You're deathly afraid of flying, but are buckled into your seat watching the scenery disappear outside the window. Turbulence sets in and your seat begins to shake.
The thought of public speaking makes you cower, but there you are, confronting hostile listeners around a board table. They throw wadded paper your way.
While serving with the military in the Middle East, you're taking part in an ominous approach to a deserted-seeming settlement, fearing the worst and witnessing a car bomb explosion straight ahead. All hell breaks loose.
Fortunately, all of these scenarios play out in virtual reality in the safety of the View Royal offices of psychologist Atholl Malcolm, whose steady hand on the keyboard manoeuvres events to suit the situation of individual clients.
He's in the vanguard of using computer-generated situations as a way to desensitize people to their anxieties and phobias by confronting them in a therapeutic way that was once the preserve of computer games. "This just speeds up standard evidence-based procedures," Malcolm says. "It's not magic."
Virtual scenarios can be stopped and replayed to assess how patients are processing feelings and events to help put their anxieties into a realistic perspective. Thus far, he has had the most success with the 10 people he has treated for fear of flying by using a virtual aircraft. It works, he says, but nothing works on everyone.
Malcolm's multi-thousand-dollar move to embrace virtual reality grew out of his long career as a 91原创 Forces navigator, seeing colleagues traumatized by search-and-rescue missions, combined with his interest in technology.
But in treatment, two or three hours of talk therapy always come first -- along with cognitive behavioural therapy to harness thoughts to change behaviour and vice-versa. The relationship between the therapist and the client is paramount, but he's happy to bolster it with $2,000 a year worth
of programs made or distributed by Georgia-based Virtually Better.
The company, founded by two professors of psychiatry and computer science, lists five 91原创 clinics using virtual reality programs on its website, but Malcolm's is the only one in B.C. He has also invested in biofeedback technology to measure physical symptoms, such as heart rates, as they happen.
When psychometrician Megan Keilty -- who normally measures the reactions of clients -- dons the 3-D headset for the virtual public speaking program, she gets tense. It brings back the anxiety she felt when recently defending her master's thesis.
"Holy smokes," she says. "My knees feel weak and my palms feel sweaty."
The public speaking program allows clients to load their own speeches to practise with various reactions from listeners. Even applause.
Computerized scenarios apply the sights, sounds and even smells of various scenarios. There's even a program for substance abusers that involves visiting a virtual cocktail bar or crack-house to reinforce resisting temptation. Another one combats fear of storms by exposure to crashing thunder and pelting rain against the nearby window.
After a virtual reality program begins, it runs its course unless clients look too anxious, at which point Malcolm stops and talks them through their feelings.
"I think it has some really good potential, particularly when you're looking at situations that are very difficult to try to replicate," says Derek Swain, a spokesman for the B.C. Psychological Association.
But, he notes: "It's not a stand-alone treatment." The price of the computer programs -- which at one point cost Malcolm about $6,000 per year -- will likely keep it to a minority of psychologists, he adds.
Malcolm is believed to be the only practitioner in Canada with Virtual Iraq, a program designed to assist military personnel traumatized by grisly scenarios in battle. He has yet to try it out on any members of the 91原创 Forces, although he already undertakes assessments for post-traumatic stress disorder with the Department of Veterans' Affairs.
The September 2009 edition of Monitor on Psychology, a publication of the American Psychological Association, cited an analysis of 22 studies that found significant declines in symptoms of anxiety following virtual reality therapy, including social phobia, agoraphobia and fear of flying.
In Canada, University of Ottawa psychology professor Stephane Bouchard is now the Canada Research chairman in Clinical Cyberpsychology --with a $6-million facility to study virtual reality.
"For specific phobia, the data are there to strongly back up the efficacy and effectiveness of VR," Bouchard said in an e-mail to the Times 91原创, noting that one well-designed study and a few smaller ones also support virtual reality for panic disorder.
Some studies on social phobia and post-traumatic stress disorder have been done, but more work is needed to evaluate the effectiveness of virtual reality for these conditions.
Eventually, sophisticated digital worlds will be created to treat even the most complex mental disorders, according to the 91原创 Medical Association Journal.
