Virtual Reality Therapy for Phobias at Duke University School of Medicine

The Virtual Reality (VR) Treatment Program at the Duke Faculty Practice offers a new human-computer interaction form of therapy for individuals with anxiety disorders due to fear of heights, elevators, thunderstorms, public speaking and flying. After an initial diagnostic interview is conducted to ensure that the service is appropriate for the presenting problem, participants are placed in a computer-generated three-dimensional virtual world and guided through the selected environment. Computer graphics and various display and input technologies are integrated to give the user a sense of presence or immersion in the virtual environment. The therapist then guides the participant through the environment and can interact with them through the entire event. Research indicates that 6 to 12 sessions are required to achieve maximum benefit. The advantages of VR over traditional exposure therapy are:

Increased Safety and Control

Virtual Reality Exposure involves exposing the patient to a virtual environment containing the feared stimulus in place of taking the patient into a real environment or having the patient imagine the stimulus. The real environment can be unpredictable and in-vivo exposure therapy leaves much to chance. The therapist through the computer keyboard controls the virtual environment ensuring exposure to the programmed situations.

More Efficient Treatment and Ease of Scheduling

The VR software and models of virtual environments have been carefully designed to support exposure therapy of anxiety disorders. Standard exposure therapy can be very costly because it usually requires leaving the therapist’s office and therefore extended sessions. Virtual reality programs can accomplish the same exposure within the standard therapy hour (usually 45-50 minutes) and within the confines of the therapist’s office. Multiple sessions can be scheduled in the same week.

Less Risk to Patient’s Confidentiality

Since therapy is conducted in the therapist’s office, there is no more risk than with any other type of unlimited potential for running into friends, encountering difficult situations and being in public should the exposure go too far.

Shorter Sessions May Mean Better Chance of Reimbursement

Many insurance companies will not pay for the extended sessions required for standard exposure therapy. This may not be a problem with a VR system to assist with exposure. The sessions are conducted in the therapist’s office and can usually be completed within 45-50 minutes.

Unlimited Repetitions of Feared Situations

The use of VR allows the therapist ultimate control over stimuli for the perfect exposure. Standard exposure therapy is bound by real world limitations, for example, only one take-off and landing per flight. VR exposure allows the therapist to manipulate situations to best suit the patient, for example, to repeatedly land the virtual airplane.

The Duke Faculty Practice is a fee for service clinic. We do not participate with any insurance companies except those Duke Employee Health Plans with Cigna as the Mental Health carve out. We suggest that you contact your insurance company to determine if your plan has any out of network benefits. If your plan does have out of network benefits, then some reimbursement may be available at the plans set percentage of their usual and customary fee for a standard 45-50 minute therapy session. The clinic charge for VR Therapy is $140 per session.

Link to the website:

http://psychiatry.duke.edu/divisions/general-psychiatry/virtual-reality-therapy-phobias

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