Virtual Reality Therapy: Mumbo Jumbo Becomes the Real Deal in Beautiful Croatia

The day is beautiful, almost ideal. The sun is at its zenith, but it is not too hot. The street is filled with the usual urban buzz of people and vehicles. A green bus approaches the stop, and when it stops, you get on and swipe your card through the control machine. The fact that you cannot see your body should not confuse you. It is enough that you can only see your hands; that is the point. It may sound like a bizarre dream, but this is the scenario of a virtual reality (VR) system designed to help people with agoraphobia – those for whom certain environments, situations, and interactions can trigger intense fear and anxiety. Scientists say that this approach, or VR therapy, allows participants in such workshops to build confidence and alleviate their fears by helping them take on real-life tasks they previously avoided.

– This type of therapy truly brings about real change in people’s lives – explained Professor Daniel Freeman, the lead researcher at the Department of Psychiatry at the University of Oxford, while presenting it.

Less Stress and Fear

Indeed, although it seems trivial, the VR experience that begins in the office of a virtual therapist, where one virtually enters scenarios such as opening a front door or staying in an office, each with different levels of difficulty, shows results. Participants in such therapeutic sessions are asked to complete tasks such as searching for a cup of coffee and are encouraged to make eye contact or approach other characters.

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Daniel Freeman, researcher from the Department of Psychiatry at the University of Oxford, claims that VR therapy truly leads to real change in lives

—As Freeman and his colleagues noted in the journal Lancet Psychiatry while researching the benefits of such therapy, psychiatrists randomly selected 174 patients with difficulties in going out into the outside world and psychosis and subjected them to therapy using VR technology. The control group of 172 patients, on the other hand, was undergoing routine therapy without the use of VR. Participants in the VR group were given the opportunity to use the technology in approximately six 30-minute sessions over six weeks, but not everyone participated and completed all sessions.

The results showed that six weeks after the start of the study, those prescribed VR therapy for agoraphobia rarely, but significantly, avoided real-life situations less and were under less stress compared to those under usual care. Further analysis showed that those who benefited the most were those suffering from severe agoraphobia; for these individuals, the effects of therapy lasted six months. On average, such patients could perform two more activities than before, such as going shopping or getting on a bus.

Expansion Continues

Virtual reality therapy (virtual reality therapy – VRT) may sound like mumbo jumbo at first, like some alternative medicine aimed solely at playing on the gullibility of people with real problems, but it is not. Not by a long shot. Not only is this therapy the real deal, not only is it widespread around the world and offered by many health and rehabilitation institutions – but it is already available in Croatia, and if our sources are to be believed, it will become increasingly prevalent here as well.

Virtual reality is an aspect of computer technology that can simulate physical presence in real-world locations or imagined, virtual worlds. If, for example, we can, thanks to computer games, ‘go’ to Hogwarts and participate in a Quidditch match with Harry Potter, overcome various interesting obstacles with Super Mario, or practice shooting at imaginary targets from drones on military ranges, and finally buy Coca-Cola in the metaverse, as envisioned by Mark Zuckerberg, then we really should not be surprised that the greatest minds in medicine have figured out that certain conditions and health problems can be treated using virtual reality.

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If judging by foreign medical media, VR therapy is used in rehabilitation, medical education, and pain control, but its greatest potential, emphasizes Renata Đonđ Perković, univ. spec. clinical psychology, lies in its increasing application in psychotherapy. It is particularly widespread in the treatment of disorders such as fear of heights, flying, and public speaking, fear of exams, animals, other people, darkness, open spaces, claustrophobia, panic attacks…

– The fundamental characteristics of VR that make it attractive for application in psychotherapy are the ability to precisely control what is presented to the client, the ability to tailor treatment according to their needs, and the ability to expose them to a wide range of conditions that would otherwise be uncertain or impractical. Specifically, it brings the outside world into safe, therapeutic conditions – emphasized Đonđ Perković.

She reminds that the first experiments with the application of virtual reality in therapy were conducted in 1992. At that time, VR technology was not yet developed, but since then, the number of studies examining its effectiveness has rapidly increased, supported by advancements in computer technology that have made VR treatments increasingly sophisticated and offering more possibilities.

Feedback Loop

Most research, she says, has focused on anxiety disorders, primarily fears, phobias, panic disorder, social anxiety, and PTSD, but other areas of application have also been explored, including therapy for various conditions: eating disorders, addictions, where exposure to virtual triggers is applied, then in psychological assessment, pain control, palliative care, rehabilitation, and more.

– Although the benefits are proven and manifold, such forms of therapy and assistance are currently not available in public health institutions, nor in the psychotherapeutic practice of professionally trained and licensed psychotherapists – highlighted Đonđ Perković.

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By the way, the basic principle of virtual reality operation is based on a feedback loop. The user is in a closed loop and connected to the computer with input and output units. Input units track their movements and send them to the computer, which then simulates the virtual environment based on this and other data. Using output units, it presents the virtual environment to the user as directly as possible. Ideally, the user’s senses should only recognize artificially induced stimuli (computer-generated), so the real world would be completely excluded. Thus, the loop closes, and the user directly sees, hears (and possibly feels, smells, tastes…) the virtual environment, with immediate results from their own movements.

From Observer to Participant

VR uses complex computer graphics and various input and output devices to construct a virtual environment in which the participant feels as if they are immersed in it. They are no longer just an external observer of images on the computer screen but an active participant in a computer-generated three-dimensional world. Three-dimensional interaction creates a sense of presence. Presence refers to the interpretation of the virtual environment as if it were real. The effectiveness of using virtual reality in therapy depends on its ability to produce a sense of ‘being there’ in the user, i.e., a sense of presence.

Typically, HMD systems for individual use are applied in therapy. These are head-mounted display systems that maintain optical connection with the client’s eyes as they turn or move. They are often used in combination with motion tracking systems, headphones, motion-sensitive gloves, and haptic feedback devices. The HMD is usually connected to a computer controlled by the therapist who leads the therapeutic process and manages the parameters of exposure to virtual scenes.

Development of Assistive Technology

As we learn from the Educational-Rehabilitation Faculty (ERF) from Professor Renata Pinjatela of the Department of Motor Disorders, Chronic Diseases, and art therapy, virtual reality systems have become increasingly interesting to numerous researchers in recent years who are trying to determine all the benefits of this technology in education and rehabilitation, and its accelerated development has enabled the creation of various systems targeting different domains of functioning for children with developmental difficulties and adults with disabilities, such as academic, social, communication, and motor skills, as well as skills necessary for daily life.

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– Therapies based on virtual reality have the potential to become commonplace in educational-rehabilitation practice, but further research is needed, especially studies examining the psychological impact of virtual reality on children with developmental difficulties. At the Educational-Rehabilitation Faculty of the University of Zagreb, virtual reality is studied as part of the Assistive Technology course, currently through literature review and insights into its potential use in the education and rehabilitation of children with developmental difficulties and people with disabilities – said Pinjatela, who also added that VR is increasingly used in teaching in Croatia.

Currently, at ERF, as part of the ‘ATTEND’ project, which is led by Carnet, with ERF, the Faculty of Electrical Engineering and Computing (FER), and the City of Reykjavik as partners, preparations are underway to equip the Assistive Technology Laboratory.

– This is particularly interesting because part of the equipment will also include a virtual reality system, so we hope for intensive practical work in this area starting next year – concluded Pinjatela.