Activity created by:
Adam Mills
Yipian Yang

Materials:

*Note: Materials for this activity, while limited in number, can be expensive.

-Virtual reality ready computer
-Virtual reality HTC Vive headset (or other VR headset preferred by the therapist)
-Steam account (or other platform account compatible with the headset)
-Room large enough to use Virtual reality headset
-Other relevant or updated tools for the VR program

Background:
Therapy can be challenging with clients who struggle with Agoraphobia. Although there are a number of existing CBT interventions specific for the treatment of Agoraphobia, they may be difficult to implement at times as they often require clients to expose themselves to their feared environment outside of therapy sessions.

This activity aims to expand the options available for treatment and exploration of phobias such as Agoraphobia. In this activity, a client will use the HTC Vive headset to explore other spaces and environments, in which the client will have more control. Clients will use the software Anyland or similar programs to create a virtual environment within their homes where they can invite other people, such as the therapist.

Instructions:
A therapist will first start with an introduction to the virtual reality (VR) technology, the headset, the program, along with a disclaimer on its potential risks. It is important for the client to understand that using VR can feel disorienting at times, and that entering and leaving the VR scene quickly can intensify this disorientation.

The therapist should also discuss with clients about different techniques for clients to ground themselves within the real environment (i.e. the therapy room), such as closing their eyes and or bringing their attention to the cable that they may feel on their back or leg.

While engaging in the VR program for therapeutic purpose, such as practicing coping strategies, it is recommended that clients should maintain a dialogue with their therapist. Clients are encouraged to express and discuss their anxiety as they enter and immerse themselves in a different space.

At the beginning, the therapist may want to engage the client in environments that are smaller and less crowded; progression to larger and more crowded spaces can be achieve across several sessions. The activity and nature of the discussions should be tailored to the client and his or her particular needs.

Target Population:

Adolescents 12 and up. Not recommended for clients who already struggle with reality testing or experience active visual and/or auditory hallucinations.

Expectation and problem-shooting:
The use of virtual reality (VR) technology in the treatment for mental health disorders has been adopted in many clinical settings and has been proven to be quite effective for a variety of presenting problems. Examples include specific phobias, anxiety disorders, posttraumatic stress disorder, persecutory delusion; VR has also been used to help people with stress management and meditation (Senson, 2016; Freeman & Freeman, 2016). The essence of VR is that once the headset is put on, the experience of the scene is so real that the progress one makes in VR is generalizable to real-life situations (Morina, Ijntema, Meyerbröker & Emmelkemp, 2015). Freeman and Freeman pointed out that the advantage of using VR therapy with clients struggling with a specific phobia is that the therapist can encourage clients to engage in behaviors that they would never consider in real-life situations (2016). It is expected that with the therapist’s introduction of the VR program and what the client can anticipate in the program, client will feel comfortable and confident to explore their fears, knowing that they are physically grounded in a safe space with the therapist present.

Given its advantages, the use of VR therapy should still be implemented with care. First, it is important that agreement should be made regarding what to do when the client feels overwhelmed by the scene in the VR program. The therapist may serve as a reminder of the external world by voicing instructions during the program; the therapist may also obtain consent to remove the VR headset for the client when he/she is over-stimulated. Another potential problem might occur when the client attempts to transfer learned skills from VR to real-life settings. After each session, it may be important to debrief with clients and discuss their comfort level in applying learned skills. The therapist may want to encourage clients to start with situations that provoke much less fear than the ones in the VR program, because real-life situations are not controlled or predictable as those in VR.

Reference:
Freeman, D. & Freeman, J. (2016, May 5). Virtual reality isn’t just for gaming—it could transform mental health treatment. The Guardian. Retrieved from https://www.theguardian.com/science/blog/2016/may/05/virtual-reality-isnt-just-for-gaming-it-could-transform-mental-health-treatment
Morina, N., Ijntema, H., Meyerbröker, K. & Emmelkemp, P. M. G. (2015) Can virtual reality expores therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments. Behaviour Research and Therapy, 74, 28-24.
Senson, A. (2016, January 6). Virtual reality therapy: Treating the global mental health crisis. Retrieved from https://techcrunch.com/2016/01/06/virtual-reality-therapy-treating-the-global-mental-health-crisis/