Virtual reality
at the service
of health

Virtual reality is a technology used to make a numerical reproduction of real or imaginary environments. In this way, in mental health, immersing patients in virtual reality brings them to safely expose themselves to alamaring stimuli. The 4th wave of Cognitive-Behavioral Therapies (CBT) has been created by this new type of exposure, called Virtual Reality Exposure Therapies.

The first scientific protocol has been validated in 1992. However, until the 2000’s, virtual reality wasn’t really known and used. Thanks to the technology improvement and to the interest shown by researchers and clinicians, the democratization of virtual reality in the health field increases.

To use virtual reality, being immersed in a virtual environment is necessary. There are different ways to do so. Indeed, in the past, CAVE, a 3D system composed with multiple screen walls, was mostly used. The user is totally immersed in the virtual world. In fact, his movements are detected in real time. However, the lack of this solution is that it’s really expensive and not very reachable. Around 2016 Oculus Rift and HTC Vive, virtual reality headset, have appeared, and their use have been accessible. Thanks to the blackout screen which virtual images are projected on, users are immersed  in virtual reality. Patient’s head movements are taken into account so he can turn his head around, exactly like in the real world.

Exposing people to a situation is a behavioral technique based on the principle of habituation. Habituation is the repetition of the stimulus providing a reaction to reach its reduction. Practically, it’s about confronting the patient to stimuli that trigger dysfunctional answers, according to strict rules, to reach a complete shutdown of them and create the activation of the habituation. Different exposure types exist such as the imaginary exposure where the patient is requested to confront himself to anxiety-provoking situations using his imagination (for example, driving a car on the highway, speaking in public during a meeting). There is, also in vivo exposure, which is being in a real and concrete exposure situation. For example, if a therapist has a patient who is scared of dogs, he will confront him to a small-sized dog behind fences. Little by little, he will reduce the distance separating the patient and the dog. Finally, the last type of existing types of exposure is the virtual reality exposure. The patient is exposed to high provoking emotional response situations, using a computer help and a numerical creation of real environments. This technique has an important asset : combining the in vivo exposure benefits with specific advantages (environment’s accessibility, security, controllability…)

Virtual environments immerse the user in various situations where he can walk around and interact with other avatars. It’s also possible to modify the functionalities. Therefore, the therapist has control of the exposure scenario. He can change elements, add or take out some stimuli (visual, auditory) or schedule interactions. Recreating environments which are difficult to access directly from the therapist office is the first goal of virtual environments. In fact, it’s possible for caregivers and for their patients to go over some reality of the field : Relaxation environments or other situations (hallucinations, complex anxiety…).

Depending on the VR headset, other devices may be required. Stand-alone headsets, such as the Pico Neo 4 , can be used as they are without the need to connect them to other devices.

Many studies approve that using virtual reality isn’t dangerous. However, there are some restrictions to protect users from possible negative consequences. Indeed, people with epilepsy shouldn’t have access to that kind of therapy. Virtual Reality can be used for people with a risk of addiction if it’s made with the help of a therapist, once a week. The professional will be able to evaluate if it’s an appropriate therapy. That’s why, developing an addiction to virtual reality after a VRET is close to zero.

Many pathologies can be treated while using VR.  VR can be used to treat behavioral and substance related addictions. Numerical stimuli are set in a consumption contextual environment, creating the craving response (which is a compelling need of consuming or doing a specific behavior). In this case, addicted patients are working on their craving to reduce their desire to consume. Moreover, cognitive work on dysfunctional beliefs personalized to each temptation situation can be done thanks to various situations (bar, casino, social contexts) related to addiction. Our virtual reality software is also efficient in dealing with eating disorders. Indeed, it helps in the identification of key etiological factors like dysmorphophobia, body images toward others, and food craving. Using VRET is also impactful on psychiatric, psychological and neuropsychological symptoms. The software provides the possibility to work on relaxation, cognitive stimulation, behavioral activation, social abilities… Bringing reminiscence in virtual reality for the treatment  of depression is a major tool. Indeed, giving to the patient the possibility to relive sensations linked to old pleasure (sports, travels, driving…) creates the hypo-activated cerebral areas’ stimulations. This is a key to a therapeutic success, and Virtual Reality is an interesting facilitator to enable people’s investment in activities. For elderly people, VRET can be used in cognitive stimulation. The activities are more ludic and are easy to use. Retirement home patients can work their executive functions and their memory using applications specifically created for them. Today, Virtual reality in the mental health field is making huge and quick improvements. Researchers, clinicians, developers are interacting together to work on new therapeutic applications depending on pathological targets.

Many healthcare professionals have access to this technology. Actually, the most representative profesional using VRET are psychiatrics, psychologists and psychotherapists. However, the software can also be used by nurses, psychomotor therapists, physiotherapists, sophrologists, dietitians, hypnotherapists … Their methods can be used in a parallel operation with virtual reality.

The therapist, by equipping himself with devices allowing the realization of therapies by exposure to virtual reality (VRET), enhances his field of competence. VRET is a full-part technique of the patient’s care. So using it increases the field of the therapist’s expertise. Therefore, it gives better visibility to prescriptors and it makes a huge difference with the most common treatment offers. Moreover, not only being a strategic asset for the development, VRET is scientifically validated within the cognitive-behavioral therapies.  The strong asset of the ludic aspect encourages therapeutic engagement. All the exposure environments are directly accessible from the therapist’s office, so it’s a significant time saving.

One of the major benefits in virtual reality is that it can be used on a wide array of the population. Scientific literature has shown that we can expose people from any age, and real therapeutic advantages are seen. Patients with any pathologies can be treated with virtual reality. Significant results have been noticed in the care in the anxiety disorder (school phobia included), autism, eating disorders, neuropsychological disorders etc. Teenagers are showing a specific interest in virtual reality, with the same satisfying results. With them, we have noticed a better therapeutic engagement with the software. Using virtual reality with elderly people is encouraging them to work on cognitive stimulation, on behavioral disorders but also on anxiety.