Virtual reality, more commonly abbreviated as VR, and mental health might not be an obvious marriage at first glance. Most often, discussions around new technology and its impact on mental or physical health are almost always in the context of causing harm. Rightly or wrongly, video games get blamed for violence, social media for increasing mental health issues in teens, cell phones for possible cancer links, and the list goes on. For once, however, this is not the case with VR technology. Virtual reality is starting to be used for mental health treatment with significant successes thus far. VR for therapy is fast becoming main stream, at least among open and forward-thinking therapists and psychiatrists. Additionally, many new potential uses for VR technology for mental health treatment are being studied, with new treatment options on the horizon.

In this guide, we’ll take a look at several examples of how VR is helping mental health treatment and opening up new frontiers for patients and therapists alike. Specifically, we’ll focus on the successful deployment of VR for therapy and treatment of anxiety, phobias, depression, and PTSD, which have shown the most promise in studies and clinical settings thus far. We’ll also highlight the role VR can play in diagnosing complex mental health disorders and conditions. Then, we’ll explore the pros and cons of VR technology for mental health, and look ahead to the future to see what kind of treatment options might become available in the next few years.

It’s also worth noting that VR helping mental health patients with their treatment is not the only current or projected therapeutic use for the technology. Great strides are being made with VR for therapy and rehabilitation for physical injuries and illnesses, too. For this guide, however, we’re focusing solely on virtual reality for mental health treatment – we’ll get to its role in physical illness and injury treatment in an upcoming article, as many of the concepts and mechanisms of use are quite different from those in the mental health arena.

VR and Mental Health Treatment

First, it’s important to point out that most of the uses of VR for therapy purposes are not meant as standalone, patient-directed treatments – they are tools that are used by therapists and professionals in the context of their practice. Like all mental health treatments, a licensed psychiatrist, psychologist, or counselor will be able to provide you with a range of treatment options based on your diagnosis, condition, and their specialties. This may or may not include virtual reality as part of a treatment plan. This article is merely a guide to how VR is helping mental health treatment at present, and does not intend to imply that VR is the best treatment for a particular condition. Likewise, this article does not constitute medical advice, and patients suffering from a mental health condition should seek professional help.

There’s no doubt that mental health care in the US could use some improvements. While we’ve come a long way from the days of locking people up in insane asylums, mental health care lags behind advances in other fields of medical care. With the stresses of the modern world, a growing dependence on medications, decreasing life expectancy, and a greater incidence of mental health conditions in younger and younger teens and children, it’s easy to see why the potential of VR for therapy has been embraced.

The statistics are somewhat startling. According to the National Alliance on Mental Illness:

1 in 5 adults experience a mental illness during any given year – that’s over 46 million people in the US.

1 in 5 teens (13-18) and 1 in 8 youth (8-15) report having experienced a severe mental disorder at some point in their lives.

Over 18% of adults report having experienced an anxiety disorder, such as generalized anxiety disorder, obsessive-compulsive disorder, phobias, or post-traumatic stress disorder (PTSD).

Over 10 million people experience mental illness that “substantially interferes with or limits one or more major life activities.”

More than 16 million adults report having at least one major depressive episode within the last year.

Perhaps least surprising through most impactful is the statistic that more than 90% of people who commit suicide show symptoms of one or more mental health issues.

More and more people need mental health treatment, and seek to improve their mental health, even absent a formal diagnosis of a condition. Medication and behavioral therapy techniques can be effective and make a huge difference, though not every treatment option works for every patient. Simple, cost-effective techniques that utilize VR for therapy are naturally an appealing new tool for therapists and patients to have in their toolbox. Let’s take a look at how therapists, psychiatrists, and psychologists are using virtual reality technology for mental health treatment of a variety of different conditions today.

Anxiety and Stress Management

As discussed above, anxiety disorders are quite common, with 18% of adults reporting an anxiety disorder of one type or another. While PTSD and specific phobias are included under the umbrella of anxiety disorders, we’ll address both of those in separate sections below, as they have some unique and different ways in which VR is helping mental health clinicians tackle those specific problems. Rather, in this section, we’re going to look at the role of VR technology for mental health treatment of generalized anxiety disorder, consistent levels of high stress, social anxiety disorder, and similar conditions.

Anyone who has ever suffered from an anxiety or panic disorder that has been severe will tell you it’s crippling and scary. Undiagnosed, the symptoms often mimic those of a heart attack or other severe physical problem, with acute onset sweating, heart palpitations, difficulty breathing, a feeling of impending doom, nausea, vomiting, and many other symptoms that can vary from person to person. They can have a metaphorical paralyzing effect on a person’s life, making work, school, and socializing impossible, or even actively avoided to prevent symptoms from occurring. That’s no way to live.

Common treatments include cognitive behavioral therapy (CBT), medications such as selective serotonin reuptake inhibitors (SSRIs), and fast-acting anti-anxiety agents for combating attacks, such as benzodiazepines like alprazolam (Xanax) and lorazepam (Ativan), or diazepam (Valium). The goal of most treatment approaches are to help the patient to be mindful of what they are feeling, recognize attacks when they are beginning, and give them tools to shut down the attacks. Additionally, when clear-cut root causes are present (such as the case of social anxiety disorder), treatments can include exposure therapy and ways of reprocessing the anxiety triggers to train the mind to not be bothered (or be bothered less) by those triggers. We’ll cover that in more detail in our discussion of phobias later in this guide, as the principles are similar to those treatments.

In all cases, teaching the patient to be mindful of their symptoms, practice breathing, meditation, and techniques to calm themselves and short-circuit the anxiety attack are typical. It is this in this arena that virtual reality for mental health treatment of anxiety disorders can really shine. VR for therapy and treatment of stress and various anxiety disorders can combine virtual scenes, colors, lights, music, and other known relaxation elements to help put patients in a better headspace, and teach them how to relax and let go of stress and unpleasant thoughts that anxiety can cause. Patients can use a VR headset during an office visit, with guidance through the experience by a therapist. Alternatively, there are some virtual reality relaxation/meditation programs out there from commercial developers which may be effective, and usable anytime by the patient on their own VR headset (even a cheap Google Cardboard with a smartphone often will suffice).

These virtual reality experiences can be more effective in helping the patients to quiet a busy and chaotic mind than visualization exercises or other meditative techniques, since all the visual stimuli are provided by the app or program through the headset, and often accompanied by relaxing audio as well. Even some guided meditation programs are available. One note of caution, however – there are a lot of apps or experiences out there that may be focused on meditation or mindfulness, that aren’t necessarily developed or endorsed by trained therapists or professionals. It’s always best to ask your psychotherapist or psychiatrist for any recommendations, especially if they introduce you to VR for therapy during in-office sessions. With that said, we’d recommend taking a look at products from Mimerse, Calm.com, the app Mindwell, and the free Breathing App, co-developed by guru Deepak Chopra with Eddie Stern.

It’s also worth noting that virtual reality may not work for everyone, and is not a cure-all when it comes to anxiety. Just as some patients respond better to medication or psychotherapy than others, some will find VR for therapy purposes more approachable and effective than others. Like any health tool – physical or mental – it’s simply one of many options that professionals can use to help patients. It’s certainly a new and exciting tool, however, and offers a lot of potential growth into new apps and experiences in the near future for anxiety sufferers. Of course, it does have benefits over medication or therapy alone, or even in combination, and can often be more easily continued on a patient’s own volition, and used regularly, than benzodiazepines or psychotherapy appointments.

VR Treatment for Phobias

Phobias are often considered a type of anxiety disorder. Common phobias that many people are familiar with (due largely to their presence in pop culture) include:

Acrophobia, or fear of heights

Agoraphobia, or fear of places that might make you feel trapped or helpless in an anxiety attack – often outdoors or public places

Claustrophobia, or fear of enclosed spaces

Pteromerhanophobia, more commonly known as fear of flying

Social phobias, a diverse group of phobias presenting as discomfort or fear of social situations, fears of judgment, self-consciousness, and related symptoms

Trypanophobia, fear of needles

There are many others, of course, including fears of certain animals (spiders, snaked, and dogs among the most popular), fear of elevators (which can be a form of claustrophobia or its own condition), germaphobia (which is really a panoply of potential pathologies), and much more. Some of these phobias may cross over into obsessive-compulsive disorders, social anxiety disorders, and other conditions.

In almost all cases, treatment goals for patients suffering from phobias include getting them to recognize the phobia, address its irrationality, teaching them steps to deal with how the phobia makes them feel, and in many cases, exposure therapy. Exposure therapy helps to normalize or acclimatize the patient to the specific triggers of their phobia, in a methodical, piecemeal, slow and controlled approach. VR for therapy of this type is a great choice, and growing in use among therapists. It can be used as a substitute for various exposures, or as a stepping stone to “real world” exposure.

For example, a patient who is afraid of heights may not be ready for a trip to the top of a 3 or 4 story building. However, progressively, they can experience similar experiences inside of VR, with a VR headset on, while seated safely in a therapists’ office. The height of the building can be changed as the patient makes progress. Anyone who has played a video game, even on a 2D screen, can attest that heights can be just as stomach-lurching when they aren’t real. With the mind-tricking capabilities of VR headsets and associated programs, there’s no question that the heights seem real. In this case, and in the case of many other phobias, VR technology for mental health via exposure therapy is making it safer, easier, and more convenient to treat phobia patients, and offering more refined control with incremental steps for exposure therapy to help patients progress and conquer their phobias more effectively.

Again, we point to companies like Mimerse as well as Psious and Limbix, who are pioneering multiple treatment-specific environments that can be adjusted and controlled by therapists who are using VR technology for mental health treatment. In many cases, these virtual reality mental health therapies augment existing exposure and other therapeutic techniques, whereas some others – especially those for phobias not easy to replicate – it might be a primary treatment method. After all, therapists can’t take their fear of flying patients to the airport and hop onto planes randomly in this day and age. Aside from security and safety, there are practical considerations and costs that prevent this from being practical. But in VR, they absolutely can!

VR for Depression

Depression afflicts millions in the US every year. Contrary to what many people think, it’s not just a matter of “being sad” or “feeling down.” It’s a meaningful mental illness that manifests with symptoms like fatigue, tiredness, indecisiveness, changes in thought patterns, loss of appetite, loss of interest in life activities, and the loss of or inability to feel pleasure from life, known as anhedonia. It’s that last aspect of depression that VR depression treatments are primarily working to improve.

When a patient is being treated for depression, there are many approaches. Medications are common, as are psychotherapies based on cognitive behavioral therapy techniques. Both of these methods have relatively good success rates, but the amount of time, number of sessions, correct medication and dosage, etc. can take quite awhile to work out and see improvement in patients. Psychiatrists and psychologists are using virtual reality technology as another tool in their treatment toolbox, to help patients be mindful, hopeful, and positive, and experience enjoyment out of life again.

As documented in several published studies, VR for therapy for the anhedonia aspect of depression often involves placing patients in a typically pleasant virtual scene, such as a day at the beach. They’re guided through the scene by the therapist, and told to describe it in detail, paying close attention to the emotions the scene elicits. Gradually, they learn to accept simple pleasures, participate in activities that can create happiness and hopefulness, and capitalize on the positive emotions and feelings that can be generated by such activities. That’s the goal of most VR depression apps, programs, and experiences that are commercially available direct to consumers, as well as those targeted at practicing clinicians.

While it doesn’t solve underlying depression-causing issues, there’s no doubt that VR helps depression patients on par with (or even more effectively than) cognitive behavioral therapy alone, at least when it comes to lack of enjoyment from life. That’s the conclusion of most of the studies performed to date, with researchers conducting larger-scale trials as VR becomes more popular, affordable, and accessible for clinicians, and the potential for virtual reality and mental health treatment becomes more widely understood. Making progress in that aspect of depression can often lead to an improvement in other related areas, serving as a stepping-stone (along with other treatment options) to a more positive, enjoyable, and productive life experience for depression patients.

VR and PTSD Treatment

When it comes to VR and mental health treatments, perhaps the most well-known combination is VR and PTSD (and not just because they are both acronyms). PTSD, or post-traumatic stress disorder, is a mental health condition characterized by recurrent flashbacks, thoughts, feelings, emotions, and memories of a traumatic incident, as well as changes in thought patterns, avoidance of similar circumstances, insomnia, mental and physical health issues, and a higher risk of self-harm, self-medication, and suicide. It’s commonly seen in soldiers, and most often associated with soldiers who have served in wartime, but there are other groups and individuals who suffer as well. Rape or sexual assault survivors, those affected by natural disasters, child abuse victims, physical or emotional abuse victims, and even survivors of car crashes and similar traumas can all develop PTSD symptoms, sometimes weeks, months, or even years after the triggering event.

So, how is VR helping PTSD sufferers? In most cases, VR for therapy and treatment of PTSD is used in a manner similar to the aforementioned phobia treatments – for exposure therapy. Medications and cognitive behavioral therapy, along with other “talk therapy” techniques, are often best combined with exposure therapy. This helps the patient to become desensitized to the thoughts, images, feelings, or images associated with the trauma, so that they no longer have control over the patient’s life, no longer create anxiety, and allow them to experience life more normally. Details vary depending on the originating trauma and severity of the symptoms, of course, but exposure therapy is often seen as the most effective approach, alongside counseling or other talk therapies, more than medication-based treatments.

VR and PTSD go particularly well together, due to the nature of the VR technology. The immersive and responsive visual simulations possible with VR headsets and content provide a far wider range of sensory stimulation to the patient than merely visualizing or recounting details from their memory to a therapist. Since the 90s, clinicians and researchers have been testing various VR-based treatments for PTSD, with virtual environments, customization of experience, and the overall level of technology and realism increasing significantly since that time. Today, VR is helping mental health practitioners deliver better patient outcomes, faster results, and fewer relapses among PTSD patients.

One of the most popular systems of VR for soldier therapy, created in partnership with the US Army, is known as Bravemind. It can virtually immerse soldiers returning from war or ex-soldiers struggling with past trauma back into the battlefield, with aural, visual, and even tactile stimulation. Advanced units of the Bravemind system even come equipped with smoke, dust, vibrations, fans to simulate wind or the blast of an explosion, and more. In short, it’s incredibly convincing to the mind of a PTSD sufferer. It helps them process the experiences, and has shown significant positive results for a number of soldiers suffering from PTSD, for whom medication and conventional therapy have not had the desired results.

VR as a Diagnostic Aid

Another key area where practitioners are taking advantage of the health benefits of virtual reality is in diagnostics. VR is helping mental health experts predict, diagnose, and develop treatment plans for a variety of mental and physical illnesses, particularly those which cause mental health symptoms. Complex diseases that can be difficult to diagnose, like ADHD and autism spectrum disorder, can be more easily addressed, and a standardized diagnostic toolkit developed with the help of VR technology. At the same time, known diseases with mental health symptoms, such as those seen in Alzheimer’s and dementia, can more easily be evaluated, staged, and accurately diagnosed with the use of virtual reality.

In both cases, traditional diagnostics generally consist of paper- or interview-based tests, questions, tasks, and similar. They are somewhat subjective, and capabilities and results will vary significantly from one individual to another, especially given the natural variation in abilities, competencies, and performance inherent in each person. Often, these forms of diagnostics don’t mimic real-life experience very well, or put the tested concepts into an everyday form that is relevant to the way the brain really works. A simple memory exercise on paper doesn’t “run the brain through its paces” the same way remembering directions to walk to the store does in real life. VR allows patients to be evaluated in more life-like ways, giving clinicians more valuable and realistic data, and better, more accurate, and earlier diagnoses for patients, which improve patient outcomes. That’s one of the key health benefits of virtual reality in this context.

Another aspect of how virtual reality and mental health have found a home together is in the diagnosis of complex mental health problems. VR can provide therapists with mental illness testing experiences for patients that are “the same” from patient to patient, providing wider, more comparable data sets. As the theory goes, this will result in more objective evaluations than are currently available from the fairly subjective interview-based methods. In autism interview-based diagnostics, for example, the tone of the interviewer’s voice, the color of their shirt, or one of a thousand other factors may cause some subjects to be under-diagnosed or over-diagnosed based on their particular pathologies. By standardizing tests through virtual environments and virtual interview-type sessions, best practices can be developed, and diagnoses can be made more consistent and accurate, allowing for more meaningful and effective treatment.

VR is helping mental health and diagnostics in another important area – treatment efficacy evaluations. New drugs and therapies are being developed all the time for conditions like Alzheimer’s. As discussed above, the same shortfalls of paper-based interviews and tests for diagnosing Alzheimer’s also limit the useful data for evaluating treatment efficacy. For drug treatment and gene therapy companies, being able to standardize testing – not only from subject to subject, but in terms of response performance, and even between human and animal test subject stimuli – can provide more meaningful results and help steer their treatment efforts in the right directions quicker and more easily. At least in theory, this should lead to better data, better results, and faster time-to-market on more effective treatments for these diseases, and create a model to be used in other diseases and conditions as well.

The Benefits of Virtual Reality in Mental Health Care and Treatment

We’ve already touched on many of the benefits of virtual reality in mental health care and treatment, in the context of the various illnesses and conditions we’ve discussed above. However, there are some more general benefits to the role of VR for therapy and mental health treatment that are worth discussing in a bit more detail, as they reveal some of the main reasons why clinicians and patients alike are embracing virtual reality as a mental health treatment option.

VR technology for mental health treatment purposes has demonstrated success and efficacy in over 300 peer-reviewed studies to date, along with real-world success stories among the patients and therapists who have embraced VR.

The level of realism and “brain-tricking” immersion possible with VR is superior to guided talk therapy, guided meditation, and other treatments that seek to elicit similar responses.

VR for therapy is more or less physically harmless, compared to medications which often have serious side effects for a large number of patients.

VR technology has become much more affordable than it used to be, and should not be out of reach of most clinical practices.

VR for therapy can be used in a clinical setting, on a patient’s own time and direction, or both. Self-directed treatment or experiences and apps that reinforce clinical treatments can be used on consumer-grade VR headsets, including smartphone/mobile headset models with little additional cost.

In the case of exposure therapies, such as phobias and PTSD, VR is helping mental health treatment in ways that just aren’t practically achievable through other means. It’s not feasible to send a solider with PTSD back into a combat zone for treatment, but in a virtual world, it’s possible, low-cost, and easy to accomplish.

VR experiences can be conducted in a clinical setting with just the patient and therapist in most cases, protecting patient privacy – something that wouldn’t be practical in real-world exposure therapies, for instance.

For many patients, VR for therapy is a more approachable, incremental, and “safer” way to process unpleasant thoughts and emotions, especially as compared to real-world exposure therapy scenarios.

By standardizing testing and diagnostics with VR technology, researchers are able to achieve more consistent, objective, and accurate diagnoses of various mental health and physical health problems. They can also get better results on potential therapy and treatment efficacy than in traditional paper-based tests, memory exercises, and similar assessments.

Disadvantages and Concerns with Using VR for Therapy

Of course, like all technologies and innovations, there are some drawbacks, disadvantages, and concerns about the use of VR and mental health/VR for therapy purposes. Most of these can easily be explained as symptomatic of a technology that is still in the early stages of widespread use, and will likely diminish in time. While some caution is always a good thing, VR for therapy is largely seen as a positive thus far, given the state of mental health treatment in the US and around the world – any additional and effective tool, even if it’s still in its infancy, is often seen as a welcome addition to the arsenal of most treatment providers. Nevertheless, it is worth looking at some of the disadvantages and concerns that have been expressed about virtual reality in mental health treatment, as a dose of caution and skepticism is often a healthy thing.

Costs for VR headsets and systems have definitely decreased in the last few years. Still, for a standalone VR setup specifically designed for therapy purposes, along with content titles and platforms, costs can be high for many clinicians. Many of the software and toolkits out there for VR for therapy have subscription/licensing fees, and specialized headset system for therapy are often much more expensive than commercially-available headsets (despite being comparable or even inferior in functional specifications).

Not everyone responds to virtual reality mental health therapy, just as not everyone responds to a particular technique of psychotherapy or particular medication or class of medications. Some people may find VR for therapy to be frustrating or not helpful, while others may find it an ideal part of their treatment plan.

VR headsets can sometimes be hard to use, uncomfortable when used for prolonged periods of time, and particularly hard to get working for people with glasses, contacts, astigmatism, and other vision disorders. This can largely be overcome with good headset design or choice, and good, adjustable optics. However, it’s harder to achieve a custom fit and adjustment on a shared VR headset unit in a therapist’s office than a personal, consumer-grade VR headset that you have all to yourself.

A lot of the content, systems, experiences, headsets, platforms, and companies that are developing virtual reality mental health products and services are relatively new and untested. Like any health treatment, until widespread and consistent use, testing, and feedback is achieved in a variety of patient demographics and professionals alike, it’s not always easy to determine what’s effective, and who is getting it right or wrong. Clinicians need to be careful and do their research in selecting products and services relating to VR for therapy before offering them to their patients.

The growing popularity of VR headsets and technology mean more and more people may be encouraged or tempted to self-direct, self-diagnose, or otherwise use VR technology for mental health without the supervision or expertise of a professional. While commercially-available stress management, mindfulness, meditation, and similar apps and experiences will hardly cause any harm to patients, self-directed VR for therapy is no replacement for a professional psychiatrist or psychologist. As we’ve mentioned several times, VR for therapy is not a cure-all, but one of many tools that can be used to improve a patient’s mental health. Further, clinicians take precautions that the average home user doesn’t, such as monitoring vital signs during exposure therapy, and bringing their training and experience to bear to find the most effective options for a given patient’s condition.

Upcoming and Future Areas of Exploration for VR and Mental Health

The future looks bright for VR and mental health, with new innovations, start-up companies, and approaches to treatment for a variety of mental health issues on the horizon. As the technology becomes more affordable, more widespread, and more accepted in all aspects of life, it’s likely the role of VR for helping mental health, and physical health treatments will continue to increase and diversify.

One area that seems poised to grow is in apps and content for mainstream headsets and platforms. Both consumer-grade content and subscription-based professional content for standalone headsets like the Oculus Go, Oculus Quest, and similar upcoming entries from other companies will doubtless proliferate. This will reduce cost barriers for therapists to use VR for therapy, add treatment uses as another motivator to get consumers to buy the VR headsets, and offer a number of opportunities for new companies and major institutions to partner on top-tier VR and mental health products.

Additionally, as with most technology products, the quality, resolution, and realism of the content offered in VR for therapy apps and products is bound to improve over time. A lot is possible with the current generation of standalone wireless headsets, though they are relatively recent entries on the market. Many of the more established brands offering VR technology for mental health treatment purposes are operating on older generation models of commercially-available headsets, or proprietary platforms. In some cases, these require base units that function as the processor and storage, not dissimilar from a tethered headset. With rapidly evolving tech and improving quality, patients will be able to experience more immersive and more customizable experiences, which should see an even greater level of treatment efficacy.

Future innovations that hold particular promise, though which are still a bit out on the horizon right now, include:

Interactive, AI-driven therapy “bots” or programs where users can participate in a virtual reality therapy session anytime, on-demand.

Networked VR technology to allow for virtual group therapy sessions from anywhere on the planet.

Advances in diagnostic VR technology to better diagnose, predict, and assess the full spectrum of mental health disorders, and the mental components of other physical health issues and disease processes.

VR for therapy coupled with more haptics – feedback devices and effects – to create even more immersive content. This is not dissimilar from the kinds of rides available at some amusement parks and attractions, with gimbaled and pneumatic seats, hot and cool air jets, fans, water spray, smoke or fog generators, and more. Nor is it that dissimilar from the Bravemind system mentioned as a way that VR is helping PTSD-suffering soldiers today. Most of these systems are too big and bulky right now for consumer purchase and installation, or even in-office use at a therapist, and confined to special purpose-built facilities. Hopefully over time, that will change, bringing these more immersive and convincing experiences into reach for a wider swath of the population.

More widespread and mainstream use of VR for therapy purposes in general, which should help to de-stigmatize mental health treatment further, and offer additional, effective treatment options to patients suffering from a variety of pathologies.

Conclusion

There’s no doubt that VR technology for mental health diagnosis and treatment is perhaps one of the most exciting innovations in mental health since the development of drugs like Prozac or SSRIs. As a relatively new tool, psychiatrist and psychologists are using virtual reality technology in numerous ways already, and seeing a high degree of success. VR for therapy, in the proper context and under the supervision of a professional, can offer effective treatments for major mental health issues, including phobias, anxiety, depression, PTSD, and more.

While there are a few drawbacks and concerns that have been raised about VR and mental health, most of those are consistent with the technology being new and statistics and data being relatively light compared to years of experience with drugs or certain therapy techniques. Over time, most of those disadvantages or concerns should be addressed as the technology, and its use develop further.

In the meantime, professional-grade VR for therapy, as well as consumer-grade experiences and programs, can help patients realize the health benefits of virtual reality, and hopefully make some impact on the rate of mental illness and quality of mental health care available nationally and globally. That’s something we all should be excited about!