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By Garry Cooper
Virtual Reality Therapy
He's back in Iraq, on foot patrol, nervously walking down a street that suggests Basra, when it happens again—an explosion right across the street. The sidewalk shakes, he smells the acrid smoke, and as the panic starts to take over, his therapist says, "Turn right and walk up those stairs over there." He goes up a stone stairway to the roof of a building and then watches the blast again, safely removed. Only the client isn't back in Iraq—he's watching the scene unfold on a computer screen.
Therapists are making increasing use of virtual reality (VR) therapy, which, several studies suggest, increases the effectiveness of exposure therapy, the most empirically supported treatment for anxiety disorders such as PTSD and phobias. A metanalysis in the April 2008 Journal of Anxiety Disorders found that VR is more effective than recalling memories exclusively through narrative, and just as effective as in vivo exposure for a wide range of anxiety disorders.
Its use may soon be growing. A study in the August 2008 Death Studies journal reports preliminary success using EMMA'S World, a VR application developed by Spanish researchers to treat complicated grief. Currently there are 50 VR sites in military hospitals and university clinics treating primarily PTSD and addictions. Albert Rizzo, associate director of the University of Southern California's Institute for Creative Technologies, points out that many of today's veterans, raised on video games and computers, are more comfortable using VR than talking in therapy. VR also enables therapists to bring a simulation of the outside world into therapy, rather than relying primarily on homework, narration, or imagination.
Until recently, VR therapy has been the exclusive province of high-tech labs and clinics, but that may be changing. A company called Virtually Better, launched by Emory University psychologist Barbara Rothbaum, a noted VR and trauma researcher, and computer scientist Larry Hodges, now markets VR software and equipment to qualified clinicians, along with technical support and training. Costs start at about $6,000 for a minimalist setup and go considerably higher if one includes the extras, such as vibrating platforms and scent machines.
But all the extra bells and whistles may not be necessary. In February, PBS's Frontline program "Digital Nation: Life on the Virtual Frontier" introduced viewers to VR therapy. Those who were expecting a completely realistic recreation of battlefields, airplanes (for flying phobias) and barrooms (for addictions) may have been disappointed because the stylized scenes are deliberately a step removed from vivid reality. Early VR studies on vets with PTSD were too intense and had a high dropout rate, and researchers realized that they could evoke enough anxiety for exposure therapy to work with less realistic scenes. The goal now is to evoke memories and emotion, not recreate the experience. Clients' traumatic, phobic, or addictive conditioning is already so strong that their own brains provide the emotional charge. "People with PTSD report seeing things like water buffalos in our Vietnam scenarios that aren't there," Rizzo says. "You can fool the brain pretty easily."
Meanwhile, therapists don't have to worry about being replaced anytime soon. Rizzo points out that VR is an aid for exposure therapy, not a magic cure-all. "Technology doesn't fix anybody," Rizzo says. "It's a tool in the hands of a well-trained clinician."
The Tracks of Our Tears
The idea that crying indicates that therapy is working and that it's good for clients is older than psychotherapy itself. Aristotle wrote that crying "cleanses the mind," and Ovid said that "grief is satisfied and carried off by tears." But for many people, crying doesn't heal and may even be counterproductive.
A study of 4,249 people who were asked about their reactions to crying, led by Jonathan Rottenberg and Lauren Bylsma of the University of South Florida and reported in the December 2008 Journal of Social and Clinical Psychology,finds that more than 50 percent said they felt better after crying, while 38 percent felt the same afterward, and just over 9 percent felt worse. The question, therefore, say Rottenberg and Bylsma, isn't whether crying is cathartic, but when it's cathartic. Understanding the function of crying is central to answering that question.