Virtual Reality and Psychotherapy / How I use it for Aviophobia

More than 99% of clients report total success in just 1 to 3 sessions
Virtual Reality and Psychotherapy / How I use it for Aviophobia
While Virtual Reality technology (VR) has been around for several decades, recent advancements have made it more ‘real’ like than ever before. That’s one reason why VR has emerged among researchers as a potent tool in mental health treatment. Nonetheless, its reach into the treatment room remains very limited. Outside of a few academic institutions, not many providers currently offer VR therapy. While some might conclude that practitioners may just feel resistant to new technologies like VR, that didn’t happen when therapy went virtual during the Covid-19 pandemic. We quickly adapted by using platforms like Zoom and Teams to connect with our clients.
Many of us still haven’t returned to in office face to face sessions and have stayed 100% virtual. The recent explosion of use of psychedelic assisted therapies, including drugs such as Ketamine and Psilocybin, shows that therapists can and do adopt new technologies and innovations rather quickly. Hence, I do not think that the lack of adoption of VR therapy is due to any “tech phobic” type of resistance on the part of therapists.
So then why haven’t very many therapists adopted VR technology? I need only to look internally to provide the answer. When I think about the ‘magic’ that happens with clients in the therapy room, there is a significant portion of it that is non-verbal. It is a truism that 93% of the meaning in communication is not in the words we use. Rather, it is in the non-verbal aspects surrounding our words. That includes voice tone, volume, speech, and cadence. It includes body language like posture, head tilt, eye contact, facial tones, facial expressions, hand gestures, and even breathing rates.
Our non-verbal interaction with clients is the most effective way to build rapport and help them feel heard and understood. Before any effective work can be done, rapport needs to be established so that the client feels they can trust that the therapist is going to help them. When we look at the virtual reality environment, it is clear that this technology cannot replicate those nuances through avatars, which are nothing more than cartoon representations of us. This is the reason, in my opinion, that most therapists have yet to adopt VR technology in their practices.

Conquer your flying phobia - permanently
99% success rate over 30 years of practice
Nonetheless, research with VR technology has shown it to be effective for anxiety, phobia, and posttraumatic stress disorder (PTSD). There have even been several studies establishing that VR treatment for aviophobia (flying phobia) is as effective as traditional therapies and that people respond to the virtual environments quite similarly to the real ones, even though they know it is not real. Thus far, all the studies of VR have employed it as an exposure tool. In other words, researchers have sought to simulate the feared situation in virtual reality and use the principles of exposure treatment through systematic desensitization in that environment. But the pitfalls of exposure therapies that I have already discussed (5 Reasons Exposure Therapy Doesn’t Work) apply to the Virtual Reality environment as well, albeit with a little more control of the variables. Even in the virtual environment, the person is still having to deal with reliving their ‘bad’ experience through exposure to the feared situation. The ethical issues involved in revivifying scary experiences and potentially re-traumatizing people who suffer from phobia and trauma apply to the VR environment just as they do to the real world.
What if there was a way to have the benefits of the Virtual Reality therapeutic environment without the pitfalls of another form of ‘exposure’ therapy like EMDR or systematic desensitization? The advantage of VR for aviophobia (flying phobia) is obvious. The cost of a plane ticket is prohibitive both for testing the phobic stimulus of flight as well as for doing any type of exposure training. Being able to replicate at least some of the experience of flight virtually is going to be advantageous regardless of what type of treatment method one is using. How I have integrated it is not as a primary change modality the way other exposure therapies use VR. Rather, I use it as a pre-test and post-test tool for measuring change in the person’s response to the feared stimulus. First, there is screening and assessment of the level of response that a person has to flight.
They complete a questionnaire asking them to rate how scary they find different aspects of flying, including preparations, going to the airport, sitting in the gate area, boarding, take off, turbulence, and landing. Based on their self-rating, the client is then asked to briefly close their eyes and for 10-15 seconds imagine being in those experiences that trigger the most distress. As soon as I can see the beginnings of a phobic response, I interrupt their imaginal return and ask them to open their eyes and re-orient to the room. That is the first pre-test. The second pre-test is having them put on the headset to virtually be in their feared situation for 30-60 seconds, during which we use a biometric device that measures their stress response in a quantifiable way.
The total amount of time that my clients re-experience or relive their feared response is no more than 60-90 seconds. Following these measurements, I explain the treatment procedure, which does NOT entail any reliving or re-experiencing, and is done with an anchor to an internal state of complete security and competence on the part of the client. With the client’s consent, the treatment procedure is delivered and completed within 20-30 minutes. Post-testing is then done first through getting the client to imagine being in the phobia-triggering situation to see if they can reproduce at least some of their phobic response. If they can, then we resume the treatment method several times more until they are unable to trigger any portion of their feared response.
Once that is established, the VR headset goes back on to fully put the client back virtually in the previously feared situation and the biometric device is attached to measure their stress response. If the technique has been delivered correctly, their phobia will have been resolved and the biometrics will demonstrate this to both the therapist and the client. The client then has the option of spending more time virtually on the plane to both reassure themselves that the change has really occurred and to help them remain not only not phobic, but also fully comfortable in that environment. So it is a post-resolution exposure experience to get them fully acclimated and comfortable with being in the situation.
It is this last portion of the treatment that makes VR so useful in my work. And that is convincing clients that the Total Reset Method has cured their phobia. For 25 years of having used this method to resolve clients’ phobias and traumas, the biggest obstacle was convincing clients that a change so profound as resolving a phobia or trauma can and has occurred in just one session! We have all been conditioned to think that therapy takes many sessions, weeks and months, to make a change.
Hence, many of my clients leave the session with some level of disbelief that a technique so simple and so quickly delivered has effectively rewired their brain. I was often relegated to saying: “I know it’s hard to believe that this worked in such a short time, but you will see when you actually get on the plane that you have a different response.” Now, I no longer have to say that. We just have them put on the VR headset and the biometric measurement device and they can see for themselves how their brain response differently to what previously was a terribly feared situation.
So VR is not a modality that can replicate the sacrosanct nature of a therapeutic relationship. It may be many years or perhaps decades before it can feel so real as to be able to be used as a place where client and therapist can meet and connect on the same level as they can in person. But it can be a tool that therapists utilize to enhance their clients’ experience and prepare them better for life in the real world.