Settling the Score: Virtual Reality as a Tool to Enhance Trauma-Focused Therapy for PTSD

Virtual Reality (VR) is an emerging technology that is reshaping healthcare research and practice methodology across a growing range of clinical conditions. Technical and scientific advances in this area are resulting in innovative approaches that can foster opportunities previously considered infeasible within the confines of traditional therapeutic approaches. The appeal of VR lies in its ability to create 3D stimulus environments that are systematically controllable, multisensory, interactive, and immersive. At the same time, VR enables advanced techniques for capturing and quantifying behavior in response to simulated conditions that can closely mimic the places, events, and challenges that a person may face in everyday life. This “Ultimate Skinner Box” capability positions VR as a promising tool for advancing assessment, intervention, and scientific research across a variety of mental health and wellness contexts. Examples of clinically proven VR applications include using VR for exposure therapy to treat anxiety disorders and PTSD (Difede J, Rothbaum BO, Rizzo AA, Wyka K, Spielman L, Reist C, Roy M, Jovanovic T, Norrholm S, Cukor J, Olden M, Glatt C, Lee F, Transl Psychiatry 12:1–9, 2022; Rizzo AA, Shilling R, Eur J Psychotraumatol 8:1414560, 2018; Rothbaum BO, Price M, Jovanovic T, Norrholm S, Gerardi M, Dunlop B, Davis M, Bradley B, Duncan EJ, Rizzo A, Ressler K, Am J Psychiatry 171:640–648, 2014; Sherrill AM, Rothbaum AO, McSweeney LB, Rothbaum BO, Psychiatr Ann 49:343–347, 2019), providing analgesic pain relief during painful medical procedures (Hoffman HG, Meyer WJ III, Drever SA, Soltani M, Atzori B, Herrero R, Alhalabi W, Richards TL, Sharar SR, Jensen MP, Patterson DR, Virtual Reality distraction to help control acute pain during medical procedures. In Rizzo A, Bouchard S (eds) Virtual reality for psychological and neurocognitive interventions. Virtual reality technologies for health and clinical applications. Springer, pp 195–208, 2019; Huang Q, Lin J, Han R, Peng C, Huang A, Value Health 25:288–301, 2022), and for the assessment/rehabilitation of physical and cognitive performance by supporting user interaction with game-based and systematically delivered challenges and training exercises (Howard MC, Comput Human Behav 70:317–327, 2017; Schweitzer JB, Rizzo AA, ADHD Rep 30:1–9, 2022). This chapter details the research and development of VR as a tool for delivering trauma-focused exposure therapies for treating PTSD.