Cognitive-Behavioral Hypnotherapy Augmented with Virtual Reality Exposure in Flight Phobia: A Case Study

By Lupu, Viorel; Matu, Silviu et al. | Journal of Evidence-Based Psychotherapies, March 2019 | Go to article overview

Cognitive-Behavioral Hypnotherapy Augmented with Virtual Reality Exposure in Flight Phobia: A Case Study


Lupu, Viorel, Matu, Silviu, Lupu, Izabela Ramona, Journal of Evidence-Based Psychotherapies


Introduction

The lifetime prevalence of simple phobia in the general population is over 10%. This mental health problem is more common in females, which account for up to 70% of the clinical cases (Ladouceur, Fontaine, & Cottraux, 1993). Patients with simple phobia have a limited daily activity and report lower levels of quality of life. In USA, phobias are considered to be one of the most frequent psychiatric disorders (Goldberg, 2001). Most common simple phobias are those related to insects, mice, reptiles, water and other animals, like dogs. Most patients with phobias present somatic and physiological symptoms, such as pallor, tachycardia, sweating, difficulty breathing and hyperventilation, right before and during the encounter with the feared stimuli or situation. Even the mental representation or watching a TV program that reminds of the situational trigger can generate intense anxious responses. That is why the patient will avoid the phobic situations, which in turn will contribute to the maintenance of the symptomatology. This is the real struggle in the cases of clients suffering from clinically severe types of phobia. Basic phobias are relatively simply to treat, with 90% of them improving greatly or even disappearing after exposure methods (Lupu, 2012). Systematic desensitization, modeling participation and in vivo exposure are very effective treatments in phobic symptomatology (Cottraux, 1990). Some authors consider that whenever possible, it is best to apply directly in vivo systematic desensitization methods instead of using imaginary desensitization in the initial stages of the psychological treatment. Being able to successfully manage a real-life situation gives the subject a greater satisfaction and more self-confidence (Holdevici, 1998). In this context, the therapist and the client have to build together a hierarchy of feared situations, in order to conduct gradual exposure. However, direct exposure even to the situations at the bottom of this hierarchy might prove to be difficult in some cases. For example, in the case of flight phobias, the feared stimulus is not readily available, and in vivo exposure might imply additional costs.

Flight phobia is a relatively common mental health problem and has negative impact on the quality of life of patients suffering from this condition. The traditional form of treatment is time-consuming, expensive and could compromise the patient confidentiality. Classical exposure implies usually several trips to the airport and flights done by both the patient and the therapist. Beside high costs, this technique also poses a danger for the confidentiality of the therapeutic intervention. Virtual reality exposure therapy (VRET) is a technologically enhanced approach to exposure treatment that might overcome these limitations (Krijn, Emmelkamp, Olafsson, & Biemond, 2004; Rizzo, & Kim, 2005), as it can be done directly from the therapist's office, at minimum costs. During the session, the patient will receive a special equipment which has the ability to transpose him or her right in the middle of the stressful event. VRET is based on cognitive-behavioral therapy (CBT) principles and it presumes real-time exposure in a 3D virtual world. With the help of a few special devices (headphones, glasses, gloves, etc.) the patient acquires the feeling that he is physically present in the computer-generated environment. Moreover, he or she can touch or move objects, hear, and depending of the equipment, feel smells or develop sensitive sensations. The moves of the patient are transmitted to computer through using different sensors (e.g., trackers) and represented in real-time in the virtual environment, which increases the level of presence in the virtual world (David, Matu, & David, 2013). Empirical evidence indicates that using virtual reality as a tool to conduct exposure in flight anxiety is an efficacious intervention (Cardos, David & David, 2017). Moreover, virtual reality has been successfully integrated with other techniques derived from CBT, such as hypnosis (Enea, Dafinoiu, Opriş, & David, 2014), make it a flexible and viable tool to provide interventions that are tailored to the patients' needs and case requirements. …

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