October 9, 2005, Updated September 14, 2012

‘All phobias are ideal for treatment using virtual reality,’ says Dr. Helaine Wallach.An old Jerry Seinfeld routine went something like this: A recent study concluded that most Americans fear speaking in public more than they fear dying. This means that at a funeral, it’s preferable to be in the casket than to give the eulogy.

However, public speaking phobia is no joke. For some people, public speaking is truly a nightmare. The fear of addressing a group of people, let alone a large audience, has hindered many a career. Hard-working corporate executives, supremely confident behind their desks, suddenly balk when they have to present their work at a conference or a board meeting. Academics who love research have trouble facing a classroom of expectant students.

Until now, the options for dealing with this problem were traditional talk therapy or anti-anxiety medications. But a team of Israeli psychologists in the University of Haifa Laboratory for Cognitive-Behavioral Techniques and Family Therapy are investigating a new approach: harnessing sophisticated virtual reality helmets invented to train brave fighter pilots in order to condition average citizens to be brave enough address a crowded room.

The research was initiated by psychologist Dr. Helaine Wallach, a specialist in phobias who lives and works in the northern city of Safed

“It all began when I was in Tel Aviv one day, and in the mall in Dizengoff Center, they had a virtual reality gaming center,” she told ISRAEL21c. “I put on the helmet and played, and immediately thought, ‘Wow, this is really something we need to work with.’

“I went back and began to read up on it and saw that psychologists were just beginning to use it for therapy.”

She teamed up with colleague Dr. Margalit Bar Zvi, and the two psychologists initiated a proposal which won an Israeli government grant, and they began researching the use of virtual reality for therapeutic purposes.

Originally their goal was to investigate the effectiveness of the technique on fear of flying. However, the modest grant was not large enough to provide subjects and a control group. To progress with their research, they joined forces with Dr. Marilyn Safir at the University of Haifa. Together, the team decided that the focus of their research would shift from fear of air travel to a fear of public speaking.

“All phobias are ideal for treatment using virtual reality. But social phobias are very prevalent, especially in the university community, which is a place where a fear of public speaking can really be a problem and impede careers,” said Wallach

The team offers their research subjects a series of therapeutic treatment based on cognitive-behavioral techniques that have never before used to combat the anxiety of public speaking. Using both virtual reality and imagination activation as central pillars, they are examining whether and to what degree these treatments are more effective than other psychological and medicinal treatments for alleviating fear in the long term.

“Drug treatment,” notes Safir, “may lessen fear, but they do not help to develop coping skills.”

Their goal is not to reduce anxiety to zero, but to a level that the person can cope with it. A certain amount of anxiety, she pointed out, is actually a good thing – it makes the adrenalin flow, and pushes people to act. Fear hampers functioning, though, when it takes over.

“It is difficult,” Safir acknowledges, “but it’s not the end of the world to suffer from some anxiety.”

In trying to measure the effectiveness of the various techniques, the research which has been in full swing for four months, involves three groups of subjects: one receiving virtual reality treatment and cognitive behavior therapy, one receiving cognitive therapy without a virtual reality element, and one that is not being treated at all. There are two therapists who run the treatments, and the principal investigators examine the participants afterwards and follow their progress.

In the virtual reality portion of the treatment, the participant in the research dons a virtual reality helmet that gives the patient the simulated feeling of facing an audience. The patient enters into this experience gradually, learning to control his or her thoughts while they speak and to develop skills at overcoming the fear. Inside the helmet, they see an expectant class of 30 people.

Standing in front of a virtual lectern with a virtual text, they are instructed to give the lecture. As they speak, the virtual students listen attentively in order to give the speaker a positive experience to remember, and create a memory to combat future anxiety.

As the participant becomes more experienced, however, the reaction of the audience shifts. The therapists who are controlling the images in the helmet have the power to make the audience look bored and yawn. In more extreme reactions, some of the virtual students may get up and leave the room, or even throw things at their hapless lecturer. This helps develop coping skills, which again, will hopefully reduce future fear.

But the extremes can be highly positive, too – the therapist is equipped to program the virtual classroom to give their lecturer a standing ovation.

“We try to control the audience reaction gradually, first of all, they speak in good conditions, to help the subject relax and overcome their fears. Then, there is gradual exposure to a variety of situations, positive and negative,” said Bar Zvi. “We found that virtual reality experiences are very close to real experiences, and they are far easier to arrange and control.”

Like real, experiences, she says, the virtual experiences stay in one’s memory, even though it didn’t ‘really’ occur.

The accompanying cognitive behavioral therapy works in a similar manner, using the patient’s imagination to determine what situations bother the person. A hierarchy of fear-inducing situations is formed. The therapist advances from one to the next only after the patient, imagining the particular setting, feels no anxiety from it.

The investigators hope that once they pinpoint the combination of approaches that result in the highest rate of success, they can take aim at other phobias, like fear of flying or fear of spiders. The sky is the limit, they say, depending largely, on the creativity of the technology, which derives from the US.

Computer programs that give you the sensation of walking down a dark street, seeing hairy spiders, or having great sex, are continually being developed so that in the future, the horizons of therapy can be expanded to deal with any imaginable phobia, said Wallach.

Wallach was born in New York, and came to Israel when she was nine years old. When she was 23, she moved to Canada to pursue her graduate degrees. “Each of my three children was born in a different city.”

She completed her PhD at the University of Western Ontario, and then returned to Israel, settling in Safed where she taught and treated patients.

In Israel and abroad, virtual reality helmets have already been harnessed effectively for post-traumatic stress therapy, notes Wallach, so the natural next step for mental health professionals is to experiment with new applications.

Right now, parallel research on virtual reality is occurring in Spain and the United States. and the Israel team is in consultation with their colleagues. Wallach hopes to make the collaboration official, and has submitted an application for a binational grant, in order to officially coordinate their work with fellow researchers in the US.

Might there come a day in the near future when a virtual reality helmet is standard equipment in every therapist’s office? Bar Zvi says it’s not likely to happen anytime soon.

“We hope so, the problem is the price. We have funds for the equipment because we are using it for research expenses; it is still very expensive for a private therapist to purchase.”

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Jason Harris

Jason Harris

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