Tuesday 19 September 2017

Social anxiety and the benefits of virtual reality

VR goggles
VR goggles

Patricia Casey

Social anxiety disorder, also called social phobia, is a common condition and is well known to the general public stemming from the multitude of articles about it in the popular press.

It is present in about 12pc of the population, is slightly more common in males and in young adults. It is often confused with shyness, which is not a psychiatric disorder but a trait that is present in many. Social anxiety disorder differs in that the fear of engaging in social situations is overwhelming - resulting in withdrawal and avoidance.

Common situations which terrify those with social anxiety disorder include walking into a crowded room, making small talk or conversing more generally, delivering a speech or lecture, eating in front of others, dating and so on.

Not everybody will experience anxiety in all of these situations so treatment must be tailored to the needs of each individual and their particular problem areas.

And each person will have a different reason for their dread - it may be fear of being judged, fear of giving offence, or not knowing what to say.

One of the mainstays of treatment for this condition is cognitive behaviour therapy (CBT) - either in a group or in an individual setting. Each has its strengths and drawbacks.

Group treatment for this condition has the obvious benefit that the individual will be exposed to the situation that is likely to be most anxiety provoking for them, ie meeting strangers. They also have the benefit of the support of others with the same problem and can draw strength from this.

On the other hand, treatment is less individualised and the pace of response to treatment may be impeded by poor responders or those with limited motivation. Individual treatment is clearly more labour intensive for therapists and can be difficult to organise - eg a gathering to which a talk must be delivered by the individual in treatment.

In the 1990s, CBT with virtual exposure, also called in virtuo exposure or virtual reality (VR) was used with success in treating flying phobia, using simulators. This approach has now been developed further for a range of other conditions including social anxiety disorder.

This has been enabled by the enhanced features in 3D graphics that include enhanced reality, smartphone applications and head-mounted displays.

However, developing the scenarios using VR for treatment of anxiety disorders requires time so that the range of anxiety-provoking scenarios is covered.

The benefits of VR for the treatment of social anxiety disorder were hailed in the April issue of the British Journal of Psychiatry.

The lead author, Dr Stephane Bouchard from the University of Quebec, in Canada, compared real life exposure with VR exposure and waiting list control in 59 subjects over 14 weekly sessions.

In the two treatment groups there were improvements in all the outcome measures but were greatest in the VR group.

The benefits persisted at follow-up.

Therapists with experience of the techniques were involved in both active treatments and were present in the room with the patient thus ensuring a therapeutic relationship during treatment.

The therapists reported that the VR exposure was more practicable.

There have been other studies of virtual reality therapy for social anxiety disorder which found that the effect was similar or inferior.

One explanation may be that in these studies, the therapist was in a room remote from the person being treated, potentially compromising the therapeutic relationship that is so important in these interventions.

Many may express uncertainty about the value of technology to deliver psychological interventions and so even antipathy to this idea. However, the possibility of face-to- face engagement with a therapist during the sessions demonstrates the benefit of direct contact.

It remains to be seen if therapists in everyday practice will have access to the necessary level of technology to deliver VR exposure therapy to those with social anxiety disorder.

Clearly more trials are needed to confirm the findings in this study. Convincing those in need of treatment that VR works may be another and more challenging matter.

For techno-geeks, VR may be fun but for a person living under the incapacitating shadow of social anxiety the real life exposure may prove more appealing.

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