Patrick McGrath, Assistant Vice President, Residential Services, AMITA Health
Your typical notion of what a therapy session for anxiety is likely nowhere near what actually happens in evidence-based treatment for anxietybased disorders. In fact, it is probably the total opposite. If your goal in entering therapy for anxiety would involve learning how to relax and figure out a way to stop having unwanted thoughts or feelings, then you would probably feel great for the 45 minutes you were in the session, and then go right back to feeling miserable once you left it.
If you truly want help with anxiety, the treatment of choice is Exposure and Response Prevention Therapy (ERP), and the goal of the treatment is to teach you how to handle the anxiety you have, not try to make it go away. ERP is performed in two steps. The first step involves exposing you to the things that you fear. For example, if you are afraid of elevators, then you must get on to an elevator at some point and learn that you can handle being on an elevator. The second part of the therapy, response prevention, involves fully engaging in the experience and not doing any safety-seeking behaviors while being exposed to the fear-inducing experience. So, you would get on an elevator, which stops you from AVOIDING the elevator. You would eventually do this on your own, without having someone there to constantly reassure you that you were not in any danger, and you would do this without a phone, or tablet, or any other DISTRACTION. Finally, you would be sober and not be using any substances while doing this exercise.
This may sound harsh, but it really is the only way to overcome the fear of the elevator. The good news is that this is often done gradually. Your first experience with an elevator maybe just staring at an elevator door and doing that until your anxiety decreases. Once it is low, you can then press the button and look inside the elevator and keep on doing that until your anxiety decreases, and so on until you are riding the elevator. This is not a flooding experience – no need to just dive into the pool, so to speak. Instead, stick a toe in and see how the water is feeling and move up from there.
"Virtual Reality will continue to move into the therapy realm, and, if done right and according to evidence-based practices, will continue to make a positive impact on the therapeutic community. Whatever can help our anxious patients better adapt to their everyday life is OK in this therapist’s book"
The only way we know how to help people overcome their fear of having them actually do the things that they fear and learn that they can handle them. They may never like it, and they may never feel all that comfortable with it, but once they know they can handle it, and then all is well.
But what if just the sight of the elevator in real life is even too overwhelming for someone? Well, now there are new technologies that are available to also help someone with that level of fear. Virtual Reality (VR) allows patients to interact, in a virtual world, with feared objects or situations prior to even having actually to face the feared situations in real life. So, our patient with elevator phobia could first start by staring at a virtual elevator through their headset. They are not actually near an elevator and have no chance of it falling or getting stuck. But, it is still realistic enough for people experiencing it that it will elicit the desired fear response.
A virtual exposure to an elevator can, therefore, involve the sights from the elevator, especially if it is a glass elevator, the sounds that an elevator makes (now and then a scraping or knocking), and even the smells that you might get on an elevator, such as perfume or coffee. You could be alone in there or have other avatars with you, who could be controlled to look happy, neutral, or totally afraid.
In the virtual world, a therapist is in total control of what is experienced in the environment, so if it is just staring into an open elevator, that can happen for 45 minutes without a problem. There are no time constraints in the VR world, and the therapist is typically in control of what happens and when it happens in the environment.
VR can also be beneficial to recreate environments that just cannot be recreated ethically in the real world. While a therapist cannot take a veteran back to Iraq, that can happen in a VR setting. The Veteran can be exposed to all of the intrusive thoughts and images they have bounding around in their head and learn that they no longer need to be afraid of their memories. Though the memories may forever be uncomfortable, they need not always be bothersome. So, they can be exposed to a loud noise that triggers a memory of an IED, but no longer react to it as if it were an IED.
As technology continues to improve, VR experiences will just become more and more life-like. Socially anxious individuals can practice giving speeches to virtual crowds, individuals with fear of flying can be seated on a virtual plane, and those who have addictions can be in a home alone setting with a bottle of alcohol in front of them and practice not picking it up and pouring themselves a drink.
Virtual Reality will continue to move into the therapy realm, and, if done right and according to evidence-based practices, will continue to make a positive impact on the therapeutic community. Whatever can help our anxious patients better adapt to their everyday life is OK in this therapist’s book.