effective. At the same time, it has many potential advantages over in vivo exposure. It is generally much less costly; it saves public embarrassment; it can be stopped if the symptoms get overwhelming. In addition, the key aspects can be repeated over and over; for instance, if someone has a fear of flying, and the therapist identifies that the take-off is the anxiety provoking aspect of flying, a virtual take-off can be replayed over and over again. Physiological monitoring of data such as heart or respiration rate is much easier to achieve during virtual than in vivo exposure. Finally, many situations that one would not replay, such as war trauma or sexual assault, can be addressed through the safety of virtual reality.

In this book, the authors present the results of numerous studies in which virtual reality proved effective for the treatment of anxiety disorders, including panic disorder, agoraphobia, obsessive-compulsive disorder, posttraumatic stress disorder, and phobias.

This book very much represents a work in progress. The use of virtual reality to treat anxiety disorders is only about a decade old. Most of the studies cited were conducted in the past 5–7 years. Part of the reason that the field is so new is that until recently the required technology was too expensive, or too primitive, for routine or even investigational use. Now, it has become much more affordable and sophisticated. In general, the more senses that are involved in a virtual reality treatment, the more expensive the technology and equipment. The least expensive treatments involve mainly sight, through video, and sound. The price increases significantly when other sensory modalities such as smell, touch, and movement are added. One of the encouraging findings from a number of studies is that very positive results are obtained without necessarily employing all of these senses.

One of the drawbacks of this book is that it is very repetitive and in many places consists of a series of detailed descriptions of research studies. Furthermore, the book is not well organized. It begins with a number of chapters on general principles, then continues with 10 chapters on the treatment of individual anxiety disorders. Much of the information in the general section is repeated in the sections on individual disorders, and much of the information on individual disorders is repeated from one disorder to the next. On the other hand, there are numerous excellent case histories that give life to the rather dry repetition of one study after another.

Could virtual reality revolutionize the treatment of some anxiety disorders? If the early results reported in this book are replicated by further studies, it is quite possible that in the future virtual reality will become a standard component of the treatment of these disorders. The mental health community should eagerly await the results of future developments in the field, including the creation of even more sophisticated, true-to-life, and inexpensive virtual reality treatment tools.

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