Virtual Reality as Treatment for Fear of Flying: A Review of Recent Research.

Virtual Reality (VR) has recently become an excellent means for conducting exposure therapy (Krijn, Emmelkamp, Olafsson, & Biemond, 2004). VR has been most extensively used and received the most empirical attention in the treatment of specific phobia: Fear of Flying, or flying phobia. Flying phobia is classified as the experience of an unreasonable and intense amount of anxiety when confronted with flying. As a result, flying is avoided or endured with intense anxiety such that it impedes on daily functioning, such as trips for business or visiting social contacts (Mogotsi, Kaminer, & Stein, 2000). Flying phobia is one of the more common forms of psychopathology with estimated prevalence rates falling from 10 to 40% for the population (Curtis, Magee, Eaton, Wittchen, & Kessler, 1998; Van Gerwen, Spinhoven, Diekstra, & Van Dyck, 2002). Of those with the disorder that are able to fly, approximately 20% are use substances such as alcohol or sedatives to endure the fear (Howard, Murphy, & Clarke, 1983). There are several excellent cognitive behavioral approaches that are frequently used to treat the fear of flying, many of which include exposure (Rothbaum et al., 2006). Exposure involves presenting the feared stimulus in such a manner that the client's fear will habituate. Habituation is a significant reduction in the amount anxiety that is experienced when confronting the feared stimulus. This is obtained through repeatedly presenting the stimulus for a prolonged period of time in a controlled manner (Foa & Kozak, 1986). In exposure therapy, the stimulus can be presented in a variety of forms, with the most common being the presentation of the actual stimulus, called in vivo exposure (Linden, 1981). Virtual Reality Exposure Therapy In vivo exposure is considered the gold standard in the treatment for specific phobias (Barlow, 2002). Despite its effectiveness, it is difficult to conduct in vivo exposure for the treatment of fear of flying because it is not always logistically possible to control, prolong, and repeat exposure to aspects of flying. This is especially true in recent times due to the increased security and financial requirements associated with flying. Therefore, clinicians must turn alternative methods of presenting the stimulus, which can include using virtual reality as in virtual reality exposure (VRE) (Choy, Fyer, & Lipsitz, 2007; Pull, 2005). VRE places the client in a virtual environment, a three dimensional computer generated representation of the feared stimulus that responds to the users actions. The virtual environment is most commonly presented through a HeadMounted-Display (HMD), a helmet with headphones and screens to provide a first person perspective. There are body tracking devices within the HMD such that the environment responds to the user's body movements in real time. An alternative method of presenting the virtual environment is through a computer automated virtual environment (CAVE). CAVE systems project the virtual environment on the floor and walls of a compartment instead of using a helmet. Similar body tracking technology is used to allow the environment to respond to the user. VRE has several advantages as a tool for exposure to flying. It allows the therapist to have greater control over the experience such that elements of the flight can be manipulated for maximum therapeutic gain that would otherwise be difficult (Rothbaum, Hodges, Kooper, & Opdyke, 1995). For example, take off can only occur twice during an exposure session to an actual flight and each take off has a finite duration. In contrast, the virtual environment permits the duration the take off to be extended until the client habituates to each stage of take off, and take off can be repeated. Another advantage of VRE is the privacy it provides to the client as treatment can be conducted within the therapist's office as opposed to a public location and risk public displays of anxiety (Riva, 2003). …