Imagine the scenario: you're sitting on a plane, strapped in and ready for take-off. But you're terrified of flying and are suddenly hit by an uncontrollable urge to spring from your seat and run screaming out of the aircraft.

However, at that moment, a soothing voice speaks to you - the voice of your therapist - telling you to try using your various coping strategies. The scene around you then disappears, you remove the headset and you're returned to the safety and tranquillity of the therapist's office in which you're sitting.

Although virtual reality (VR), or computer-simulated environments, sound like a premise that would excite only computer geeks and Star Trek fans, doctors and scientists are increasingly using it to treat a range of disorders, from fear of public speaking and flying, to post-traumatic stress disorder (PTSD) in soldiers returning from Iraq. And, in the past few weeks, scientists have reported that it can also be used to treat drink and drug addictions, and even to help people give up smoking.

“With virtual reality we can bring a version of the real world into the clinic. We can help people test out their fears and practise different ways of coping. They can take the confidence gained in VR into the real world,” says Dr Daniel Freeman, a clinical psychologist at King's College London, who is investigating whether the technology can be used to treat paranoia.

In a study recently reported in the British Journal of Psychiatry, he sent 200 volunteers on a virtual reality ride on the London Underground, in a carriage full of computer-generated passengers. He discovered that 40 per cent of the volunteers experienced paranoid or suspicious thoughts. One of the female volunteers said: “I felt trapped between two men in the doorway,” despite the men being computer characters. Now that Dr Freeman has shown that VR can generate paranoia feelings, he is hoping to use it in the therapy process.

Overcoming a fear of flying

Dr Page Anderson, a psychologist at Georgia State University, has used VR technology to help people overcome their fears of flying and public speaking. “The gold-standard treatment for people with phobias is exposure, which is, basically, facing your fears. Repeating an exposure in the real world is hard to do, as flying over and over again would get expensive. However, if you do it virtually, you can, for example, do take-offs many times.”

Dr Anderson's study indicated that the patients who use VR therapy did as well as those treated with real-life flying. So why use VR? “Facing fears in a virtual world is much more appealing than facing them in real-life,” says Dr Anderson. “This may make treatment more accessible.” For patients with a fear of public speaking, she can make the audience look bored, talk among themselves, raise hands, or fall asleep. She can even make virtual mobile phones ring mid-talk.

So how do researchers send patients into the virtual world? The equipment looks slightly comical. The seated patient wears a headset with a visor in which they see the virtual world. Built-in headphones deliver sounds and block out ambient noise. The chair is placed on a vibrating platform, and smells are delivered through an electronic scent machine. The patient is immersed in the sight, sounds, smells of the virtual world. The therapist sits beside the patient in front of a screen, through which he or she can see exactly what the subject sees. The therapist can speak through a microphone wired into the patient's headphones.

Does it resemble a video game?

While for years virtual reality has been blighted by laughably poor graphics and a distinct lack of realism, the technology has improved recently. But there is still a long way to go. Can patients really treat something that looks like a cheap video game with any seriousness? Yes, according to Dr Anderson, who has had patients cry and suffer panic attacks on virtual flights.

According to Mel Slater, a professor of virtual environments at University College London, virtual worlds are good enough to fool your brain into thinking they are real. “When you go into one of these virtual-reality environments everything is lifesize. The characters are good enough for a level of the brain to think ‘OK, this is happening, so let's make the normal response', despite your higher consciousness knowing it's not real.” Slater saw this effect in action when he conducted an experiment in which volunteers were put into a virtual world where a fire broke out. The virtual characters started to run out of the building and many of the volunteers leapt out of their seat, as if to leave.

Treating traumatised soldiers

Virtual worlds have also been used to help soldiers recover from PTSD. Dr Josh Spitalnick is the director of research at Virtually Better, an Atlanta-based company, which has pioneered much VR technology. “In PTSD, the fears typically manifest as nightmares or, in daytime, daydreams. For example, if someone smells the fumes of gasoline, that will take them back to being in a war. They could be shopping, smell gasoline and freak out,” he says.

A Virtual Iraq program is being used at a number of hospitals in the US. Further, researchers at Emory University, Atlanta, are 18 months into a five-year state-funded study of using the technology to treat PTSD sufferers. Soldiers are assessed before starting the treatment to check that the experience won't overwhelm them or prove harmful. Initial anecdotal reports from the study are promising.

Dr Maryrose Gerardi, one of the researchers, says: “Some of the veterans say ‘It just looks like a video game' until we start doing the work, and then it doesn't seem like a video game any more.” She continues: “Virtual reality seems to be helpful in dealing with painful memory, as you go over and over the memory. We're teaching them not to be afraid of it.”

Recently scientists at the University of Houston reported that VR was useful for treating addictions, from alcohol and tobacco to marijuana and crack cocaine. Volunteers were guided through various virtual scenarios, from smoke-filled parties to seedy crack dens. “We can put you in a virtual-reality party and the therapist can teach you skills to use in that situation, to avoid drinking or smoking,” says Dr Patrick Bordnick, who led the research.

The next big thing?

Widely used in the US, virtual-reality technology is mainly used in research in the UK - although it is available at a few private clinics. Why is this? “The use of VR is at the early stages of taking off in the UK. The expertise has not yet been fully developed here,” says Dr Freeman. Dr Spitalnick believes that technophobia is another barrier. “There are computer people in the health industry, then there is the other 95 per cent,” he says. But, despite this, all those involved in the area of virtual reality believe that it has real therapeutic potential. “Once the word gets round, through more scientific publications, I think take-up is inevitable because it is such a good application for this field,” says Slater. He even sees it one day having leisure applications and being used to create “holodecks”, leisure rooms in which humans can interact with holograms in fantasy role play, as seen on Star Trek.

“I can well imagine in the home of the future a room with a virtual-reality environment where you go to relax, with a virtual beach and sun lamp. Star Trek predicted mobile phones, so why not the holodeck?”

Other conditions that scientists treat with virtual reality (VR) technology:

Binge-eating By interacting with food in a virtual world, patients learn to control appetite.

Pain VR can distract adults and children when they're undergoing minor surgery.

Stroke Scientists are investigating whether VR can help to retrain the brains of stroke victims.

Burns Scientists have developed SnowWorld, a snowy VR world that can help to ease burn victims' pain.

For more information, visit virtuallybetter.com

VIDEOS USED COURTESY OF VIRTUALLY BETTER INC

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