A virtual therapist for real fears

17 July 2018

Interview with

Daniel Freeman, University of Oxford

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Picture the scene - you’re swaying on a rickety rope bridge slung 500 feet above a canyon. A gust of wind sends you swinging alarmingly; and the creaking noises issuing from the supporting ropes are far from reassuring… Are we making you nervous? If so, you might be one of the approximately twenty percent of us who suffer from a fear of heights. Surprisingly though, few of us actually seek any treatment for this. But this could soon change, because a team at Oxford University are developing a VR - or virtual reality - therapist, that could see you facing your fears from the comfort and safety of your living room. Isabelle Cochrane heard how from Daniel Freeman…

Daniel - When someone's overcoming a mental health problem, what you want them to be able to do is go into the situations that trouble them and feel fine about it. But normally when you have a mental health difficulty, for example feeling socially anxious going into a room full of people is difficult, for a fear of heights going to a height is difficult and what we can do in VR is present these situations and train the person in the moment how to overcome their difficulties.

Isabelle - So how does this VR compare with the treatment someone with a fear of heights for example would normally get?

Daniel - In many ways the treatment we would provide with VR is very similar to what you would get if you were seeing a highly skilled therapist doing the best psychological treatment. Because what we've done is try to automate the provision of really good treatment in VR so you don’t have the difficulties of trying to find a therapist, but in VR we also do some stuff that you can't do with a real therapist. We do things by virtual heights that push the fears a bit more than we might in the real world so we have like a platform that goes out in the middle of a large atrium where you rescue a cat. You wouldn't do this in real therapy but can do it in VR and when you can conquer these things in VR then it makes everyday situations around heights a lot easier.

Isabelle - Even just hearing about that platform makes me feel a little bit queasy I have to say.

Daniel - Yes I mean it's hard work. The thing about it is that the people that you know with fear of heights are sweating and it takes a lot of courage and determination. But at the same time, they're also smiling because they know it's not real. That's the beauty of it, you know it's not real, you do things that reward you would struggle with it, and you also have this added delight to find actually conquering it in VR transfers to the real world.

Isabelle - How realistic does it actually have to be in order to trigger this feeling of fear?

Daniel - It doesn't take much in VR to trigger a fear of heights. We’re very keen on making sure that things are engaging and appealing. So we're going for a reasonable amount of realism and we're also putting lots of fun elements in. Mental health treatments traditionally can be less than fun and we're trying to make something that's really engaging and appealing for people to help them overcome their problems, even rescuing the cat from the tree. Many people really quite enjoy that task.

When I do it, it certainly makes me very anxious. You’re 10 stories up basically on a plank trying to pick up a cat that is meowing at you, but people can also see the sort of comedic value of this as well.

Isabelle - What else do you get people to do?

Daniel - We do a bit of xylophone playing right by the edge of the virtual height for example.
And at the end when you've done all of the therapy tasks you get a chance to write a virtual whale around the atrium.

Isabelle - So that's your reward! How well does it work?

Daniel - Really well. Even I was surprised how good the results are. The average reduction in fear of heights was two thirds patient to the treatment which is extraordinarily good.

Isabelle - How are you measuring that?

Daniel - We use three different clinical assessment scales which can be validated against reactions at real heights. In other work we've done we actually take people to real heights before and after and you can just see the change.

Isabelle - Do you think we'll be able to use this for other phobias? So for example insects I think is quite a common one.

Daniel - Yes. I mean I guess Oxford our ambitions are much greater than just phobias, because we think it could be applied to most mental health conditions. We're working on a project that uses VR automated delivery of psychological therapy for patients with severe mental health problems such as schizophrenia. There are very few mental health conditions where you can not see VR as one aspect of care.

A lot of patients with severe mental health problems through current treatments still have quite a few problems. They’re often mistrustful, they might be hearing voices, they might be feeling depressed or socially anxious. The end result of all of this is that when they go into the real world for example around other people, everyday social situations they get very frightened and that means actually what they tend to do is draw from life, stay indoors. So again what we're dealing with here is helping people go back into everyday situations and learn that they're safe and that they can cope.

Isabelle - So how are you planning to make this available? Is something that you're planning to use in the context of clinics for example or is it just something that anyone will be able to download onto their smartphone or their VR device?

Daniel - Well it's a good question and I think the answer may change over the years. What we plan to do is to put it into an NHS psychological therapy service so the equipment is there, but of course as the kit becomes more widely available at home and it becomes lighter and more affordable and technically better, it will be like living in people's homes and you can envisage in the future people also doing these sorts of treatments in their comfort at home whenever they want.

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