For people with katsaridaphobia, or the fear of cockroaches, the common pests are more than nuisances—they are the stuff of nightmares. When some phobics spot one of the skittering beasts they start sobbing uncontrollably, whereas others who have seen them in their homes seriously consider moving. Psychologists can treat such disruptive fears with exposure therapy, in which a therapist gradually presents the feared stimulus to the patient in increasingly intimate scenarios. Recently, some psychologists have successfully combined exposure therapy and virtual reality to treat fears of flying, heights and spiders, asking patients to interact with simulated environments that guarantee their safety.



Now, a team of psychologists has completed the first clinical trial testing the treatment of cockroach phobia with augmented reality—a younger cousin of virtual reality that layers digital animations over video or photos of a real-world environment. The new study, published in the September issue of Behavior Therapy, is the most recent and most significant step toward bringing augmented reality therapy out of the lab and into common clinical practice.



"I am thrilled with the research," says Stéphane Bouchard, a psychologist at the University of Québec in Outaouais who has studied virtual reality therapy, but was not involved in the new study. "This study shows reliably the feasibility of augmented reality to treat specific phobias."



In the study psychologist Cristina Botella of the University of Jaume I in Spain and her colleagues treated six women diagnosed with cockroach phobia, according to criteria in the Diagnostic and Statistical Manual of Mental Disorders IV. The women wore an enclosed helmet comprising a camera and a monitor that allowed them to view their surrounding environment sprinkled with a few digital embellishments—incredibly realistic animated cockroaches, which the therapist could shrink, enlarge, multiply or vanish at will.



"With augmented reality you can modulate the exposure in ways you never could in real life," says Soledad Quero, Botella's colleague and a co-author of the paper. "It really shows the potential of new technologies to help people with psychological problems."



Staring into the helmet viewer, the participants saw cockroaches scrabbling on the floor, encroaching on their personal belongings or crawling all over their fingers. The experimenters asked the phobics to keep the helmet on until their anxiety subsided by two or three subjective units of discomfort, as measured by a standard eight-point, self-reported Likert scale.



After treatment that lasted just under two hours on average all the participants demonstrated a significant reduction in their anxieties. They also reported a lessening of their condition's severity and its ability to disrupt daily life, which the experimenters measured using similar standard scales. Most participants showed a reduction from a score of 7 or 8 to a score of 1 or 2. At a checkup 12 months later, most participants maintained these drops in angst. Directly after the therapy all the participants had been able to approach a jar containing a live cockroach, open it and place their hands inside for a few seconds. Before the procedure none could bring themselves to even touch the jar. During the checkup all but two participants successfully completed a repeat of the jar test, and three participants each killed cockroaches near their feet with a fly swatter.



"The most important finding is that the patients improve, but not only in reporting that they feel better—the changes affected what they could do in their real lives, too," Quero says.



The trial's small size makes it difficult to draw general conclusions about the efficacy of augmented reality therapy, but Bouchard says the results are robust enough to validate further larger studies—especially studies that specifically compare augmented reality therapy with alternative treatments, like virtual reality therapy and the most common technique, in vivo exposure, in which patients confront their fears in reality, whether it be living spiders or standing on the top floor of a skyscraper.



Successfully completed in vivo exposure therapy is usually quite effective, but nearly one quarter of patients drop out because of its intensity. In the new paper the researchers note—and Bouchard confirms—that augmented reality is not only more appealing for many patients, it should cost less than virtual reality therapy because the former involves simulating only the feared stimulus rather than an entire environment. Quero even envisions giving patients "augmented reality" homework to complete on mobile devices: Imagine, for example, using an iPhone or Droid to create the illusion of creeping cockroaches on the kitchen table.



So far, augmented reality therapy only exists in the lab, but Bouchard is encouraged by Botella's study. "This is a pioneering application," he says. "I can imagine we will see a diffusion of augmented reality into therapeutic settings just as we have seen with virtual reality."