Posted by Dr Charles Nduka.

Is clinical VR the new CBT?

In the UK, depression is the leading cause of death among young men and 1 in 15 people attempt suicide in their lifetime. Something needs to change this distressing statistic. Cognitive behavioural therapy (CBT) has been the answer for over 50 years as one of the leading psychotherapies but is it time for a change? The focus on the individual’s ability to bring a transformation to themselves, via homework or setting personal goals, limit CBT’s effectiveness in complex mental health issues. Using CBT along-side a more immersive treatment, one where the therapist can work through issues in a real-life setting, can give the treatment more relevance to the individual, especially amongst young men who struggle to relate to traditional therapy. 

The application of immersive virtual reality (VR) as a treatment medium for mental health disorders is increasing, but what makes it a potential candidate for therapy? It may have something to do with the similarity between VR and how the human brain functions. This new popular hypothesis is known as predictive coding.[1]

Research found that the brain creates a simulation of our body and the world around it which is termed our ‘body matrix’. This mental model of the environment is formed by the interaction of a network of somatosensory brain regions, allowing us to adapt to any changes in/around our body. Predictive coding enables us to make predictions about future sensory input we may come across to avert any surprises. Similarly, a VR experience predicts the outcomes of your actions, to let the individual manipulate the environment as if it was the real world.[2]

This leads the path to an innovative way of treating individuals that struggle to interact with daily life, which is a recurring symptom across a wide range of complex disorders, such as anxiety, paranoia, depression, phobias, body dysmorphia, and PTSD. 

The idea of clinical reality was first discovered in the mid-90s. The ideas were big, but the technology was lacking. The graphics were poor, the computers were slow, and the software couldn’t keep up. This did not feel like reality, and so produced data lacking ecological validity, the sole purpose of Clinical VR.

Over the last 30 years technology has jumped leaps and bounds enabling a more engaging setting, faithful to a patient’s usual environment. For example, Psious is one of the pioneering companies in the field of clinical VR and they have paired up with Healthy Living Counselling centre to offer 3D VR environments to therapists. Currently, virtual reality exposure therapy (VRET) is the most popular form of VR treatment for phobias and anxiety, whereby a patient undergoes a gentle introduction to a stimulus via a graded exposure hierarchy, e.g. fear of flying. This gives therapists the ability to keep their patients in a safe, controlled environment while still enabling the necessary steps to recovery. 


The uses of VR in healthcare don’t end there. Imagine next time you’re waiting for a root canal you’re lying on a beach in Barbados listening to the waves, almost feeling the warmth on your skin. The brain is no multitasker, so overloading it with inputs decreases its capacity to focus on pain. This non-addictive form of pain management is being used by appliedVR as a form of relief from intimidating medical procedures.

The applications of VR are endless, and the technology is on the cusp of changing how we treat everyday situations. The foundation of these VR therapies is their similarity to how our brain works, and it is this that makes them so effective. With more research into the human brain comes greater opportunities for developing treatments into these life changing diseases.

Now with the prospect of recording individual experiences to clinical VR environments, via emotion sensing technology, there will be a deeper-rooted understanding of symptoms, leading to even more progressive treatments. 

[1]Talsma D. (2015) ‘Predictive coding and multisensory integration: an attentional account of the multisensory mind.’, Frontiers in Integrative Neuroscience, 9:19.

[2]Moseley, G, L., Gallace, A. and Spence, C. (2012) ‘Bodily Illusions in health and disease: Physiological and clinical perspectives and the concept of a cortical ‘body matrix’’, Neuroscience and Biobehavioural Reviews, 36(1), pp. 34-36.