Better, Virtually: the Past, Present, and Future of Virtual Reality Cognitive Behavior Therapy
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Better, Virtually: the Past, Present, and Future of Virtual Reality Cognitive Behavior Therapy Philip Lindner 1 Accepted: 5 October 2020/ # The Author(s) 2020
Abstract Virtual reality (VR) is an immersive technology capable of creating a powerful, perceptual illusion of being present in a virtual environment. VR technology has been used in cognitive behavior therapy since the 1990s and accumulated an impressive evidence base, yet with the recent release of consumer VR platforms came a true paradigm shift in the capabilities and scalability of VR for mental health. This narrative review summarizes the past, present, and future of the field, including milestone studies and discussions on the clinical potential of alternative embodiment, gamification, avatar therapists, virtual gatherings, immersive storytelling, and more. Although the future is hard to predict, clinical VR has and will continue to be inherently intertwined with what are now rapid developments in technology, presenting both challenges and exciting opportunities to do what is not possible in the real world. Keywords Virtual reality . Immersion . Gamification . Seriousgame . Embodiment . Avatar
Introduction Since its merging into a coherent therapeutic tradition in the 1980s, cognitive behavior therapy (CBT) has proven a remarkable success in treating a wide range of mental disorders, psychosomatic conditions, and many non-medical issues for which sufferers need help with. A distinguishing feature of CBT, common to and prominent in both its behavioral and cognitive roots, is the emphasis on carrying out exercises designed to change behavior and/or cognitions related to some problem area (Mennin et al. 2013). This is often explicitly framed as a multi-stage process, including first providing a psychotherapeutic rationale for the exercise, and then detailed and concrete planning, controlled execution, reporting of specific outcomes, drawing lessons learned, and
* Philip Lindner [email protected]
1
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Katrinebergsbacken 35A, 117 61 Stockholm, Sweden
International Journal of Cognitive Therapy
progressing to the next exercise. Since exercises are so central in CBT—congruent with its historical emphasis on specific as opposed to common factors (Buchholz and Abramowitz 2020)—this therapeutic tradition is inherently well suited for technology-mediated delivery formats that do not rely on there being a traditional client-therapist relationship. The rapid, paradigm shifting and often unpredictable development and dissemination in the last decades of different consumer information technologies (everything from personal computers to portable media players, smartphones, and wearables) have allowed researchers and clinicians to explore new avenues for treatment design and delivery. A prominent success story of the merger of technology and psychotherapy is Internetadministered CBT (iCBT), which enjoys a robust evidence
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