Before she began her therapy last year, Miss Muffet's condition was quickly spiraling into a "crescendo effect." Overcome by arachnophobia, she began to compulsively scrub her car twice a day, leaving a burning cigarette in the ashtray because, she believed, spiders hated smoke. She would scour her room before sleep, seal her windows with duct tape, and barricade the base of her door with a towel. She even ironed each piece of her clothing after a wash and stored them individually in Ziploc bags.
But last spring, the arachnophobe became patient zero in a pioneering new treatment, which sends phobics into an immersive virtual-reality simulation of their worst nightmare in order to cure them. After just 12 one-hour sessions in the tarantula-infested SpiderWorld, developed by the University of Washington's Human Interface Technology Lab, Miss Muffet reached "systematic desensitization," and has even become cavalier enough to go backpacking alone.
With extremely high success rates like hers, VR phobia treatments for a variety of disorders, ranging from the fear of being in high places to the anxiety of public speaking, are rapidly moving from research labs into the mainstream. Beginning next week, VR phobia therapy will have its first public trial, as a PC-based fear of flying system will start shipping to private practices across the country.
SpiderWorld, modeled with a US$90,000 Division computer, was constructed out of a simple VR kitchen demo, says HIT researcher Hunter Hoffman. Patients don a VR helmet and glove to explore the 360-degree space, with an animated tarantula slinking around in the background. While the visuals are refreshed 10 to 15 times a second, Hoffman intensified the system with physical component: a mobile, toy spider to be touched by the patient and tracked by the machine.
Hoffman says this link between the imaginary and physical - what he calls "cyberheft" - cements one of the important aspects of treating people in VR: "You must make sure that the image translates into real fear or it's a waste of time."
When Miss Muffet entered treatment, "she was pretty freaked out," says Hoffman. Her legs shook at the initial sight of the VR tarantula, and her phobic rating shot up to 15 on a scale of 1 to 10, Hoffman recalls.
As the first step, Hoffman and therapist Albert Carlin helped Miss Muffet relax by allowing her to touch the spider image without any force-feedback in glove. As Hoffman describes, "She was shaking hands with the enemy." Then, with the therapist at her side, she was instructed to breathe deeply and concentrate as the spider inched forward session by session.
Miss Muffet's progress was remarkable. Near the end of her therapy, the HIT team struggled to invent ways to keep her scared while Miss Muffet got more courageous, even playful.
"She started doing this thing that cats do where they will put a toy down and pretend that they don't know that it's there and then pounce on it," remembers Carlin, who helped develop SpiderWorld.
Some patients, however, weren't able to muster the suspension of disbelief. "One guy said, 'This looks like an awful lot of fun, but we're talking about the world of Homer Simpson and it just doesn't do it for me,'" says Carlin. "For some, presence is an issue."
Carlin says current phobia therapy is hampered by the limits of two of its treatments: imagistic and in vivo desensitization. The former method, in which patients are presented with frightening photographs, is flawed because "some people can't scare themselves with imagery." While the "live" in vivo system works, Carlin admits, it's impractical, expensive, and occasionally risky to the doctor. VR treatment replicates the qualities of in vivo, but allows the therapist to manipulate the degree of intensity.
The VR treatment uses of the fundamental nature of phobias to its advantage. While phobias can be paralyzing, they're not necessarily symptomatic of deeper psychological problems, says Carlin. By pinpointing the specific terror, therapists can effectively root out the trauma though systematic desensitization and conditioning.
One of the biggest reasons for the success of VR treatment may be, in fact, the machine itself. Usually with phobia treatment, doctors must deal with recalcitrant patients and their resistance to treatment, a condition called "approach avoidance." But with SpiderWorld, "they're repulsed by the spiders but intrigued by the machine," says Hoffman. "We unwind the condition that has been put in place by avoidance.... They go into VR world and they're fascinated."
The field of VR therapy is rapidly expanding out of simple phobia treatments. Georgia Tech professor Larry Hodges, who designed a fear-of-flying system with a vibrating airplane chair, will start VR treatment for post-traumatic stress disorder with Vietnam veterans this fall. The HIT group has already done preliminary testing on using VR to distract burn victims from the excruciating pain of skin cleansing and grafts. "Pain requires constant attention," says Hoffman, "and VR is uniquely attention-grabbing, even at that level of pain."
From the Wired News New York Bureau at FEED magazine.
