Virtual reality (VR) has been used for more than 20 years as a tool for counselors to administer virtual reality exposure therapy (VRET).

Per wikipedia, Virtual reality therapy (VRT), also known as virtual reality immersion therapy (VRIT), simulation for therapy (SFT), virtual reality exposure therapy (VRET), and computerized CBT (CCBT), is the use of virtual reality technology for psychological or occupational therapy. Patients receiving virtual reality therapy navigate through digitally created environments and complete specially designed tasks often tailored to treat a specific ailment. Technology can range from a simple PC and keyboard setup, to a modern virtual reality headset. It is widely used as an alternative form of exposure therapy, in which patients interact with harmless virtual representations of traumatic stimuli in order to reduce fear responses. It has proven to be especially effective at treating PTSD. Virtual reality therapy has also been used to help stroke patients regain muscle control, to treat other disorders such as body dysmorphia, and to improve social skills in those diagnosed with autism.

Randomized, tightly controlled, acrophobia treatment trials at Kaiser Permanente provided >90% effectiveness, conducted in 1993–94. (Ext. Ref. 2, pg. 71) Of 40 patients treated, 38 showed marked reduction in phobic reaction to heights and self-reported reaching their goals. Research found that VRT allows patients to achieve victory over virtual height situations they could not confront in real life, and that gradually increasing the height and danger in a virtual environment produced increasing victories and greater self-confidence in the patient that they could actually confront the situation in real life. “Virtual therapy interventions empower people. The simulation technology of virtual reality lends itself to mastery oriented treatment … Rather than coping with threats, phobics manage progressively more threatening aspects in a computer generated environment … The range of applications can be extended by enhancing the realness and interactivity so that actions elicit reactions from the environments in which individuals immerse themselves” (Ext. Ref. 3, pg. 331–332).

At this point, all patients benefit from the virtual reality exposure therapy. The degree to which d-cycloserine coupled with virtual reality exposure therapy is more or less effective in reducing anxiety symptoms compared with placebo or alprazolam will not be known until the study is completed by the end of August, 2011.

The stimuli used for activation during the startle assessment consist of two-minute video clips of scenes depicting the Iraq theater of combat including that of a Humvee driving alone along a desert highway, a Humvee traveling within a convoy along a desert highway, and a soldier on foot patrol in an Iraqi city.

There are a few ethical concerns concerning the use and development of using virtual reality simulation for helping clients/patients with mental health issues. One example of these concerns is the potential side effects and aftereffects of virtual reality exposure. Some of these side effects and aftereffects could include cybersickness (a type of motion sickness caused by the virtual reality experience), perceptual-motor disturbances, flashbacks, and generally lowered arousal (Rizzo, Schultheis, & Rothbaum, 2003). If severe and widespread enough, these effects should be mitigated via various methods by those therapists using virtual reality.

Another ethical issue of some concern is how virtual reality is use by clinicians in that clinicians should be certified to use virtual reality for their clients/patients. Due to the relative newness of virtual reality exposure, there may not be many clinicians who have experience with the nuances of virtual reality exposure and the therapy that virtual reality exposure is meant to be used for. According to Rizzo et al. (2003), virtual reality technology should only be used as a tool for qualified clinicians instead of being used to further one’s practice or garner an attraction for new clients/patients.