Oliver Scheibenbogen is a clinical and health psychologist. At the Anton Proksch Institute in Vienna, he oversees not only the academy but also clinical psychological assessment and treatment.
What are your areas of focus, and where do you use VR?
At the Anton Proksch Institute, Europe’s largest addiction treatment center, we use VR in cue exposure therapy (VR-CET) for patients with alcohol dependence. By presenting complex alcohol-related stimuli while simultaneously preventing a response (no consumption), the association between the stimulus and the response is gradually extinguished, thereby reducing cravings and the risk of relapse.
What has been your experience with VR?
The VR-CET can incorporate not only simple visual or olfactory stimuli, but also complex social situations. Patients are not confined to the role of mere observers; rather, they interact with avatars in typical everyday situations, such as with a bartender while visiting a bar, with party guests, or while shopping at a supermarket. Social pressure increases through toasts and pressure to drink (bar, private celebration/party). Newly learned coping strategies can be actively practiced in a situation very similar to a familiar social setting rather than in a craving-reducing treatment environment (addiction clinic).
What role does immersiveness play, and which factors are particularly important?
To be therapeutically effective in the long term, therapy requires an intense experience in which the patient can deeply perceive their own feelings. It is only through this experience that the opportunity for change arises. VR technology creates an intense sense of immersion; patients actually feel as though they are physically present in the virtual environment. Stimulus flooding—that is, exposing oneself to the stimulus at full intensity—is the “gold standard” in behavioral therapy and the most effective approach; however, it is often impossible to implement in treatment due to resistance on the part of the patient. VR technology helps us clinical psychologists and psychotherapists come significantly closer to achieving this intense therapeutic experience.
You once said that the VR Coach smart system was better than Tomb Raider—what exactly did you mean by that?
We administered a questionnaire designed to quantify the degree of immersion in virtual reality. The results are impressive: On two out of three scales (involvement and perceived realism of the Igroup Presence Questionnaire), the patients scored higher than the control group of Tomb Raider players. This is a clear indication that immersion in the addiction-specific scenes is highly successful and that those affected truly “arrive” there. Users of the VR headset also exhibit increased skin conductance (a measure of heightened general arousal) and more pronounced tremors due to sympathicotonic overexcitation during stimulus exposure. Both the questionnaire results and clinical behavioral observations underscore the high degree of immersion.
What are your thoughts on the future and trends of VR?
I see tremendous potential in VR technology. Patients find this type of therapy very appealing, which also increases adherence, as therapy often fails because those affected do not believe they can manage a life without alcohol. VR-CET boosts confidence in one’s own ability to avoid resorting to alcohol—the “old (problem-)solver”—even in high-risk situations, thereby increasing substance-specific self-efficacy.
In addition to sensory exposure, I also see potential applications for VR technology in learning imaginative techniques. Immersion in other worlds can be viewed as an intermediate step, a kind of technology-assisted visualization exercise. There is a group of patients who, for example, struggle greatly with the concept of a “safe place” or a “place of peace and strength” and find it emotionally difficult to connect with it. In such cases, presenting images of, for example, secluded ocean coves can help initiate this process.
When it comes to the use of new technologies in general, it is important to me that they are developed in close collaboration with clinical experts. Simply “digitizing” existing therapeutic methods is usually ineffective and doomed to fail. Rather, what is needed is a new development in which research, clinical trials, and technical implementation go hand in hand.
Addiction Treatment Using Virtual Reality