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Disclaimer: This article is for informational purposes only. Please speak with a medical professional before seeking treatment.

What can virtual reality exposure therapy help with?

Treating symptoms associated with anxiety and PTSD, and training attention for patients with TBI

What is virtual reality exposure therapy?

Virtual reality exposure therapy (VRET) is a form of exposure therapy that uses technology. Exposure therapy seeks to help decrease the intensity of the stress responses you might have to situations, thoughts, or memories which provoke anxiety or fear. In a controlled and safe environment you are exposed to your PTSD triggers. In some cases, it is difficult to recreate the experiences that led to your PTSD, like military-related combat or severe motor vehicle accidents, for example. VRET can safely mimic those situations and provide an environment that can simulate the person’s real-life experience.

The layers … they just peel back and they just get you to your core. At first you don't want to, but you break down and do it, and it's absolutely amazing.

Kevin Tergliafera, Veteran, Army National Guard

What is virtual reality exposure therapy like?

You’ll spend time getting to know your therapist and discussing what caused your trauma. Then your therapist will create the environment for your VRET. You might use a virtual reality headset or enter a dark room with many screens that create an immersive environment mimicking what your trauma was like. There can be sights, sounds, smells, and vibrations to further recreate the traumatic experience and emotional response. There can be sights, sounds, smells, and vibrations to further enhance the experience. The setup is designed to help you confront the situations that cause you fear and anxiety, but in a safe and controlled environment. You’ll discuss these immersive experiences with your therapist. Medication and training in coping skills may also be used in conjunction with therapy.

Please Note: VRET can cause dizziness or headaches, which may be more noticeable for those with brain injury.

What do patients say?

It was a completely different experience. I don’t remember having the physiological reaction… In 13 weeks I’d completely changed who I had been for the previous ten years. Before the treatment, 80-90 percent of my dreams were Iraq related. Now I can’t remember the last time I had one. I live in a completely different way now.

— Jimmy Castellanos, Veteran, U.S. Marine Corps

 

The layers … they just peel back and they just get you to your core. At first you don't want to, but you break down and do it, and it's absolutely amazing.

— Kevin Tergliafera, Veteran, Army National Guard

Why does virtual reality exposure therapy work?

When some people experience a traumatic event, they may have a natural response that creates an intense fear reaction to sights, sounds, or other elements that remind them of the trauma. This can cause them to avoid situations that include those triggers, like the sound and sight of fireworks for someone with PTSD due to military combat. As you expose yourself to triggers through virtual reality, you have the chance to confront your fear in a safe environment. As with traditional prolonged exposure treatment, this allows you to learn how to cope with your anxiety and reframe your thinking about the traumatic event. This can result in slowly getting used to the triggers and coming to terms with the experience. Over time, your stress responses to triggers will become less and less intense.

How strong is the evidence?

Evidence suggests that VRET may be effective in treating symptoms of PTSD. There are a number of studies that have shown that VRET is linked to reduced symptom severity in both PTSD and depression, and that as the number of VRET sessions increases, the effectiveness of symptom reduction also increases. These effects also have lasted over time, at 3 month and 6 month follow up appointments. A randomized controlled clinical trial replicated these findings, reporting that patients who received VRET experienced a decrease in PTSD, depression, and anger symptoms. This study concluded that VRET was most effective in combination with other, more traditional treatment techniques. Although preliminary findings are promising, more research is needed.

What makes for effective virtual reality exposure therapy?

Find a licensed psychologist or other qualified therapist experienced in using prolonged exposure treatments including VRET for PTSD and/or TBI. It is helpful if they have experience working with your particular source of trauma.

References

Beidel, D. C., Frueh, B. C., Neer, S. M., Bowers, C. A., Trachik, B., Uhde, T. W., & Grubaugh, A. (2019). Trauma management therapy with virtual-reality augmented exposure therapy for combat-related PTSD: A randomized controlled trial. Journal of Anxiety Disorders, 61, 64–74.

Deng, W., Hu, D., Xu, S., Liu, X., Zhao, J., Chen, Q., Liu, J., Zhang, Z., Jiang, W., Ma, L., Hong, X., Cheng, S., Liu, B., & Li, X. (2019). The efficacy of virtual reality exposure therapy for PTSD symptoms: A systematic review and meta-analysis. Journal of Affective Disorders, 257, 698–709

How Virtual Reality Exposure Therapy (VRET) Treats PTSD. (2020, June 29). Verywell Mind.

Kothgassner, O. D., Goreis, A., Kafka, J. X., Van Eickels, R. L., Plener, P. L., & Felnhofer, A. (2019). Virtual reality exposure therapy for posttraumatic stress disorder (PTSD): a meta-analysis. European journal of psychotraumatology, 10(1), 1654782.

Loucks, L., Yasinski, C., Norrholm, S. D., Maples-Keller, J., Post, L., Zwiebach, L., Fiorillo, D., Goodlin, M., Jovanovic, T., Rizzo, A. A., & Rothbaum, B. O. (2019). You can do that?!: Feasibility of virtual reality exposure therapy in the treatment of PTSD due to military sexual trauma. Journal of Anxiety Disorders, 61, 55–63.

Disclaimer: This article is for informational purposes only. Speak with a medical professional before seeking treatment.

 

Reviewed by Amy Shapiro-Rosenbaum, PhD, Cooper Hodges, PhD, Lyndsay Tkach, MA, CBIS, and Michelle Neary, March 2021.

The BrainLine Treatment Hub was created in consultation with TBI and PTSD experts.