By Linda Carroll

(Reuters Health) – People who are terrified of heights may be able to conquer their phobia using a virtual reality app and an inexpensive set of cardboard VR googles, a Dutch study suggests.

Study volunteers using the self-guided cognitive behavioral therapy app had improvements comparable to what patients typically achieve with an actual therapist, researchers report in JAMA Psychiatry.

The study shows “that fear of heights, or acrophobia, can be effectively treated without a therapist through our treatment delivered via smartphone application, called ZeroPhobia, in combination with basic $10 VR goggles,” said Tara Donker, an assistant professor and licensed cognitive behavioral therapist. “This means that effective treatment for specific phobias is possible at a fraction of the cost of existing face-to-face treatment or high-end VR exposure therapy.”

In traditional cognitive behavioral therapy, patients with a phobia are gradually exposed to what they fear, and a therapist helps the patient reinterpret their responses and anxieties.

But not all people with phobias have access to or can afford sessions with a therapist. Donker, who is affiliated with Vrije University Amsterdam, and senior study author Jean-Louis van Gelder of the University of Twente developed the app to offer an affordable alternative. They plan to release it commercially.

The game-like app takes users through a series of challenges that would be terrifying for someone with acrophobia, such as replacing a lightbulb on a kitchen ladder, fixing a lamp while standing on the edge of a high balcony, or saving escaped kittens on a high footbridge above a stage. “The VR scenarios were developed (to cover) a broad spectrum of acrophobia situations,” Donker said in an email.

To test the app, the researchers recruited 193 adult volunteers with acrophobia and randomly assigned them to use the VR treatment or to be on a waiting list. At the beginning, and three months later, volunteers filled out a questionnaire that assessed acrophobia symptoms.

The six animated modules of VR cognitive behavioral therapy were delivered to the treatment group over a three-week period. Participants were able to run the scenarios on their phones, at their leisure.

Based on questionnaire responses, Donker and colleagues concluded that volunteers who used the app had a significant improvement.

“Our effects in terms of symptom reduction are comparable in size to effects found in previous research in which traditional CBT with a therapist was examined,” Donker said. “Furthermore, our results are comparable to previous therapist-guided studies using high-end VR equipment for acrophobia.”

Experts welcomed the latest virtual reality therapy.

“The bottom line is this is fantastic,” said Dr. O. Joseph Bienvenu, an associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine in Baltimore. “It’s great news that a simple smartphone-based app is available as an efficient exposure therapy.”

Bienvenu, who wasn’t involved in the study, believes this type of therapy could be the wave of the future.

“It’s not hard to imagine that programs like this will blossom for treating other specific phobias, besides heights, and posttraumatic stress disorder,” Bienvenu said in an email. “This is very exciting!”

VR therapies may fill the void caused by the shortage of therapists, said Dr. Robert Hudak, an associate professor of psychiatry at the University of Pittsburgh, who wasn’t involved in the study. “Finding good cognitive behavioral therapy can be tough in a lot of places and something like this may be the only choice,” he added.

Still, Hudak thinks, it’s better if a therapist can be involved when people use VR to help overcome their phobias. “My preference would be that they use it at home under the direction of a trained mental health professional.”

If the VR doesn’t work, people shouldn’t assume there is no help for them, Hudak said. At that point, “I would suggest they see someone about their phobia.”

SOURCE: JAMA Psychiatry, online March 20, 2019.