Social Phobia at About.com
Therapy Links at About.com
Social phobia is a common and disabling anxiety disorder (Kessler et al., 1994; Rapee, 1995). Sufferers fear, and whenever possible avoid, social and performance situations (e.g., meeting people, eating in restaurants, public speaking). These fears often lead them to underperform at work and make it difficult for them to establish and maintain close relationships. Complications include alcohol abuse, depression and suicide.
Cognitive-behaviour therapy, the leading psychological treatment, involves systematic exposure to feared social situations and the use of cognitive techniques to help patients identify and challenge anxiety-related negative thoughts. Controlled trials have shown that existing cognitive-behavioural treatments are effective, but that there is also considerable room for improvement, as in more than half of patients substantial social fears remain (Chambless & Gillis, 1993; Mattick & Peters, 1988).
Two developments are likely to enhance the
effectiveness of cognitive-behavioural therapy. First, improved
understanding of the distorted information processing strategies
utilised by social phobics. Second, better ways of presenting patients
with realistic and controllable social situations as part of therapy.
In principle, virtual reality could substantially contribute to both of
Virtual reality (VR) is a powerful technique that uses computer representations to transform people's sense of presence, so that they feel themselves to be in a virtual environment rather their current one. This presence-transforming function enables people's environments to be precisely manipulated in a way that is not possible in the psychological laboratory or the everyday world. Some applications of VR to psychological therapy have recently been reported (e.g., Carlin, Hoffman & Weghorst, 1997), but the field is still relatively new and undeveloped.
Research into the possibility of using VR in a mental health setting has tended to concentrate upon its application to problems such as fear of heights, fear of flying and fear of spiders. It has been regarded as a natural extension of the systematic exposure component of cognitive-behaviour therapy. The first feasibility studies were conducted at Georgia Tech in Atlanta and used VR to treat acrophobia, or fear of heights (Rothbaum, Hodges, Kooper, Opdyke, Williford & North 1995). Results from these early trials suggested that subjects did indeed experience a wide range of physical anxiety symptoms consistent with their being present in a threatening situation involving heights. Not only was the affect generated by the experience of the right kind, subjects also reported a subsequent reduction in anxiety in real life situations and were less inclined to avoid heights.
Various studies report similar success in
the application of VR to a variety of other phobias. Fear of flying has
been treated, as has fear of Spiders and agoraphobia. The success of
these pilot studies has been such that several companies have been set
up in the United States with the aim of developing and marketing
commercial virtual reality phobia treatments. In 1998 a virtual reality
treatment for public speaking apprehension was attempted with apparent
success. Although it was not a controlled clinical trial and no
invetsigation was conducted into factors contributing to its
effectiveness, the study was significant because it signalled an
attempt to extend VR exposure therapy to the treatment of social
phobias, where interaction of some kind with other people rather than
with an inert environment is the anxiety provoking stimulus.
Independently of the research in the United States, a Masters research
project was being conducted at UCL in 1998 into the potential of using
VR for the the treatment of fear of public speaking. This line of
enquiry was suggested by previous research in the department into
interaction between users of a collaborative virtual environment. Key
findings from this project (Pertaub 1998, Pertaub, Slater, Pertaub
& Steed 1999) were that participants reacted to a virtual audience
as though it were a real audience, in that they were more anxious and
rated their own performance less highly after speaking to a virtual
audience that was programmed to respond to them in a negative fashion
than after speaking to virtual audiences programmed to respond
neutrally or positively.
Current research in this field aims to further develop the VR application to social anxiety in a series of pilot studies which will provide a more comprehensive validation of the procedure as an analogue of feared social situations and develop the technology to allow virtual reality to be used as a sophisticated instrument for assessing information processing biases and enhancing treatment effects.
Specific issues that will be addressed in the pilot work are as follows:
Carlin, A.S., Hoffman, H.G., & Weghorst, S (1997). Virtual reality and tactile augmentation in the treatment of spider phobia: a case report. Behaviour Research and Therapy, 35, 153-158.
Chambless, D.L., & Gillis, M.M. (1993). Cognitive therapy of anxiety disorders. Journal of Consulting and Clinical Psychology, 61, 248-260.
Clark, D.M. (1999). Anxiety disorders: why they persist and how to treat them. Behaviour Research and Therapy, 37, S5-S27.
Hackmann, A., Surawy, C, and Clark, D.M. (1998) Seeing yourself through others eyes: a study of spontaneously occurring images in social phobia. Behavioural and Cognitive Psychotherapy, 26, 3-12.
Kessler, R.C., McGonagle, K.A., Zhao, S., Nelson, C.B., Hughes, M., Eshleman, S., Wittchen, H.-U., & Kendler, K.S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Archives of General Psychiatry, 51, 8-19.
Mattick, R.P, & Peters, L. (1988). Treatment of severe social phobia: Effects of guided exposure with and without cognitive restructuring. Journal of Consulting and Clinical Psychology, 56, 251-260.
Pertaud, D.-P. (1998). Virtual exposure therapy for public speech anxiety. MSc thesis, Department of Computer Science, University College London.
Rapee, R.M. (1995). Descriptive psychopathology of social phobia. In R.G. Heimberg, M.R. Liebowitz, D.R. Hope, & F.R. Schneier (Eds.), Social phobia: Diagnosis, assessment and treatment. New York: Guilford.