Virtual reality can help treat children with phobias, study finds

A single session of exposure therapy using virtual reality (VR) can help reduce anxiety symptoms in children with phobias, a small-scale study has found.

Exposure therapy is a psychological treatment for phobias that involves gradually exposing the patient to the feared object or situation in a controlled and safe environment. By facing their fears, patients find that their anxiety diminishes over time.

It can be difficult in traditional psychotherapy to recreate the situation that causes anxiety, however. If a child fears storms, the best that a psychotherapist can do is ask the child to imagine being in a storm, which limits the effectiveness of the approach.

Using virtual reality makes it possible to create, virtually, any condition or situation and to immerse the individual in it through a VR headset.

In the study, published in Child Psychiatry & Human Development, Kesley Ramsey and her colleagues at Johns Hopkins University School of Medicine aimed to explore the use of VR exposure therapy for treating anxiety disorders in children.

Moderately severe phobias

The study involved three children, two girls and a boy, all around 12 years old, who had phobias of storms, spiders and dogs, respectively. These phobias were of moderate clinical severity.

The treatment involved a single VR exposure session using an HTC Vive headset, headphones, and the Virtually Better exposure phobia suite. The treatment started with the therapist explaining what anxiety, exposure therapy and coping techniques are, and why they were using the VR exposure method. They then made a plan for the VR exposure procedure.

Each child received a brief explanation of how to use the VR headset and controllers, followed by an exposure session in which the therapist guided the child to progress up the exposure treatment hierarchy. When the child mastered the current level of exposure to the feared situation or object, the treatment progressed to the next step, which represented a more intense exposure.

Before and after the VR exposure treatment, children underwent clinical assessments for anxiety symptom severity. The researchers measured skin conductance changes to assess distress and monitored for VR-related adverse effects, such as eye strain, nausea, and fatigue, using the Simulator Sickness Questionnaire.

All three children were able to complete multiple VR exposures within the single treatment. On average, they needed 50 minutes. However, the first two children completed the full VR exposure treatment protocol consisting of 13 and 19 situations. The third child (the one with a fear of dogs) discontinued after five VR exposures due to an intense anxiety response.

Symptoms reduced after treatment

Children reported some mild adverse effects of VR use, but these did not persist to the end of the treatment. Both children and parents reported being satisfied with the help they or the child received. Anxiety assessments showed that symptoms were reduced after the treatment.

The VR exposure led to subjective distress and also produced the expected physiological responses. The participants showed signs of physiological habituation to virtual reality exposures.

“Our findings provide preliminary support that VR exposures are feasible, acceptable, and demonstrate initial evidence of the potential therapeutic effects for youth with anxiety,” the study authors wrote. “Indeed, albeit on a smaller scale, the positive treatment effect of VR exposures parallels the findings and clinical trajectory of symptom improvement observed in other OST [one session treatment] protocols for childhood anxiety.”

They added: “Moreover, VR exposures elicited similar subjective and physiological responses to parallel in vivo exposures. Collectively, this suggests that VR exposures show therapeutic potential for the treatment of childhood anxiety disorders, and overcome many of the traditional barriers confronting in vivo exposures (e.g., access and availability of exposure stimuli).”

Although the results were promising, the very small scale of the study, and its single-session format limit the generalisability of its conclusions, the authors say. They add that further research with larger participant groups and extended treatment durations is necessary to fully understand VR exposure therapy’s efficacy and scope.