With TERVs, your phobias will become a bad memory

Contrary to what one might think, virtual reality exposure therapy is not as recent as one might think. The first therapeutic trial was carried out in 1992 on a person with a phobia of flying. A lot of other research has been carried out since then and has shown very encouraging results in the treatment of patients. The massive use of this technology and the progress made since then have made it economically more accessible and is becoming an increasingly popular tool for health professionals.

1. What is Virtual Reality Exposure Therapy?

VRT (Virtual Reality Exposure Therapy), also known as VRT (Virtual Reality Therapy), is a therapy that uses a virtual reality headset to immerse you in environments that bring out your behaviours, thoughts and emotions.

It is a brief therapy, based on CBT (cognitive and behavioural therapy). This therapy consists in creating a phenomenon of habituation. Thus, thanks to virtual reality, you will be able to be confronted with the environments or objects that make you anxious. The habituation in virtual reality will allow you to learn a new way of functioning, and thus, by the principle of transfer and generalisation of the acquired knowledge, you will find the same developments in reality.

If, for example, you are afraid of the motorway (amaxophobia), in virtual reality you will go on this type of road again. By repeating the exposures, and thanks to the feeling of presence in virtual reality, we will have access to the same deconditioning process. Because yes, if you suffer from amaxophobia, it is because your brain is now conditioned to feel this type of emotion. So we are going to work to condition it, to have more adapted behaviours.

TERVs are effective on all types of anxiety disorders such as phobias (claustrophobia, agoraphobia, aquaphobia, brontophobia, ochlophobia, thanatophobia…), anxiety and severe disorders (depression, burnout, post-traumatic stress disorder…) or eating disorders.

2. Why make a TERV?

Using TERVs to deal with your problems has many advantages:

• It is part of the brief therapies. The number of sessions needed to achieve your goals will be shorter than with other therapies.
• Unlike traditional CBT, you do not need to use your imagination. Virtual reality recreates phobogenic environments/objects for you. Thus, this same imagination can be used as a tool to manage your emotions.

In addition, in CBT, the practitioner will advise you to do in vivo exposures, which will also be the case as the virtual reality therapy progresses. The advantage of virtual reality is that you will have already experienced being in the situations that brought up the negative emotions.  Whether it is cognitive restructuring or habituation, virtual reality will have allowed you to experience the implementation of these tools in a situation, making it easier for you to expose yourself in reality.

• Virtual reality is a much appreciated playful tool, which brings an even more important motivational aspect of engagement in the therapy.
• You will be totally involved in your therapy!

Contrary to the real exhibitions, the therapist will be able to manipulate the environments and objects, in front of which you will be confronted. Thus, he will be able to make very progressive exposures, in order to adapt to your evolution during the therapy. The exposures will thus be less difficult for you to experience.

3. Who can do a TERV?

Almost anyone can undergo virtual reality exposure therapy! If you are over 5 years old, do not have photosensitive epilepsy and do not have a pacemaker, you can use virtual reality.

Virtual reality therapy can be used for a wide range of problems at different ages: anxiety disorders, phobias, addictions, neuropsychological disorders (ecological environments of cognitive stimulation) and other mood disorders such as depression (through behavioural activation which is a major therapeutic lever).

How can exposure therapy help cure a phobia?

As previously mentioned, this therapy is closely related to CBT since it is based on the same models, the same functioning…

CBTs and VCRs are currently very effective in the context of phobias. In fact, for all phobias combined, the TERVs enable the phobia to be extinguished in 80% of cases.

So you will be confronted with your phobia in virtual reality. This exposure to situations/objects that may be anxiety-provoking will be done gradually. The therapist will be able to fully modulate the environment in which you find yourself in order to adapt to YOUR phobia. Because yes, the same phobia will not necessarily be felt in the same way by everyone.

As you are exposed to more and more things and as the tools are put in place during the therapy, you will feel a reduction in your anxieties, or even an end to them.

4. How does a session work?

Virtual reality exposure therapy is a therapy that works in a similar way to CBT.

• Getting to know the therapist: 

First, with the therapist, you will review the reasons why you came, the emotions, environments/objects that impact your daily life. Thus you will be able to begin to explain your emotions and physical sensations in connection with these, your automatic thoughts which arrive when you are confronted with these emotions, and the behaviours which you use (e.g. often in the context of anxiety for example, one will be in the avoidance of anxiety-provoking situations).

In order to better understand how you function in the face of these problems, the psychologist can fill in questionnaires with you, which allow you to further schematise what you say.

At the beginning of the therapy, you will also define the objective(s) you wish to achieve during this therapy.

• Prioritisation of situations

Very quickly, the psychologist and yourself will start a hierarchy of situations. That is to say that you will see, together, the situations that will bring the least negative emotions to those that bring the most.

For example, if you suffer from fear of heights (acrophobia): If you explain to your therapist that the higher you are, the higher the anxiety. And that on top of that, the “world” factor tends to increase the anxiety. On the other hand, the presence of barriers tends to reassure you. The therapist will be able to take you to small heights at first, and gradually increase the number of people with you, and decrease the height of the railings (or even remove them).

All exposures will be very gradual, and the therapist will not change situations as long as you still present with anxiety.

• Psychoeducation 

Always at the beginning of the therapy, the professional will take the time to bring you different scientific knowledge concerning your problem, this is called psychoeducation. This is called psycho-education and it will give you the knowledge to understand how your emotions and the therapy work and will give you different terms that will be used throughout the therapy.

This psychoeducation is the first step in the process of change. It will allow you to begin to become aware of the evolution of your emotions.

• Expositions

Then the virtual reality exhibitions will begin. The therapist will put the helmet on your head and launch the environments seen together beforehand into the helmet. Thus begins the work on 3 different spheres:

• Exposure: will begin to condition your brain and create habituation to situations. During these exposures you will not be passive but active.
• Emotions: Throughout the therapy, the psychologist/psychiatrist will help you to implement various tools for managing your emotions. In this way you will learn to calm down and manage your negative emotions. This part of the therapy will allow you to be totally autonomous and to be able to deal with all kinds of situations that lead to negative emotions.

Depending on the therapists, their specialities… you will not necessarily have the same tools. So little by little you will be able to fill your “toolbox”, in order to pick from it when you feel it is necessary. The therapist will bring you, among other things, relaxation tools, the setting up of the ACARA system…

• Thoughts: Negative emotions such as anxiety are linked to automatic catastrophic thoughts. The aim of the therapy will be to identify the situations that bring these emotions, identify the emotion felt and the thoughts attached to it. Once this has been identified, the aim will be to find alternative thoughts, in order to bring forward more positive and realistic thoughts of the situation. This exercise can be done with the help of Beck’s chart.  The work on thoughts will also be done by identifying cognitive distortions, beliefs…

All the work described above is done in the first instance during your virtual reality exhibitions. But the final goal is the exposure in reality! So, after a few sessions, the therapist will suggest that you start exposures in vivo, i.e. in reality. These exposures will be done progressively, just like in virtual reality. Your therapist will help you to find situations in which you can expose yourself.

Once you are no longer experiencing negative emotions such as anxiety, or at least are able to manage them easily, that is the end of the therapy!

5. How long does a therapy last?

According to studies, TERVs last on average 10 sessions. The number of sessions can vary depending on the problems and the people being treated. The number of sessions to be carried out will be evaluated with the therapist at the beginning of the follow-up. Of course, this remains an indication and may vary slightly. Depending on the therapist, a session can last between 45 minutes and one hour.

How many tv sessions are needed to treat a phobia?

As previously mentioned, the number of sessions is around 10 on average. Depending on the phobia to be treated, the number may vary, so it is important to determine the phobia(s) at the beginning of the treatment. For so-called “simple” phobias such as arachnophobia, claustrophobia, etc., the number of sessions will often be lower than for more complex phobias such as agoraphobia or social phobia…

6. What equipment is needed for virtual reality therapy?

Despite what you might think, very little equipment is needed in this therapy. If your therapist has a virtual reality headset containing software related to this therapy, you don’t have to bring anything.

Some psychology organisations, such as C2care, offer distance learning VRT. For this you need a virtual reality headset at home. If you do not have one, the same organisation can rent you one for the duration of the therapy. On this headset, you will have unlimited access to the software, which will allow you to have a remote follow-up in therapy by exposure to virtual reality.

7. Who uses TERVs?

The main professionals using VRT are psychologists and psychiatrists who are trained in this type of therapy. You may be able to find other types of professionals practising virtual reality therapy, but always make sure that they are trained in its use.

As this type of therapy is still in its infancy, there are still few professionals who use it (often because they are not aware of the possibility of using virtual reality).

However, some companies (C2Care)and professionals have specialised in this type of treatment. You can find therapists trained in virtual reality.

8. Are the TERVs reimbursed?

Virtual reality therapies, like any other therapy, can be reimbursed. It is not the therapy itself that is reimbursed but the professional who follows you.

If you are being treated by a psychologist: Some psychologists may be reimbursed by the social security system, with particular organisations, however, few of these psychologists will use virtual reality. You can also ask your mutual insurance company. Indeed, there are mutual insurance companies that reimburse a certain number of sessions with a psychologist.