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  • Dr. Dug

Targets of Virtual Reality Exposure Therapy

For many, Exposure Therapy is the terrifying treatment depicted in movies like Anger Management. You might imagine that Exposure Therapy for something like fear of heights may involve the psychologist forcing you to stand on top of the tallest skyscraper in your city... and then locking you out!

Fortunately, in real life, you are in control of how treatment proceeds and your willingness to challenge yourself is vital for success.

When Virtual Reality (VR) is brought into the mix, this dramatically increases the control of the exposures. After all, when you get onto a normal plane, you cannot tell staff how many passengers you want on the plane, but you can in the VR environment.

Below, I provide some additional details about specific diagnoses; however, keep in mind that the uses for Virtual Reality Exposure Therapy (VRET) are much more far-reaching. It is helpful for any situation where you may overly focused on trying to avoid, change, or get rid of feelings of fear or discomfort - to the point where it has affected your ability to pursue those things that make your life feel meaningful.


A phobia is when some stimulus causes intense feelings of fear, worry, and/or disgust. Some examples are storms, injections, blood, small spaces, flying, and heights. In the VR environment for flying, we can put you into an empty plane, in your favorite seat, on a sunny day, with a smooth ride. We will then work up to a full plane, in your least favorite seat, on a stormy night, hearing anxious comments around you, with turbulence. Or perhaps your anxiety starts when you’re at home getting ready or in the taxi going to the airport. In those environments we can also adjust the stressfulness level. In contrast to real life, not only can we control many variables, but we can also repeat an environment as many times as you need (in real life, it would become expensive to keep riding a taxi or to keep buying plane tickets!).

Panic Disorder and Agoraphobia

People with agoraphobia often have panic disorder but people with panic disorder do not always have agoraphobia. Often, the main concern with these disorders is the fear of fear. Therefore, in VR exposure treatment, we work on helping you develop a new relationship with fear and have greater tolerance for physiological symptoms.

When someone has a panic attack, the body is in full “danger” mode. The heart speeds up in order to make sure muscles have enough oxygen to fight or run, digestion stops processing in order to divert focus to muscles, rational thinking gets shut off so that it does not get in the way of instinctual acting, sweat production goes up to maintain temperature while running or fighting, etc. This typically can feel like something is wrong and people will think they are having a heart attack or going crazy.

In the VR environment for people who have panic attacks while driving on the freeway, we can put you into the car as the sole passenger, on a clear day, with no other cars on the road, on a straight road, going at a moderate speed. We can then advance until you are the driver in a car full of passengers, driving on a rainy night, going very fast, listening to loud music, on a curvy road.

Social Anxiety

People who experience social anxiety can feel afraid of negative judgment by others (and themselves) for their actions and nervousness.

Perhaps you feel social anxiety in the workplace, in which case the VR environment would be an office where you are in a conversation with just one person or several, the other people may act interested or bored, and they may make positive or negative comments.

Or, maybe social anxiety results in fear of public speaking. Similar to the other environments, we can adjust many variables, such as number of people in the audience, what kind of comments or questions people raise, etc.

Obsessive-Compulsive Disorder

OCD can lead to the fear of consequences of either doing something (e.g., checking the stove before leaving home) or not doing something (e.g., not touching walls in public spaces).

The mental obsessions can be in the form of deep worrying about something that is just not right. One VR environment that we may use to target fears of contamination would be a public bathroom. In the less stressful situation, your avatar does not touch anything, you are in a clean bathroom, and people around you are wearing masks. We would then advance to a more stressful setting in which your avatar uses the toilet and touches things in a dirty bathroom where people are mask-less.

Gastrointestinal Disorders

GI disorders are often accompanied by symptoms that may look similar to social anxiety or agoraphobia; however, that may not be the case.

People with GI disorders may be fearful of going out for multiple reasons, including not being able to find food they can eat, having gas or diarrhea, needing to use the toilet frequently, and needing to talk about their medical condition in order to explain the aforementioned behaviors.

If you’ve been missing out on social outings to bars, friends’ houses, restaurants, etc., that is the VR environment we will use in order to help you develop a new relationship with fear, worry, and discomfort.

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