Dr. Hunter Hoffman treats a spider phobic at the HIT Lab

M.M. ("Miss Muffett") was so afraid of spiders that she duct-taped her bedroom windows shut nightly, sealed her clothing in spider-proof plastic bags, daily fumigated her car, and scanned each sidewalk crack for spiders -- if she went outside at all. When her crippling arachnophobia made it virtually impossible to leave the house, she finally, after twenty years, sought therapy.

If you're afraid of, for example, flying, you're not alone. According to Boeing (they should know), more than twenty-five million Americans have "aerophobia" - and one-fifth of those who must fly on a regular basis use sedatives or alcohol in-flight to calm themselves.

In fact, phobias are today's most widespread psychiatric disorder, more common than major depression, alcoholism, or substance abuse. Fully six percent of us suffer "unrealistic or excessive fears of objects or situations which dramatically reduce quality of life" -- paralyzing phobias such as arachnophobia, fear of heights (acrophobia), fear of public places (agoraphobia), and fear of flying.

No one knows how or why phobias start, but many researchers and clinicians cite "aversive conditioning" - the systematic avoidance of a feared object or situation until the fear increases to irrational proportions - as a major factor. Bitten by a spider in childhood, you associate spiders with fear. Instead of facing your fear by facing a spider, you avoid both, and your avoidance feeds your fear. Twenty years later, you live in mortal dread of spiders. The cure, professionals believe, lies in breaking the association between stimulus and fear by subjecting patients to anxiety-producing stimuli while allowing the anxiety to dissipate.

Thus most phobics who seek treatment receive exposure therapy or "desensitization" -- gradual, increased exposure to the feared object or situation -- repeated until the patient, using pre-learned relaxation techniques, can face the stimulus at least relatively calmly. Using "imaginal" visualization (you imagine the spider), or onsite "in vivo" experiences (you confront actual, real-life spiders), you face the spider, feel the fear…then relax, until the spider is no longer scary. To confront your fear, goes the theory, is to control your fear, and thereby lose it.

While that may be true in theory, in practice, it's often easier said than done. Some patients cannot imagine vividly or sustainedly enough for therapy to take hold. And scary, public conditions, often difficult to recreate and control, can panic and humiliate patients before treatment has a chance to work. (For that matter, what therapist wants to handle a tarantula?).

What if you could control the fear of spiders by controlling the spider itself? Suppose you could control a wide variety of fears by controlling whatever object or situation had produced that fear. Wouldn't that make cure easier, more far-reaching, perhaps more complete and permanent? Yes, say a new breed of "virtual therapists" - researchers, scientists and clinician practitioners who are using virtual reality to treat phobias.

They believe "virtual therapy" -- the use of immersive virtual reality to treat psychiatric disorders including phobias -- may offer dramatic new hope for therapeutic intervention and cure. "Virtual reality is a context for healing," declares researcher Dr. Max North of Clark Atlanta University, whose Virtual Environments Desensitization (VED) treatment outfits agoraphobic subjects with VR helmets and navigational joysticks, and places them on virtual balconies and elevators, in dark barns (some with a cat inside), covered bridges and empty rooms, and even in a virtual canyon with a series of bridges.

Immersed in increasingly anxiety-provoking situations under their control (for example, they may hold a switch that governs elevator movement) and monitored by their therapist, patients reported "increased habituation" and decreased SUDS ("Subjective Unit of Discomfort Scale") with each session

Researchers Dr. Larry F. Hodges and Dr. Barbara O. Rothbaum of Emory University report similarly successful findings with both acrophobics and aerophobics, citing the patients' "sense of presence... of immersion in the reality" as the key to success ("If they weren't really frightened, it wouldn't work," notes Rothbaum).

Immersing themselves in scary but safe, private, controllable VR environments, phobics have the time and space to "observe, challenge and change the dysfunctional beliefs" which underlie their phobias, claims Dr. Ralph Lamson of Kaiser-Permanente Hospital in San Rafael, California. Acrophobics treated in Lamson's "Fear of Heights" study don headmounts to walk over a plank that leads them across a virtual Golden Gate Bridge -- with no railings.

After just one session, many are able to walk across an actual bridge. Says Marianne Descalso, a San Francisco native and lifelong acrophobic who, after completing Lamson's program, was able to walk across the real Golden Gate Bridge for the first time: "It's a big breakthrough. Before I did virtual reality therapy, I visited the Grand Canyon twice and never saw it."

VR allows patients to stay with (and within) the virtual experience long enough to develop "new thinking strategies," explains Lamson. These strategies reduce their stress, increase their confidence, and allow them to manage, or even eliminate, their fears.

M.M. sought help at the Human Interface Technology Lab. There, clinical psychologist Dr. Albert Carlin joined HITLab researchers Dr. Hunter Hoffman and Suzanne Weghorst to create SpiderWorld -- an arachnophobic's virtual nightmare complete with 3D virtual spiders programmed to scale walls, scuttle across floors and counters, drop unexpectedly from the ceiling, and jump wildly when touched ("Unlike a real spider, virtual spiders obey commuter commands," notes Hoffman).

VR arachnids can also be touched without danger. Outfitted with a VR glove that mapped to her "cyberhand" in the virtual world, M.M. was encouraged to pick up the virtual creatures, place them in particularly anxiety-provoking positions, and pull off their little virtual legs. To maximize the "level of presence" of the virtual experience, and to spin a web from the virtual to the real world, the researchers added "tactile augmentation": a "mixed reality" in which M.M. used her real hand to touch real-world objects position-tracked to correspond to virtual objects.

Gluing fur from the tail of a stuffed toy dog onto a toy spider, Hoffman created a palm-sized replica of a Guyana bird-eating tarantula, tracked to its virtual counterpart. As M.M. reached out her cyberhand to hold the virtual tarantula, her real hand held its toy double. The virtual spider now felt furry and had weight ("cyberheft"); moreover, M.M. could control it by moving the toy.

"I think the touching changed her relationship with spiders forever, sort of like shaking hands with the enemy," notes Hoffman. Though she exhibited "great anxiety" (trembling, sweating, dryness of mouth, teariness -- all indicative of the convincing reality of the experience), M.M. was even able to squash the virtual spiders with a mixed-reality ping pong paddle.

Prior to treatment, M.M. suffered recurring nightmares crawling with super-intelligent, "creepy" spiders. After just two VR sessions, M.M. was able to talk to the spiders during her nightmare. "You're scaring me," she told them. "Don't take it personally, lady," the spiders replied, "We scare everyone." "Please go away," M.M. requested. A few nights later, M.M. again dreamed of spiders. But this time they were gone -- only their webs remained, and she was not frightened.

Before her VR therapy, M.M. filled out a fear-of-spiders questionnaire along with 280 undergraduate psychology students. Only one student had a higher fear-of-spiders rating than M.M. After twelve one-hour visits to SpiderWorld, M.M. had a lower score than eighty of the students. Since completing treatment, she has stopped her obsessive-compulsive spider rituals, can interact with real spiders with "moderate but manageable emotion," and even enjoys her new hobby -- outdoor camping.

Excited by their "huge success" with M.M., Hoffman's spider treatment team has since completed successful treatment of patients suffering a range of phobias. "Hopefully," concludes Hoffman, "VR exposure therapy will become popular, and a much higher proportion of phobics will confront their fears and get on with life."

In an effort to realize this possibility, Dr. Larry Hodges has founded VirtuallyBetter, Inc. based in Decatur, Georgia. VirtuallyBetter develops and markets turnkey hardware and software virtual therapy systems to help clinicians treat many phobias, including fear of flying, heights and public speaking, among others. Through its Clinical Partners Program, VirtuallyBetter makes these systems available at a surprisingly affordable cost: approximately $15,000 - $20,000 U.S., payable in low monthly installments.

Dr. Hodges has also pioneered the use of virtual therapy in the treatment of another anxiety disorder, post traumatic stress syndrome (PTSD), especially among some of its most agonized and frustrated victims, Vietnam War veterans.

Almost fifteen percent of all male veterans and nine percent of all female veterans have been found to suffer from PTSD fifteen or more years after their service. That's almost a million veterans, to say nothing of the twelve million victims of rape and ten million victims of aggravated assault in the U.S., over a third of whom report the same symptoms of PTSD, often years after the trauma.

While conventional exposure therapy appears of more benefit than other treatments, for many veterans, the treatments do not work at all, perhaps because they have difficulty imagining, visualizing or describing their traumatic experiences (which obviously cannot be recreated "in vivo.") That's where virtual therapy can be of unique help - by immersing these sufferers in a reality they can feel and relive as their own, complete with a dramatically heightened sense of presence.

By confronting their trauma in a Virtual Vietnam scenario which allows them to relive it in vivid detail, these veterans have been able to accept, manage and significantly reduce their terrible anxiety.

Also using the VirtuallyBetter system, Dr. Brenda Wiederhold, Director of the Center for Advanced Multimedia Psychotherapy in San Diego, California, reports great success in treating those with numerous phobias including fear of flying.

Virtual therapy appears of real and lasting help to an increasing number of those afraid of heights, bridges, driving, flying, public speaking, snakes - all of whom have been able to change the way they think and react so they can live normal lives again: fly to see loved ones, take elevators to top-level business meetings, and go camping amidst snakes and spiders.

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Photo courtesy Hunter Hoffman
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