In this article, we will explore the viability for virtual reality technology with the application for hypnosis treatment.
Scientific evidence for the viability of hypnosis as a treatment for pain has flourished over the past two decades. The theory in developing virtual reality hypnosis was to apply three-dimensional, immersive, virtual reality technology to guide the patient through the same steps used when hypnosis is induced through an interpersonal process. Virtual reality replaces many of the stimuli that the patients have to struggle to imagine via verbal cueing from the therapist.
There is the potential for virtual reality technology to expand the application of hypnosis as an analgesic treatment modality. We have found virtual reality technology to be helpful in several settings, particularly where resources are limited, or there are considerable distractions to patients with an already compromised cognitive capacity. Virtual reality hypnosis could potentially eliminate the need for the physical presence of a clinician at most interventions. With less dependence on the skill of a trained hypnotist, such technology may increase our capacity to reach a greater number of patients who could benefit from hypnotic analgesia. The initial acquisition cost of this technology may be expensive now, but is certain to come down in price with improved electronic technologies. With the move toward telemedicine and providing more services to patients in rural areas and underserved regions, this is an exciting concept to explore.
It is important to note that virtual reality hypnosis can never completely replace live hypnosis. For complex clinical problems there will always be the need to individualize hypnotic interventions to identifiable patient characteristics. However, at this point, there are many diverse clinical settings, such as pain control from medical procedures or smoking cessation, that are amenable to the more generic type of hypnosis afforded by virtual reality hypnosis. This technology also holds great promise for those patients with hearing impairments as written suggestions can be incorporated into the programme. In addition, we argue that virtual reality may enhance hypnotic response in those with low hypnotizability.
Hypnotizability was first described by Hilgard as a trait measure that assesses a person’s ability to be hypnotized (Hilgard and Hilgard, 1975). As mentioned earlier, assessing a person’s hypnotizability is important in these studies. We theorize that virtual reality hypnosis may capture attention in those that have trouble with imagination and absorption. The illusion of going inside the three-dimensional computer generated environment is known as ‘presence’ (Hoffman, Sharar, Coda et al., 2004). This concept of presence is believed to be the key factor in making immersive virtual reality more effective for pain control than traditional methods of distraction such as video games or watching a TV. The sensation of going into’ the virtual world enhances a patient’s presence in the environment and draws attention away from the pain.
Attentional processes are regarded as central to hypnotic analgesia as well. Attention is a critically important step in a hypnotic induction (Crawford, 1990; Crawford 1994; Crawford, Knebel, Kaplan et al., 1998; Gruzelier, 1998). In fact, differences in hypnotic susceptibility have been linked to the efficiency of the frontal lobe and those who are highly susceptible show a functional dissociation of conflict monitoring and cognitive control processes (Jamieson and Sheehan, 2004; Egner, Jamieson and Gruzelier, 2005). With attentional mechanisms as a common denominator, the attention-captivating qualities of virtual reality and the suggestion inherent in hypnosis, the potential for a synergistic effect between these modalities is significant for several reasons. First, hypnotic suggestion may help an inhibited patient relax and immerse themselves in a virtual world. Further, hypnotic suggestion can be used to deepen a patient’s sense of presence in the virtual world.
Shelley Wiechman Askay,1 David R. Patterson,1 and Sam R. Sharar, MD