Mind
Virtual Reality in psychotherapy: the importance of guided and personalized use

Virtual Reality in psychotherapy: the importance of guided and personalized use

It may seem trivial to repeat it, but it will never be sufficiently reiterated, that it is not the experience of virtual reality that heals, but its insertion within the care relationship and the path of intervention shared with the patient.

 

Advertising message Marina Morgese’s article introduces very well reflections regarding the use of virtual reality in a therapeutic context, while opening the opportunity to go further, in the light of the ever-increasing availability of virtual reality equipment and the now ten-year scientific literature to support.

I would not dwell on the specificity of the intervention on phobias, in particular that of the airplane, on which there are repeated tests of scientific evidence and intervention forecasts that also integrate future technological developments (Botella et al., 2017). Instead, I focus my reflection on all the new possible uses of virtual reality, such as the futuristic one (but not too much) that was discussed in the article cited above. We do not know what the developments of virtual reality could be five years from now: if we look back, only five years ago there was no possibility to use virtual reality viewers without a support computer, therefore with the request for a capacity technique by a therapist to manage this degree of complexity.

Usability is a first element to define when we talk about virtual reality, because it is not an accessory aspect: if the patient has difficulty interacting with the environment, for example if the latter jerks or has moments in which due to development problems the movements of objects do not follow the laws of real world physics, there will be a much less strong sense of presence. The sense of presence is the central element of the effectiveness of virtual reality (Riva et al., 2007), therefore usability problems decrease the effectiveness of the intervention with a practically direct proportionality.

As far as content is concerned, however, the diffusion of virtual reality allows the psychotherapist to have a much wider portfolio of solutions available, mainly thanks to two reference areas: free content created by other users (in some cases, psychotherapists to them time) and content created by companies that are investing in the psychological sector. Both solutions also increase at the same time the target of professionals able to easily integrate virtual reality into their own therapeutic action without distorting it: leaving the specific context of phobias, historically linked to the cognitive-behavioral approach, in fact increases a possible integration with other approaches.

Advertising message The second element to highlight is how to be able to choose within the multiplicity of available resources: the key aspect in this direction for me is represented by the fact that I have personally tried and tested the environment in virtual reality. This indication certainly creates a practical filter, because it requires the therapist interested in the professional use of virtual reality in the psychological field to be at least in part a “little nerd”, as it is necessary to take time to discover and enjoy the virtual environment . Only in this way is it possible then to be able to confront the patient at the end of the virtual experience, having the opportunity to grasp all the aspects that may have affected him knowing exactly what he is talking about. Virtual reality is an immersive experience, so many details can affect the patient emotionally more than other classic techniques. It may seem trivial to repeat it, but it will never be sufficiently reiterated, that it is not the virtual experience that heals, but its insertion within the care relationship and the path of intervention shared with the patient. Only with a clear explanation of the rationale for which this technique is chosen and a subsequent space for comparison and reworking can it be inserted in a shared formulation of the case, which is one of the most favorable prognostic elements both for the outcome and for the construction of the relationship itself. It may seem trivial to repeat it, but it will never be sufficiently reiterated, that it is not the virtual experience that heals, but its insertion within the care relationship and the path of intervention shared with the patient. Only with a clear explanation of the rationale for which this technique is chosen and a subsequent space for comparison and reworking can it be inserted in a shared formulation of the case, which is one of the most favorable prognostic elements both for the outcome and for the construction of the relationship itself. It may seem trivial to repeat it, but it will never be sufficiently reiterated, that it is not the virtual experience that heals, but its insertion within the care relationship and the path of intervention shared with the patient. Only with a clear explanation of the rationale for which this technique is chosen and a subsequent space for comparison and reworking can it be inserted in a shared formulation of the case, which is one of the most favorable prognostic elements both for the outcome and for the construction of the relationship itself.

The third element on which to base the therapeutic intervention using virtual reality as a technique to encourage change is the ability to predict, or at least hypothesize, which are the aspects of the patient’s clinical picture on which the immersive experience in the virtual environment will be able to intervene. A comparison that can be useful to guide reflection in my opinion is the use of the DES scale in the basic EMDR protocol, to exclude patients at high risk of dissociation. In the same way it is appropriate to evaluate, even without tests but with an in-depth clinical evaluation, what the risks and benefits of the virtual experience can be. Let’s go back for a moment to the futuristic experience of I met you, assuming that in 5 years it may be available in all our offices or outpatient departments as a possibility to manage mourning for patients: which of our clinical cases can we think of using it? With those who are in the early stages of mourning (Kubler Ross, 1973) or with those who report a mourning pending for years? With more emotional patients or those with more structured defense mechanisms?

As expected, advancing into practical reflection does not allow for all the answers because the charm of the clinical intervention always remains the need to customize one’s own action within one’s own theoretical reference horizon and in the light of the patient in front of us. It is a basic belief that my ten years of working with virtual reality in psychology have not scratched, indeed it has been continuously strengthened in my growth as a psychotherapist, despite my repeated flirts with this technique often referred to as “cold “. At the same time, the need for personalization reminds us to always shift our attention from the so-called wow effect of virtual reality to what it can give us from a therapeutic point of view: no matter how futuristic the experience is, because amazement rarely has a healing power. We must also be able to differentiate within us therapists which virtual environments surprise us and excite us and which ones can be useful to excite: this border does not seem so subtle, yet it is an important alarm bell to not get involved in virtual realities cool, but let us be convinced by potentially therapeutic (and possibly evidence-based) virtual realities. The essential is not only to understand well what virtual reality can do, but to aim at the training of therapists towards a professional use of the same, which allows to avoid improper use of the means that technology offers us, reflecting instead on the potential that a guided use of these new tools will surely have in our field.