THE DAILY MAIL
14 OCTOBER 2018
CAN A COMPUTER HEADSET CURE YOUR FEAR OF HEIGHTS?
Welcome to the world of Virtual Reality-assisted therapy, a method by which therapists can treat their patients’ phobias, anxieties and past traumas.
Are you scared of heights? It’s one of my biggest fears. My kids tease me mercilessly about it and over the years have offered me all sorts of incentives to go to Alton Towers, but it’s never happened
Nor is it ever likely to. One winter holiday our family went to Qatar and stayed in one of those skyscraper hotels overlooking the desert. They upgraded us to a room with floor-to-ceiling windows on the 55th level. I spent most of the time plastered in terror against the opposite wall, yet irrevocably drawn to the edge. Thinking about it still makes me queasy.
Yet here I am in a disused building, about 30 ft or more above the ground, standing on a platform being told to walk across a narrow wooden plank.
There’s no safety net. Below me is a deadly drop like a filthy elevator shaft with no elevator. One duff move could send me plummeting.
As someone whose balance is so bad she can barely ride a bike, I can’t bring myself to take the first step, but after some encouragement, shuffle one foot out an inch, then the other, arms out for balance. Should I be crawling across on all fours? Someone dares me to jump off the plank and I freeze. Not helpful. Not helpful at all.
Though this is only a simulation — I am in a room at Stanford University’s Virtual Human Interaction Laboratory (VHIL) in California experiencing all of this in Virtual Reality — it feels almost realer than real.
When I eventually make it to the other side, legs quivering, heart flailing around like a caged bird, headset, ankle and wrist sensors off, I feel an overwhelming sense of achievement — even though I knew the whole time that all there was beneath me was patterned carpet.
Welcome to the world of VR, or more accurately VR-assisted therapy, a method by which therapists can treat their patients’ phobias, anxieties and past traumas in a way that traditional CBT (Cognitive Behavioural Therapy, a widely practised type of psychotherapy in which a patient is encouraged by a therapist to frame negative thinking patterns into positive thoughts) never can.
In a nutshell, by repeatedly exposing us to high-quality, recreations of anxiety-provoking situations; by encouraging us to confront our worst fears in perfectly safe virtual environments with positive therapeutic guidance, our brains can be tricked more rapidly and more effectively into forming new neural pathways, ultimately prompting ourselves to make better, healthier choices in the outside world.
Theoretically if I walked this plank, say, 30-60 times (the approximate number of times it takes for VR exposure therapy to kick in), I should be cured. Who knows, it might make a tightrope walker of me.
I’m here at Stanford University, courtesy of the team at Limbix, a virtual therapy start-up company in Silicon Valley, on whose board sits VR pioneer Professor Jeremy Bailenson, who founded this groundbreaking lab in 2003.
As Bailenson points out in his book Experience On Demand, VR-assisted therapy, is not new. We may associate it with the gazillion- dollar video gaming industry (Call Of Duty, Fortnite etc), in fact it has been used to treat PTSD in trauma survivors and war veterans for more than 20 years.
But because the technology has been so prohibitively expensive until recently (in the mid-Nineties, lab headsets cost more than £35,000) not to mention unhygienic, clunky and uncomfortable (early adopters will be familiar with ‘virtual reality motion sickness’), it has never gone mainstream.
The perfect storm of lower prices in consumer VR (a headset such as Oculus Rift now costs £199 at John Lewis), newer, better technology and the huge global escalation of mental health issues (58 per cent of us are afraid of heights — now Britain’s biggest phobia — while more than a quarter of us are nervous of getting on a plane) has given rise to a growing number of new companies getting in on the game.
Take Oxford VR, a spin-out company from Oxford University, co-founded by Daniel Freeman, professor of clinical psychology at Oxford University. Freeman, who has been studying VR for 16 years, has developed a programme for those like me who suffer from acrophobia, as it is called. Unlike Limbix, the therapist coaching you while you look over the edge of a skyscraper in Freeman’s scenarios is virtual, not real.
‘Our ambition is to greatly increase access to the very best psychological therapists using automated VR treatments,’ he says. ‘We’re now putting treatments into NHS hospitals, but with no need for a trained therapist to be in the room. The eventual idea is to put mental health services directly into people’s homes.’
But no company is pushing the technology to quite the same extremes as the Stanford University lab. Limbix was co-founded by Benjamin Lewis, a successful entrepreneur who worked at Google and later at Facebook soon after it acquired Oculus.
"When I make it across the plank, legs quivering, heart pounding, I feel a massive sense of achievement – even though I know it’s all an illusion."
Though the start-up is not yet two years old, it is based on two decades of evidence-based clinical research. Addiction, autism, body dysmorphia and all sorts of phobias are all conditions which past studies show respond faster, and potentially better, to VR-assisted therapy than more traditional treatments.
It may be more palatable, too, for those of us who are resistant, for one reason or other, to traditional talking therapies. According to one study published in the latest edition of The Harvard Review of Psychiatry, 27 per cent of phobic patients refused ‘normal’ therapy while only three per cent refused VR exposure.
My young, energetic host is chief operating officer Jon Sockell, now showing me around the company’s airy ground floor headquarters in Palo Alto. Posted on one wall is a cartoon of two birds in flight wearing VR headsets with the caption: ‘It’s like I’m actually walking.’
Stacked up against another is a pile of Limbix VR Kit packages, each containing a wireless VR headset, a custom-built tablet and the software containing all the various virtual scenarios.
Although the latest models will not be ready until January, the kits have already been used to great effect by Limbix’s director of psychology, Dr Sean Sullivan, and a team of therapists working out of the National Mental Health Innovation Center in Colorado.
So far, the scenarios which have proved most successful are fear of flying, fear of driving and fear of speaking up in the boardroom.
With others in the pipeline, the aim is to build up a Netflix-style library of interactive scenarios, potentially available to consultants worldwide.
One includes a bar with clinking glasses, a TV broadcasting sport and bartenders proffering drinks. Ideal for the recovering alcoholic, newly out of treatment, who has to walk by his local every day.
As the technology advances, the scenarios will become more tailored to personal needs.
Google Maps has already been incorporated into Limbix’s technology allowing users to be teleported to exact locations or trigger points: the street corner where a former addict bought his drugs; the building where a victim was sexually assaulted; the airport kerbside that always triggers the flight phobic’s panic attacks.
‘Limbix’s exposure therapy is designed to be used within the basic framework of CBT,’ says Dr. Sullivan, who has his own thriving practice in San Francisco.
‘The idea is that your thoughts impact your emotions and your emotions impact your behaviour. Therapists want to help you intervene and change that [negative] cycle as effectively as possible.
“I once gave a speech for a small charity event and froze under the spotlight.”
‘In virtual reality exposure therapy (VRET), we develop a fear hierarchy that typically ranges from 1-10. Say you have a debilitating fear of flying, grabbing your keys to drive to the airport might be a 2, where taking off in the plane might be a 10.
One of his patients, a young man, was so terrified of flying, he wouldn’t discuss it. After several sessions at a virtual airport and eventually flying on a virtual plane, the man was able to take long haul, international flights.
‘In traditional exposure therapy you might ask your patient to close her eyes and imagine the situation while talking through it,’ says Dr Sullivan. ‘That can be effective, but it has limitations because everything is taking place only in your imagination.’
While your therapist can’t see inside your brain, they can check what you’re looking at inside VR.
Unless you practice with the actual fear you feel when you confront it in real life, the phobia often creeps right back.
You need repetitively to practice linking up your cognition, emotion and behaviour in a healthy way, but that’s tricky (and expensive) if beating a fear of flying, for example, means buying multiple air tickets. Which is why VR is such a breakthrough treatment.
Thankfully, I have no problem with flying or driving. Speaking up in front of my peers, though, that could be interesting. I once gave a speech for a small charity event and froze under the spotlight.
Though I knew the speech by heart, the act of standing up and delivering it in front of people I knew momentarily paralysed me.
I’m not alone — more than half of us in Britain are afraid of speaking in public.
And so I enter my second virtual reality environment of the day, a boardroom, with me at the head facing eight other ‘colleagues’, all real, live people, as opposed to computer-generated simulations, each looking at me expectantly.
The good-looking shaggy-haired man to my left is smiling encouragingly. A pretty short-haired woman on the other side looks vaguely familiar (I realise later she’s Limbix’s design director.)
Unlike my walk-the-plank experience, the boardroom requires no computer or ankle and wrist sensors. Jon controls the whole scenario on his tablet.
With one flick of the dial from ‘casual’ to ‘formal’, everyone goes from casually dressed to business suits. When he switches another dial from ‘positive’ to ‘neutral’, the smiles disappear.
Then he ratchets it up to ‘negative’. The short-haired woman now has her arms crossed and is shaking her head. The good-looking shaggy guy is tapping idly into his mobile. Someone stifles a yawn. They’re blatantly not paying attention and even though I know this is not real, I feel weirdly responsible for their reactions.
“I feel a daredevilry I didn’t have before”
This ‘sweet spot’ of total immersion despite knowing full well it is not real, is what underpins the whole effectiveness of VR-assisted therapy in contrast to the traditional ‘imaginative’ kind.
In a third, more meditative scenario, I’m offered a beach scene in Costa Rica, with crashing waves and swaying coconut trees. This is one of the calming ‘mindfulness’ experiences being developed to distract a patient who might be in immense pain — burn victims or cancer sufferers.
‘VR is for more than just Exposure Therapy,’ says Jon. ‘It has an important role in pain management and addiction.’
The possibilities, as technology advances and prices drop, are endless. Autism, Alzheimer’s, ADHD, even schizophrenia are just some of the conditions now being considered.
Ditto body dysmorphia and eating disorders. Psious, a Madrid-based company, has devised a restaurant scenario complete with a range of menu items to practise on, such as hamburgers and french fries and so forth.
When the patient is in the scenario, the therapist can pick a dish to suit their disorder. Already there are online courses for UK therapists to use the Psious therapeutic tool kit.
As technology advances, so will the precision. Already Limbix’s robotics and artificial intelligence researcher is working on replacing the faces of the virtual avatars with photographs of the patient’s acquaintances and colleagues.
Imagine being able to present to your actual boss and colleagues?
Imagine, too, being able to smell that beery pub you always drank in, or the diesel fumes and burning rubber that bring back your time as a soldier in Afghanistan or Iraq.
Already a library of olfactory cues, such as garbage, body odour and spices is being tested on war veterans suffering PTSD by the virtual reality pioneer and Limbix board member Dr Skip Rizzo.
If it all feels a bit like an episode of TV sci-fi drama series Black Mirror, I’m with you.
Technology is not a cure-all. It needs to be administered safely and responsibly, particularly when applied to treating trauma. And conventional therapy, when done well, must never be written off.
On the other hand it is an interesting alternative to that plodding weekly 50-minute session in which talking about one problem for however many months or years has not made it go away.
Its similarity to gaming visuals may also encourage more men to seek help — men, who often suffer in silence because of therapy’s persistent cultural stigma.
Back in London I keep thinking about Walking The Plank. I wish I could try it again. Though that short blast of VR Therapy can’t have cured my acrophobia, I feel a daredevilry I didn’t have before.
The kids are too old for Alton Towers now, but how piquant it would be to send them a picture of me aboard the Nemesis rollercoaster having the time of my life.