Immersing yourself in a virtual fantasy world where you can take up the role of a knight or wizard certainly has its appeal. But what if that virtual world was full of spiders, confined spaces, or hundreds of people laughing at you? For start-ups like Fearless and oVRcome, which use VR technology to help people overcome their greatest terrors and phobias, these latter worlds are the ones with the real appeal.
Phobias are intense, irrational and often debilitating fears that affect around 9% of the population. Unlike standard fears, which are generally considered helpful adaptations, phobias cause unnecessary suffering and can stop victims from performing even basic tasks.
The standard treatment for such conditions is called exposure therapy, which involves the patient being systematically exposed to the object of their fear in a controlled environment. Recurring sessions that gradually get more intense help the subject desensitize themselves to the feared stimulus.
Yet, more often than not, encountering fears in vivo (real life) is wildly impractical, let alone safe—take phobias of sharks or aeroplanes. When this is the case, the default is to switch to imaginal exposure, where the patient attempts to visualise the feared stimulus and work from there. But this represents a significant limitation.
Virtual reality (VR) offers an alternative way to treat phobias. Using VRET (virtual reality exposure therapy), psychiatrists can place their patients in simulated worlds where they can encounter any type of fear at any level of intensity. This avoids the dangers and impracticalities of in vivo exposure and offers far more flexibility around manipulating the stimulus.
As before, patients gradually increase their exposure across multiple sessions to improve their emotional regulation. This progress in the virtual world should then carry over to the real world and reduce the degree of phobia behaviour displayed.
Illusions and embodied cognition
An immediate criticism of VRET is that this carrying over of progress to the real world seems unfounded. During therapy, patients know the fear stimulus is computer-generated, meaning real-world cases are fundamentally different.
However, numerous studies have demonstrated that this intuition is baseless, from the original 1995 study on acrophobia (fear of heights) published in The American Journal of Psychiatry to the more recent 2021 paper on the same topic by the Norwegian University of Science and Technology.
These positive results come down to the technology’s impressive ability to make us experience a phenomenon known as ‘presence’. We feel embodied inside the virtual world and physically comport ourselves as if we were there. Users cannot help but duck when virtual rocks are hurling at them, suggesting that at some level, we are unable to fully internalise the fact that the simulation is fake. This has also been recorded on a physiological level, where researchers at the Polytechnic University of Catalonia reported cases where users’ nervous systems aroused a flight-or-fight response when unknown avatars were approaching them.
The future is supernatural
VR tech is only getting more advanced and realistic. With each new iteration, this process becomes ever more promising. It is possible that as virtual worlds start to simulate in vivo experiences effectively, VR will have the added advantage of hyperstimulation—the ability to generate situations beyond those found in real life. After all, if you can overcome a six-foot spider in a simulation, even the mightiest tarantula should not bother you.