Scared of heights? How virtual reality can help people overcome their phobias
Fay Nugent challenged her phobias in a series of virtual scenarios
Fay Nugent's fear of escalators had become so debilitating it was starting to interfere with her day-to-day life.
The U.K.-based project manager, 52, can remember the phobia starting as a fear of heights. She recalls being in her early 30s and on a weekend getaway with some friends.
"We decided as part of this weekend to do some adventure activities, which involved climbing up a pole and then walking out across ropes at different heights," she told CBC Radio's Tapestry.
When it came time to walk across the rope, however, Nugent couldn't do it. She froze in fear. After that, whenever she was in a situation involving heights, she'd start to feel dizzy and this "overwhelming sense of concern" would wash over her.
For the next 20 years, she avoided heights as much as possible, especially escalators. Her breaking point came in 2018 when she was at an airport in the Netherlands with some colleagues.
"[They] were heading toward an escalator with luggage to go down and check-in," she said. Nugent had to follow them but was terrified.
Not long after, she heard an ad on the radio from Oxford University. Researchers were looking for people who had a fear of heights to participate in a new clinical trial. The trial involved testing out a new virtual reality technology as a therapeutic tool.
"I thought, 'Well this is it,'" said Nugent. "This is something that I can try and get back to some sort of normality in my day-to-day life."
Virtual reality-based (VR) therapy combines other forms of therapy, including talk, with technology, allowing patients to immerse themselves in their fears in a groundbreaking way. It's been used to treat post-traumatic stress disorder, anxiety and other mental health diagnoses.
In Nugent's case, a form of virtual exposure therapy presented her with challenging situations in a controlled setting.
With a VR headset, a patient can pause an experience or step away from it if it feels too overwhelming, said John Francis Leader, a psychologist and cognitive scientist who specializes in psychology and technology at University College, Dublin.
The researcher describes the approach as "theme park meets therapy." He said that VR therapy is still an emerging field, and at its core is a combination of the physical, the virtual and the imaginary.
Virtual scenarios to challenge phobia
The imagination can be a very powerful driver of anxiety on its own, said Leader.
"Very often, somebody's doing a form of mental rehearsal using imagination," he said.
"And the problem is whether [or not] they've had real-life experiences of a challenge, they've imagined it so many times that it feels like they've had thousands of challenging experiences."
VR-based therapy is believed to treat phobias by triggering the amygdala — a part of the brain that causes a fear response — and causing an emotional reaction, said researcher Stéphane Bouchard. With support from a therapist, a patient can then respond to that reaction in a logical way, helping to reframe the phobia.
"You compare the gold-standard treatment, which is exposure in vivo, and then you compare it with VR…. Most studies suggest that it is as effective," said the Université du Quebec en Outaouais professor, who has been studying cyberpsychology since the 1990s.
During Nugent's treatment, she was taken to a shopping centre in Oxford and asked to go down an escalator while being filmed by a researcher. She couldn't do it. "I was scared for myself," she said.
She was then given a VR headset to put on, and entered a world she describes as "very cartoon-like, very blocky." She said it didn't feel real at all, yet the tasks she was given in this virtual space still provoked a sense of fear in her.
At first, the challenges were simple, like leaning over a balcony, but they got progressively more difficult and "more frightening," she said.
"I had to do things like rescue a cat from a tree," she said. Another challenge had her "walk out over a rickety railway line."
The final task, which Nugent said was the most terrifying, had her standing in the shopping centre as it filled with water when suddenly "a killer whale came along, and I had to stand on its nose while it swam around," she said.
Though it was virtual and she knew she was safely in an office, Nugent said she experienced the same fears and physical responses as she would in real life.
"My heart would beat fast, I'd feel anxious, I'd feel a bit sweaty," she recalled. Eventually, those feelings subsided.
VR an alternative to real-world experiences
Leader said this kind of discomfort can be helpful.
"When someone has anxiety around something, very often encountering or interacting with that particular thing is a very important part of the therapeutic process," he said.
This kind of exposure therapy is common, but VR is allowing doctors to use it in a new way, particularly where setting up a scenario might be difficult.
Exposure therapy for someone living with social anxiety is one example. Helping that person interact with other people would be useful, but because of their anxiety, it might be hard to do so organically.
"That's where the virtual can be very handy," he said, "because you can create a scene that has other characters, other people in it, and the person can put on the virtual reality headset and they can practise."
Bouchard said that virtual reality on its own isn't therapeutic. Rather, VR can be a tool in a therapist's toolkit combined with traditional therapy.
"You can purchase a VR system. It won't treat you. You can purchase a VR system [for] spiders or fear of flying. It won't treat you," he said.
"Therapy is much, much more complex, and VR is just a detail in the whole story."
As technology — and patient's comfort with VR — advances, he said that such systems could be useful in teletherapy, linking people with remote therapists. Advances in artificial intelligence may also provide better options for self-guided VR-based therapy, but such options are closer to a self-help book at present, he noted.
For Nugent, virtual practice helped reset her perception of risk. After a morning spent doing tasks in a VR setting, the researchers at Oxford took her back to the shopping centre and asked her to once again go down the escalator.
"I just got on it without a second thought," she said.
Nugent was surprised at her new reaction to heights. "I just thought, I don't understand what's happened here. My feelings from this morning or the anxieties have just completely gone," she said.
While she said it hasn't eliminated her fear of heights completely, Nugent does say the impact of VR therapy on her life has "been huge."
At 51, she took her first skiing lesson — something she never imagined possible before.
"I can go shopping with my daughter and not worry about there being escalators in the shopping centres," she said.
With files from Jason Vermes. Produced by Theo van Beusekom and Sameer Chhabra